A Cross-Sectional Study on Symptom Burden, Malnutrition Risk, Psychological Distress and Palliative Outcomes in Cancer Patients Undergoing Chemotherapy

Abstract

This study aimed to assess chemotherapy-related symptom toxicities, nutritional status, psychological distress and palliative outcomes among adult cancer patients in a tertiary care centre in India. This cross-sectional observational study selected 254 adult cancer patients undergoing chemotherapy at a tertiary care hospital. Eligible patients were selected for the study. Patients with histologically confirmed malignancies were enrolled, irrespective of cancer histology or prior chemotherapy cycles. Patients with diagnosed severe psychiatric disorders (e.g., schizophrenia, bipolar disorder or major depressive disorder affecting decision-making capacity), those receiving exclusive palliative care or those unwilling to provide informed consent were excluded. A face-to-face interview lasting 10–15 min was conducted after obtaining informed consent, using validated tools such as the National Cancer Institute -PRO-CTCAE ® , full Mini-Nutritional Assessment (MNA), National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) and palliative outcome scale (POS) to assess chemotherapy-related toxicities, nutritional status, distress and palliative care needs. The data were analysed with Jamovi v2.6. Sociodemographic and clinical variables were documented. Descriptive statistics employed frequencies and percentages. Inferential analyses presented continuous data as mean ± standard deviation or medians (Shapiro–Wilk normality tested) and categorical data as proportions. Associations between age, body mass index (BMI), MNA, POS and distress were examined using non-parametric Spearman’s ρ correlations ( p < 0.05 significance). Among 254 chemotherapy patients (71.3% female; mean age 58.5 ± 12.5 years), breast cancer predominated (63%), with 83.9% below the poverty line and 83.1% having comorbidities (diabetes 42.2%, hypertension 36.5%). PRO-CTCAE ® revealed moderate-severe toxicities: Alopecia (36.2%), decreased appetite (18.1%) and fatigue (17.3%). Distress affected 64.6% (DT ≥ 4). Significant malnutrition prevalence (57.1%) was observed, with 36.2% of patients additionally identified at malnutrition risk. Patients exhibited a moderate palliative care burden, with a Palliative Outcome Scale (POS) median score of 2 per item and a mean total score of 19.4 ± 4.7. Spearman’s ρ showed BMI-POS (ρ = −0.230, p < 0.001) and MNA-POS (ρ = −0.150, p = 0.017) were inversely correlated. There were no age associations (all p > 0.05). Chemotherapy patients exhibited high malnutrition (57.1%), distress (64.6%) and toxicities (alopecia 36.2%). BMI and nutritional status showed weak inverse correlations with palliative burden (ρ = −0.230, p < 0.001; ρ = −0.150, p = 0.017). These validated tools (PRO-CTCAE ® , MNA, DT, POS) reveal substantial unmet needs. The absence of multivariable analysis limits confounder adjustment. Targeted nutritional interventions, distress management and symptom control should be explored in future intervention studies to potentially improve quality of life in socioeconomically vulnerable Indian cohorts.