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

Risk of Malnutrition and Impact on Treatment Outcomes Among Gynecological Cancer Patients in Two Cancer Centers, Kigali, Rwanda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk of Malnutrition and Impact on Treatment Outcomes Among Gynecological Cancer Patients in Two Cancer Centers, Kigali, Rwanda Eugene Ngabonziza, Samson HABIMANA, Kenneth RUZINDANA, Blaise DUSHIMIYIMANA, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8490095/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract 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. Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Malnutrition is an independent risk factor that negatively affects patient’s clinical outcomes, body function and autonomy ( 1 ). It has been defined as “a state resulting from lack of intake or uptake of nutrition that led to altered body composition and body cell mass that led to reduced physical and mental functions with impaired clinical outcomes of disease” ( 2 ). After a gynecological cancer diagnosis, patients should be examined to identify those who are at high risk for malnutrition to implement nutritional intervention for better outcomes. Nutritional interventions were found to improve body weight and body mass index, protein and energy intake, quality of life and response to cancer treatments ( 3 ). Nutritional screening and subsequent assessment should be done for all cancer patients for better treatment outcomes. Malnutrition has a negative impact on cancer treatment if no intervention is done to correct this status. It has been associated with increased hospital length of stay, readmission, cost of care and increased risk of post operative infections ( 3 ). To mitigate bad outcomes, practitioners within the field of global oncology should screen and provide nutritional intervention for those at risk. Several studies have shown that in oncology patient population, the prevalence of malnutrition or those at risk of malnutrition ranges 20–80% ( 4 – 7 ). Some studies have been done in Africa to assess the nutritional status of cancer patients and found that the risks for malnutrition are cancer itself, treatment modalities for cancer and poor nutritional profile ( 4 , 8 ). Diverse sets of methods are available for assessing nutritional status in cancer patients each with its strength and weakness ( 9 ). These include anthropometric measurement (weight change, arm circumference, triceps skin fold), quantitative biochemical essays (serum albumin, transferrin, Nitrogen balance studies), subjective global assessment (SGA), patient generated SGA(PS-SGA). The utility of these screening tools has been evaluated for their ability to detect clinical outcomes, complications, length of hospital stay and survival ( 9 ). Prior research has demonstrated that nutritional status is a key factor affecting recovery after surgery for gynecological cancer, and that pre- and post-operative assessment of nutritional status is of key importance ( 10 ). Post-surgically, both oral and enteral nutritional interventions have been shown to be safe and seem to reduce the length of hospital stay, postoperative complications, and immunological parameters ( 11 , 12 ). Nutritional risk has been shown to correlate with risk of surgical site infection among gynecological patients ( 13 ) as well as length of hospital stay ( 14 ). In one study, abnormal preoperative albumin, a marker for nutritional status, was shown to predict blood loss, morbidity, and mortality in gynecological cancer surgery ( 14 ). In another study, malnutrition in gynecological cancer patients was linked to postoperative complications, hospital re-admission, reoperations, ICU admission, and cancer recurrence ( 15 ). Despite the clear link between nutritional status and surgical outcomes, there has been limited research attempting to assess nutritional status of gynecological cancer patients globally in low-resource settings or design sustainable interventions to address this need. This study aimed to examine the nutritional status of gynecological cancer patients and determine the surgical outcomes among those undergoing surgical management in 2 tertiary cancer centers in Rwanda. Study aim The general objective is to examine the relationship between nutritional status and clinical outcomes among gynecological cancer patients undergoing METHODOLOGY Area of Study and Period The study was conducted at Kigali University Teaching Hospital (CHUK) and Rwanda Military Hospital (RMH), both of which provide comprehensive surgical care for women with gynecologic malignancies. Patients presenting at these hospitals for their first visit with a diagnosis of gynecological cancer were incorporated into the study. The study was conducted over a period