Triagem Nutripal Adaptada e Sobrevida Global em Pacientes com Câncer em Cuidados Paliativos

Maria da Paixão Rodrigues; Aline do Vale Firmino; Thais Manfrinato Miola

doi:10.32635/2176-9745.RBC.2026v72n2.5648

Authors

Maria da Paixão Rodrigues A. C. Camargo Cancer Center. São Paulo (SP), Brasil. https://orcid.org/0000-0003-2351-7857
Aline do Vale Firmino A. C. Camargo Cancer Center. São Paulo (SP), Brasil. https://orcid.org/0000-0002-4016-5497
Thais Manfrinato Miola A.C.Camargo Cancer Center https://orcid.org/0000-0002-6554-6923

DOI:

https://doi.org/10.32635/2176-9745.RBC.2026v72n2.5648

Keywords:

Nutrition Assessment, Screening, Palliative Car, Survival Analysis, Prognosis

Abstract

Introduction: Nutritional risk is common among cancer patients receiving palliative care and is associated with reduced life expectancy. The Nutripal screening tool is specifically designed for this population, integrating the patient-generated subjective global assessment (PG-SGA) and the Glasgow prognostic score (GPS). Objective: To analyze the applicability of an adapted version of Nutripal, excluding albumin, and to assess its association with overall survival. Methods: This retrospective cohort study was conducted at a Cancer Center between July 2023 and July 2024 and included patients receiving palliative care. The Nutripal screening tool was applied in its full version (grades 1 to 4) and in an adapted version (grades 1 to 3). The primary outcome was overall survival at 180 days. Results: A total of 200 patients were included, most of whom were at nutritional risk (79%) and had a diagnosis of severe malnutrition (76%). PG-SGA scores ≥9 were not associated with mortality. Patients classified in the highest risk category, in both the full and adapted versions of Nutripal, had a higher risk of mortality at 180 days (p=0.02; HR = 1.57; 95% CI: 1.04–2.36), regardless of age, oncological diagnosis, and Palliative Performance Scale (PPS) results, with moderate and similar discrimination between versions (C-statistic = 0.651 for the full version and 0.637 for the adapted version). Conclusion: The adapted Nutripal screening tool proved applicable for identifying nutritional risk and demonstrated the ability to predict reduced overall survival.

Downloads

Download data is not yet available.

References

Silva IF, Santos RS, Santos ATC, et al. Cuidado nutricional de pacientes com câncer em cuidados paliativos: uma revisão integrativa. Vittalle. 2022;34(1):81-92. doi: https://doi.org/10.14295/vittalle.v34i1.13692 DOI: https://doi.org/10.14295/vittalle.v34i1.13692

Worldwide Hospice Palliative Care Alliance. Com nossos 473 membros organizacionais em mais de 100 países, fornecemos uma voz global sobre cuidados paliativos [Internet]. London: WHPCA; 2023 [acesso 2025 dez 27]. Disponível em: https://thewhpca.org/

Hassankhani H, Rahmani A, Taleghani F, et al. Palliative care models for cancer patients: learning for planning in nursing (review). J Cancer Educ. 2020;35(1):3-13. doi: https://doi.org/10.1007/s13187-019-01532-3 DOI: https://doi.org/10.1007/s13187-019-01532-3

Laviano A, Di Lazzaro L, Koverech A. Nutrition support and clinical outcome in advanced cancer patients. Proc Nutr Soc. 2018;77(4):388-93. doi: https://doi.org/10.1017/S0029665118000459 DOI: https://doi.org/10.1017/S0029665118000459

Horie LM, Barrére APN, Castro MG, et al. Diretriz BRASPEN de terapia nutricional no paciente com câncer. BRASPEN J. 2019;34(1):2-32.

Castro M, Ribeiro PC, Matos LBN, et al. Diretriz BRASPEN de terapia nutricional no paciente grave. BRASPEN J. 2023;38(2):2-46. doi: https://doi.org/10.37111/braspenj.diretrizDOENTEGRAV DOI: https://doi.org/10.37111/braspenj.diretrizDOENTEGRAVE

Hart PC, Rajab IM, Alebraheem M, et al. C-reactive protein and cancer-diagnostic and therapeutic insights. Front Immunol. 2020;11:595835. doi: https://doi.org/10.3389/fimmu.2020.595835 DOI: https://doi.org/10.3389/fimmu.2020.595835

Rosa KSC, Wiegert EVM, Oliveira LC, et al. Proposal of a nutrition screening algorithm for patients with incurable cancer receiving palliative care. Aspen J. 2023;39(2):485-99. doi: https://doi.org/10.1002/ncp.10953 DOI: https://doi.org/10.1002/ncp.10953

Xie H, Wang S, Wei L, et al. Inflammatory score as a predictor of survival and nutritional deterioration in cancer patients: insights from a multicenter cohort study. Front Nutr. 2025;12:1631483. doi: https://doi.org/10.3389/fnut.2025.1631483 DOI: https://doi.org/10.3389/fnut.2025.1631483

Mauriz P, Wirtzbiki PM, Campos UW, et al. Protocolo cuidados paliativos [Internet]. Fortaleza: Instituto de Saúde e Gestão Hospitalar (ISGH); 2014 [acesso 2025 dez 27]. Disponível em: https://isgh.org.br/intranet/images/Servicos/Protocolos/isgh_protoco_cuidado_paliativo.pdf

Costa MC, Schieferdecker MEM, Correa MR, et al. Cuidados paliativos: dignidade, fragilidade e funcionalidade na alimentação de conforto. Rev Bioet. 2025;33:e3986. doi: https://doi.org/10.1590/1983-803420253986PT DOI: https://doi.org/10.1590/1983-803420253986pt

