Ing on the other hand is quick, easy and provides an indication of a patient’s nutritional risk. Several tools have been designed and available for use in specific patient groups however the absence of a universally agreed criteria in identifying malnutrition has resulted in a lack of consensus among experts as to the “best” or “correct” way of screening for nutritional status [20?3] One such screening tool is the Nutrition Screening Initiative (NSI) Checklist[20]. The NSI is an American national effort to increase public and health professional awareness of the importance of nutritional problems among older persons[20]. It consists of a self-administered awareness checklist describing characteristics Mdivi-1 web associated with poor nutritional status and was designed to predict adequacy of nutrient intake and MS-275 dose overall perceived health[20]. The NSI checklist identifies older persons at nutritional risk due to inadequate nutrient intake as definedPLOS ONE | DOI:10.1371/journal.pone.0156008 May 27,2 /Nutritional Risk in Elderly Asian Cancer Patientsby an intake of less than 75 of the recommended daily allowance (RDA) and is used throughout the United States in the assessment of nutrition risk[20]. To date there is a scarcity of studies evaluating malnutrition or nutritional risk in elderly Asian patients. Most of the validated screening tools consist of items such as current weight or body mass index (BMI), decreased dietary intake and unintentional weight loss[23]. None of the available and validated screening tools are based on clinical factors in elderly patients in the setting of a diagnosis of cancer in Asia. We aim to identify CGA based clinical characteristics in elderly Asian cancer patients which are associated with moderate to high nutritional risk as determined by the NSI checklist[20]. These clinical risk factors, which are routinely evaluated in the clinic can form the basis for a simplified screening tool for nutritional risk in the elderly Asian cancer patients.Patients and Methods Study Design and PatientsThis is a retrospective analysis of the CGA data collected from elderly patients attending outpatient oncology clinics at the National Cancer Centre Singapore between May 2007 and November 2010. Patients aged 70 years and older with a diagnosis of cancer at any stage were interviewed by a research nurse prior to their first visit with an oncologist. All patients provided written informed consent before inclusion into the study. The study was approved by the local institutional review board and conducted according to the principles expressed in the Declaration of Helsinki.Clinical DataThe CGA questionnaire used in this study was previously described[24] and was developed after a thorough review of the literature and guideline recommendations. The CGA consists of seven distinct domains. Functional status was assessed using Eastern Cooperative Oncology Group (ECOG) performance status[25], the index of activities of daily living (ADL)[26], instrumental activities of daily living (IADL) of Lawton et al[27], the get up and go test[28], and the dominant handgrip strength test. Comorbidities were classified according to the Charlson comorbidity index[29]. Cognitive status was assessed using the mini-mental state examination (MMSE) [30] and clock drawing test[31]. Affective status was assessed via the Geriatric Depression Scale (GDS) Short Form 15[32]. Polypharmacy was documented in terms of number of medications, appropriateness and interac.Ing on the other hand is quick, easy and provides an indication of a patient’s nutritional risk. Several tools have been designed and available for use in specific patient groups however the absence of a universally agreed criteria in identifying malnutrition has resulted in a lack of consensus among experts as to the “best” or “correct” way of screening for nutritional status [20?3] One such screening tool is the Nutrition Screening Initiative (NSI) Checklist[20]. The NSI is an American national effort to increase public and health professional awareness of the importance of nutritional problems among older persons[20]. It consists of a self-administered awareness checklist describing characteristics associated with poor nutritional status and was designed to predict adequacy of nutrient intake and overall perceived health[20]. The NSI checklist identifies older persons at nutritional risk due to inadequate nutrient intake as definedPLOS ONE | DOI:10.1371/journal.pone.0156008 May 27,2 /Nutritional Risk in Elderly Asian Cancer Patientsby an intake of less than 75 of the recommended daily allowance (RDA) and is used throughout the United States in the assessment of nutrition risk[20]. To date there is a scarcity of studies evaluating malnutrition or nutritional risk in elderly Asian patients. Most of the validated screening tools consist of items such as current weight or body mass index (BMI), decreased dietary intake and unintentional weight loss[23]. None of the available and validated screening tools are based on clinical factors in elderly patients in the setting of a diagnosis of cancer in Asia. We aim to identify CGA based clinical characteristics in elderly Asian cancer patients which are associated with moderate to high nutritional risk as determined by the NSI checklist[20]. These clinical risk factors, which are routinely evaluated in the clinic can form the basis for a simplified screening tool for nutritional risk in the elderly Asian cancer patients.Patients and Methods Study Design and PatientsThis is a retrospective analysis of the CGA data collected from elderly patients attending outpatient oncology clinics at the National Cancer Centre Singapore between May 2007 and November 2010. Patients aged 70 years and older with a diagnosis of cancer at any stage were interviewed by a research nurse prior to their first visit with an oncologist. All patients provided written informed consent before inclusion into the study. The study was approved by the local institutional review board and conducted according to the principles expressed in the Declaration of Helsinki.Clinical DataThe CGA questionnaire used in this study was previously described[24] and was developed after a thorough review of the literature and guideline recommendations. The CGA consists of seven distinct domains. Functional status was assessed using Eastern Cooperative Oncology Group (ECOG) performance status[25], the index of activities of daily living (ADL)[26], instrumental activities of daily living (IADL) of Lawton et al[27], the get up and go test[28], and the dominant handgrip strength test. Comorbidities were classified according to the Charlson comorbidity index[29]. Cognitive status was assessed using the mini-mental state examination (MMSE) [30] and clock drawing test[31]. Affective status was assessed via the Geriatric Depression Scale (GDS) Short Form 15[32]. Polypharmacy was documented in terms of number of medications, appropriateness and interac.