of six months, from December 2023 to May 2024, with data collection concluding in June 2024. Study design and procedures This was a cross-sectional prospective study conducted in tertiary hospitals. After the diagnosis of gynecological cancers, nutritional status assessments were conducted as part of a comprehensive assessment to prepare patients for treatment. Nutritional Risk Screening (NRS) 2002 was used to screen all new patients for malnutrition risk. If malnutrition risk was detected, clinicians further assessed patients using the Scored Patient Generated Subjective Global Assessment (PG-SGA). NRS 2002 and PG-SGA are validated tools for the assessment of oncology patients. Anthropometric measurements, including weight, height, and BMI calculation, were evaluated after cancer diagnosis. Basic biomarkers such as hemoglobin, serum creatinine, and albumin, collected as part of standard care practices, were extracted from patient records. Based on these measures, patients were classified into one of three groups: malnourished, at risk of malnourishment, or adequately nourished. Treatment outcomes included those related to surgery and postsurgical outcomes, chemotherapy, and radiation therapy. For all types of cancer treatment, the rate of hospital readmission for treatment complications was evaluated in relation to categories of malnutrition. Selection Criteria Patients consulting at the two hospitals and fulfilling the following criteria were included: Voluntary participation in the study. Ability to consent based on cognitive status, and over the age of 18. Newly diagnosed with gynecological cancer. No prior treatment for the current gynecological cancer. Data Collection Data were collected using a pre-designed data collection form, incorporating patient demographics, type of cancer, stage of cancer, risk factors for malnutrition, category of malnutrition, objective biomarkers, nutritional intervention, and treatment complications. Sample Size The sample size was calculated using a formula, considering a malnutrition frequency of 30% and a 95% confidence interval, with a precision of 5%. The estimated sample size was 278 individuals, and this target was successfully met. Data Analysis Study data were entered using EpiData 3.1 software and analyzed using SPSS statistics software. Descriptive statistics compared PG-SGA categories and biomarker measurements, with a p-value < 0.05 (two-sided) considered statistically significant. Data was extracted from data collection forms and medical records into a password-protected Excel spreadsheet stored on a secure computer. Personal health information was removed from the spreadsheet, leaving individual patients identifiable by study ID number only. This de-identified spreadsheet was used for research purposes and analyzed using SAS or R. Descriptive analysis included central tendency measures (mean, median, mode) and dispersion measures (standard deviation, range) for continuous variables, with frequencies and proportions for categorical data. Sophisticated visualization tools, such as bar graphs, pie charts, and histograms, were used to elucidate data trends. Comparative analysis utilized cross-tabulation and chi-squared tests to delineate associations between nutritional status and demographic variables. Multivariate analysis further elucidated the interplay between nutritional status and outcomes. Statistical significance for associations was considered at p < 0.05. RESULTS The median age of the patients was 54 years, ranging from 18 to 81 years. The age distribution showed that the majority (48.16%) were between 46–65 years, while 23.53% were over 65 years, 19.85% were between 35–45 years, and only 8.46% were under 35 years. Regarding nutritional status, 11.4% of the patients were undernourished, 61.03% had a normal BMI, 20.96% were overweight, and 6.62% were obese. Parity data indicated that 51.84% had more than four children, 41.91% had between one and four children, and 6.25% were nulliparous. Additionally, 41.54% of the patients reported alcohol consumption, while 58.46% did not (Table 1). {Insert Table 1} Cervical cancer was found to be the most prevalent, affecting 50% of the patients (136 out of 272). The Ovarian cancer, histologically confirmed, comprising 24.63% of cases (67 patients). Endometrial cancer accounts for 11.76% (32 patients), while vulvar cancer represents 6.99% (19 patients). Gestational trophoblastic neoplasia (GTN) is present in 5.51% of the patients (15 patients), and vaginal cancer is the least common, affecting 1.1% (3 patients) [Figure 1, appendix 1]. For types of gynecological cancers stage III was the most common, affecting 33.5% of patients (91 out of 272). This is followed by stage I, which accounts for 32.3% of cases (88 patients), and stage