Carvalho CS, Souza DS, Lopes JR, et al. Relationship between patient-generated subjective global assessment and survival in patients in palliative care. Ann Palliat Med. 2017;6(Suppl 1):S4-12. doi: https://doi.org/10.21037/apm.2017.03.03 DOI: https://doi.org/10.21037/apm.2017.03.03

Santos RCC. Aplicação da ASG-PPP no paciente oncológico durante tratamento em clínica particular em Salvador-BA. Braz J Health Rev. 2020;3(4):10756-74. doi: https://doi.org/10.34119/bjhrv3n4-283 DOI: https://doi.org/10.34119/bjhrv3n4-283

Forrest LM, McMillan DC, McArdle CS, et al. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003;89(6):1028-30. doi: https://doi.org/10.1038/sj.bjc.6601242 DOI: https://doi.org/10.1038/sj.bjc.6601242

Wiegert EVM, Oliveira LC, Chaves GV, et al. New cancer cachexia staging system for use in clinical practice. Nutrition. 2021;90:111271. doi: https://doi.org/10.1016/j.nut.2021.111271 DOI: https://doi.org/10.1016/j.nut.2021.111271

Pearson K. On the criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling. Philosoph Magazine. 1900;50(302):157-75. doi: https://doi.org/10.1080/14786440009463897 DOI: https://doi.org/10.1080/14786440009463897

Fisher RA. On the interpretation of χ² from contingency tables, and the calculation of P. J R Stat Soc A. 1922;85:87-94. doi: https://doi.org/10.2307/2340521 DOI: https://doi.org/10.2307/2340521

Student. The probable error of a mean. Biometrika. 1908;6(1):1-25. doi: https://doi.org/10.2307/2331554 DOI: https://doi.org/10.2307/2331554

Fisher RA. Statistical methods for research workers. Edinburgh: Oliver and Boyd; 1925.

Kleinbaum DG, Klein M. Kaplan-Meier survival curves and the log-rank test. In: Kleinbaum DG, Klein M, editors. Survival analysis. Statistics for biology and health. New York: Springer; 2012. p. 19-41. doi: https://doi.org/10.1007/978-1-4419-6646-9_2 DOI: https://doi.org/10.1007/978-1-4419-6646-9_2

SPSS®: Statistical Package for Social Science (SPSS) [Internet]. Versão 29. [Nova York]. International Business Machines Corporation. [acesso 2025 mar 9]. Disponível em: https://www.ibm.com/br-pt/spss?utm_content=SRCWW&p1=Search&p4=43700077515785492&p5=p&gclid=CjwKCAjwgZCoBhBnEiwAz35Rwiltb7s14pOSLocnooMOQh9qAL59IHVc9WP4ixhNTVMjenRp3-aEgxoCubsQAvD_BwE&gclsrc=aw.ds

Conselho Nacional de Saúde (BR). Resolução nº 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. Diário Oficial da União. 2013 jun 13 [acesso 2025 dez 27]; Edição 112;Seção 1:59. Disciplinas: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html

Schiessel DL, Orrutéa AKG, Silva SE, et al. Perda de peso em pacientes oncológicos: prevalência e prognóstico relacionados a sexo, idade, localização do tumor e sintomas de impacto nutricional. BRASPEN J. 2020;35(1):84-92. DOI: https://doi.org/10.37111/braspenj.2020351014

Cunha MS, Calixto-Lima L, Wiegert EVM, et al. Validation of the scored Patient-Generated Subjective Global Assessment Short Form as a prognostic tool for patients with incurable cancer. JPEN J Parenter Enteral Nutr. 2021;45(8):1809-17. doi: https://doi.org/10.1002/jpen.2251 DOI: https://doi.org/10.1002/jpen.2251

Yule MS, Machado AM, Brown LR, et al. Dissecting the Global Leadership Initiative on Malnutrition criteria in advanced cancer: reduced intake vs. inflammation. Clin Nutr ESPEN. 2025;67:114-21. doi: https://doi.org/10.1016/j.clnesp.2025.03.007 DOI: https://doi.org/10.1016/j.clnesp.2025.03.007

Pourhassan M, Cederholm T, Donini LM, et al. Severity of inflammation is associated with food intake in hospitalized geriatric patients: a merged data analysis. Nutrients. 2023;15(14):3079. doi: https://doi.org/10.3390/nu15143079 DOI: https://doi.org/10.3390/nu15143079

Huang Z, Wang K, Huang S, et al. Prognostic value of baseline C-reactive protein in diffuse large B-cell lymphoma: a systematic review and meta-analysis. Transl Cancer Res. 2023;12(8):2169-80. doi: https://doi.org/10.21037/TCR-23-1157 DOI: https://doi.org/10.21037/tcr-23-1157

Hutajulu SH, Astari YK, Ucche M, et al. Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy. PeerJ. 2025;13:e19319. doi: https://doi.org/10.7717/peerj.19319 DOI: https://doi.org/10.7717/peerj.19319

Kang E, Kang JH, Koh S, et al. Early integrated palliative care in patients with advanced cancer. JAMA Netw Open. 2024;7(8):e2426304. doi: https://doi.org/10.1001/jamanetworkopen.2024.26304 DOI: https://doi.org/10.1001/jamanetworkopen.2024.26304

Prompantakorn P, Angkurawaranon C, Pinyoporpanish K, et al. Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study. BMC Palliat Care. 2021;20(1):73. doi: https://doi.org/10.1186/s12904-021-00773-8 DOI: https://doi.org/10.1186/s12904-021-00773-8