Risk of Malnutrition and Impact on Treatment Outcomes Among Gynecological Cancer Patients in Two Cancer Centers, Kigali, Rwanda

This cross-sectional study evaluated nutritional status and risk factors for malnutrition among 272 gynecological cancer patients in Rwanda. The median age was 54 years (range 18–81), with nearly half (48.2%) aged 46–65. Cervical cancer was the most common diagnosis (50.0%), followed by ovarian (24.6%) and endometrial (11.8%). Disease stages were distributed as: Stage III (33.8%), Stage I (26.5%), Stage II (23.2%), and Stage IV (16.5%). Body mass index (BMI) classification showed 11.4% undernourished, 61.0% normal weight, 20.9% overweight, and 6.6% obese. Using nutritional assessment (PG-SGA or equivalent), 67% had normal nutrition, 21% had moderate malnutrition, and 12% had severe malnutrition — yielding an overall malnutrition prevalence of about 33%. Severe malnutrition correlated with older age, more advanced cancer stage, and lower BMI, hemoglobin, and serum albumin levels. Patients older than 65 exhibited the highest malnutrition prevalence (54.7%). Multivariable analysis identified cancer type and cancer stage as independent predictors of malnutrition. Additionally, malnourished patients faced a higher likelihood of postoperative morbidity. The study highlights that older and nulliparous women were particularly vulnerable. Given these findings, the authors recommend routine nutritional screening for gynecological oncology patients, early and targeted nutritional interventions, strengthened multidisciplinary care involving dietitians and oncology teams, and patient education on nutrition during cancer treatment. Implementing these measures could improve surgical and treatment outcomes, reduce postoperative complications, and enhance overall quality of life for gynecological cancer patients. The study underscores the importance of integrating nutrition assessment and management into standard oncologic care pathways, especially in resource-limited settings.