II, representing 23.2% (63 patients). Stage IV is the least common, with 11% of patients (30 patients) diagnosed at this advanced stage (Fig. 2, appendix 1). Most patients, 67% (182 out of 272), had normal nutritional status, 21% (56 patients) had moderate malnutrition, and 12% (34 patients) had severe malnutrition and the results show that the prevalence of malnutrition is 33% among patients with gynecological cancers (Fig. 3, appendix 1). Malnutrition was associated with the age of the patient where patients with severe and moderate malnutrition were found to be older with a median age of 64 years and 61.5 years respectively compared to those with normal nutritional status with median age of 52 years. Body mass index (BMI) also showed statistical significance for detection of malnutrition where patients with severely and moderately malnourished had lower BMI compared to those with normal nutritional status (p < 0.001). Hemoglobin levels for malnourished patients were lower at 11.1g/dl compared to 13 g/dl in well-nourished group (p < 0.001). Serum albumin levels were significantly lower in the severely and moderately malnourished groups compared to the group with normal nutritional status (p < 0.001) [Table 2]. {Insert Table 2} Ovarian cancer patients have a high rate of malnutrition (56.72%), followed by endometrial cancer (46.88). Cervical cancer, vulvar cancer GTN and vagina cancer had lower rates of malnutrition. There was no statistical significance between those with normal nutritional status and those with malnutrition in each type of gynecological cancer. When considering cancer stages, malnutrition increases with stage progression: stage I (20.45%), stage II (9.52%), stage III (49.45%), and stage IV (70%). These results indicate that malnutrition is more prevalent in advanced cancer stages and specific cancer types like ovarian and endometrial (Table 3). Patients in stage III cancer were 3.8 times more likely to have malnutrition compared to those in stage I (OR = 3.8, 95% CI: 1.96–7.37, p < 0.001) and those in stage IV cancer were 9 times more likely to have malnutrition compared to those in stage I (OR = 9.07, 95% CI: 3.55–23.16, p < 0.001). Patients with ovarian cancer are 8.5 times more likely to have malnutrition compared to those with GTN (OR = 8.52, 95% CI: 1.78–40.74, p = 0.007) and those with endometrial cancer are 5.7 times more likely to have malnutrition compared to those with GTN (OR = 5.73, 95% CI: 1.11–29.64, p = 0.037) {Insert Table 3} The study on risk factors for malnutrition among gynecological cancer patients in Rwanda identifies several significant associations. Patients over 65 years had a higher prevalence of malnutrition (54.69%) followed by those below 35years (47.83%) with the least being 46–65 (27.48%) and 35–45 (14.81. Parity also influenced malnutrition risk, with nulliparous women having higher odds by being 2.9 times more likely to have malnutrition compared to women with more than 4 children (OR = 2.95, 95% CI: 1.05–8.25, p = 0.039). Chronic disease presence, alcohol consumption and economic category did not show significant associations with malnutrition (p = 0.682, p = 0.674 and p = 0.107, respectively). Malnutrition was strongly associated with postoperative morbidity, where patients with malnutrition were 12 times more likely to have postoperative morbidity compared to those who did not have malnutrition (OR = 12, 95% CI: 5.23–27.51, p < 0.001) [Table 4]. These post operative comorbidities include hospital readmission, length of hospital stay, fascia dehiscence, surgical site infection, re-operation among others. Patients with advanced cervical cancer from stage II to IV have been analyzed for post operative morbidity since their treatment is concurrent chemoradiation. {Insert Table 4} The multivariable logistic regression analysis showed that cancer type and stage of cancer are the independent risk factors of malnutrition; and malnutrition is associated with higher chance of postoperative morbidity (Table 5). {Insert Table 5} DISCUSSION This study provides an in-depth analysis of the clinical and nutritional status of patients with gynecological cancers in Rwanda, highlighting significant findings related to age, nutritional status and malnutrition risk factors among patients with gynecological cancers. The median age of the patients was 54 years, with a broad age distribution: 48.16% were between 46–65 years, 23.53% were over 65 years, 19.85% were between 35–45 years, and only 8.46% were under 35 years. The median age in the current study is comparable to the one reported among patients with cervical cancer in Ethiopia by Assefa et al. (2022) who reported a mean age of 52.4 years ( 16 ). The same age distribution was reported from other lower- and middle-income countries ( 6 , 7 ). The median age in the current study is different from those reported from middle and high-income countries among gynecological cancer patients who are often diagnosed at a slightly younger age and this might be attributed to differences in healthcare access and screening practices namely advanced screening and healthcare infrastructure distribution ( 6 ). Regarding cancer types, cervical cancer was the most prevalent, affecting 50% of patients, followed by ovarian cancer (24.63%), endometrial cancer (11.76%), vulvar cancer (6.99%), gestational trophoblastic neoplasia (5.51%), and vaginal cancer (1.1%). This aligns with other studies’ findings where cervical and ovarian cancers are often the most common gynecological cancers ( 17 ). The analysis of nutritional status showed significant variations among different stages of cancer and types of cancer. Patients with severe malnutrition were older and had poorer nutritional indicators, including lower BMI, hemoglobin levels, and serum albumin compared to those with normal nutritional status. This finding is consistent with global literature indicating that advanced cancer stages and poor nutritional status are associated with worse outcomes and higher morbidity ( 18 , 19 ). The prevalence of malnutrition in the current study was found to be 33% which is low compared to the one reported from the study done by Melo Silva et al. (2015) in Brazil, reported the prevalence of malnutrition to be 71.1% among general hospitalized patients ( 7 ). The prevalence of malnutrition in the current study is also low compared to that reported by Das et al. (2014) from India who reported that the prevalence of malnutrition was 88.3% among patients with gynecological cancers ( 6 ). The findings of the current study are in accordance with the findings from the study done from three centers in Kenya by Opanga et al. (2017) who assessed the nutritional status of patients with cancers also using the PGSGA tool and reported the prevalence of malnutrition to be 30% in their study participants ( 4 ). The findings of the current study are also in accordance with the findings from the study done by Almeida et al. (2020) who reported that 33% of the patients with cancer were malnourished ( 20 ). The results of the current study are different from those of reported from the study conducted on gynecological cancer patients in Australia reported that 20% were classified in PG-SGA category B (moderate malnutrition), 80% in category A (normal nutrition status), and none in category C ( 18 ). The elevated rate of malnutrition in Rwanda, compared to developed countries, can be attributed to a high incidence of preexisting malnutrition and late diagnosis of cancers. Cervical cancer patients had the highest prevalence of normal nutritional status, while ovarian cancer patients had higher rates of moderate and severe malnutrition. These findings highlight the variability in nutritional impact based on cancer type, consistent with the results of other studies which reported that different cancers affect nutritional status differently due to their metabolic demands and treatment effects ( 4 , 11 , 12 ). The results of the current study are in accordance with the results from the study done by Laky et al. (2007) who reported that patients with ovarian cancers had a high rate of malnutrition compared to patients with other cancer types ( 18 ). The results of the current study were different from the results of the study done by Das et al. (2014) who reported that the type of gynecologic cancer was not associated with nutritional status ( 6 ). The study also identified several risk factors for malnutrition. Younger patients (under 35 years) had a higher prevalence of malnutrition compared to older age groups, and nulliparous women had a higher likelihood of malnutrition compared to women with more children. This higher prevalence of malnutrition among younger patients and nulliparous women with gynecological cancer may be due to a combination of cancer type, higher metabolic demands, treatment side effects, psychological stress, hormonal differences, and varying levels of social support and health awareness ( 11 , 13 ). The results of the current study are different from the results of the study done by Melo Silva et al. (2015) who reported that older patients (> 65 years) had more risk of malnutrition among cancer patients ( 7 ). The findings of the current study align with research suggesting that younger age is associated with higher nutritional risk in cancer patients ( 21 ). The results of the current study are different from the results of the study done by Das et al. (2014) who reported that age was not associated with high risk of malnutrition among patients with gynecologic cancers ( 6 ). Our results are also different from those reported by Bozzetti et al. (2012) in their study who found that age did not correlate with risk of malnutrition ( 21 ). Malnutrition was strongly associated with postoperative morbidity, with significantly higher odds for those with malnutrition experiencing postoperative morbidity, which is consistent with the literature indicating that malnutrition which exacerbates the postoperative complications should be routinely screened ( 2 , 15 ). Multivariable logistic regression analysis confirmed that cancer type and stage of cancer are significant predictors of malnutrition among patients with gynecological cancer where patients in advanced stage and those with ovarian and endometrial cancers are more likely to have malnutrition. This suggests that the severity and progression of the disease, along with specific cancer types, likely exacerbate nutritional deficiencies and metabolic demands as reported by previous researchers ( 3 , 12 ). Malnutrition was also found to be a significant predictor of postoperative morbidity among patients with gynecological cancers. This finding is supported by the findings from the study done by Kathiresan et al. (2011) who reported that malnutrition was associated with higher rates of post-operative complications, reinforcing the importance of nutritional monitoring and management in cancer care ( 15 ). CONCLUSION AND RECOMMENDATION Conclusion Our study reveals that malnutrition is a significant issue among gynecological cancer patients, with 21% experiencing moderate malnutrition and 12% severe malnutrition making a total prevalence of malnutrition of 33%. Malnutrition was found to be more prevalent in patients with advanced-stage cancer and was found to be associated with post-operative morbidity in patients with gynecological cancers. Key factors associated with malnutrition included cancer stage and type of cancer highlighting the need for targeted nutritional interventions. Recommendations Regular nutritional assessments should be conducted for all gynecological cancer patients, particularly focusing on younger and nulliparous women, to identify those at higher risk of malnutrition early in their treatment journey. Initiate specialized nutritional support programs for patients with advanced-stage cancer and those experiencing postoperative morbidity, as they are at a significantly higher risk of severe malnutrition. Incorporate dietitians and nutritionists into the oncology care team to provide tailored nutritional counseling and interventions, aiming to improve serum albumin levels and overall nutritional status. Declarations Author Contributions Conceptualization, E.N. and S.H.; methodology, K.N., B.D,O.M. and D.K.W.; validation, D.N.,T.R.,T.M.A, A.M., E.N. and S.H.; formal analysis, E.N. and S.H.; investigation E.N. and S.H.; resources, B.D,O.M. and D.K.W.; data curation, B.D,O.M. and D.K.W.; writing—original draft preparation, B.D,O.M. and D.K.W.; writing—review and editing, K.N., B.D,O.M. and D.K.W.; visualization, E.N. and S.H.; supervision, D.K.W. All authors have read and agreed to the published version of the manuscript. Limitations and Recommendations Limitations: Inability to exclude all potential confunders Recommendations: Conduct studies with multiple logistic regression to control for all potential confounders. Funding This research received no external funding. Institutional Review Board Statement Not applicable. Meanwhile,the study protocol was approved by the Institutional Review Board of College of Medicine and Health Sciences, University of Rwanda, with reference number 480/CMHS IRB/2023. Informed Consent Statement Not applicable. Data Availability Statement The data are contained within the article. Ethical Considerations The study protocol was approved by the Institutional Review Board of College of Medicine and Health Sciences, University of Rwanda, with reference number 480/CMHS IRB/2023. All research was performed in accordance with the Declaration of Helsinki. Conflicts of Interest The authors declare no conflicts of interest. Acknowledgements This study conducted for the certificate in gynecological oncology would not have been possible without the combined efforts and support of many individuals, to whom I am deeply grateful. I extend my heartfelt thanks and appreciation to the Almighty God, for abundant blessings, guidance, protection, and intercession throughout my studies and work. I am thankful to the Government of Rwanda, specifically the Ministry of Education, for the scholarship provided through the University of Rwanda, College of Medicine and Health Sciences, Faculty of Medicine, in collaboration with the Ministry of Health through the Human Resource for Health program. My gratitude also goes to Rwanda Military Hospital for their daily support. I appreciate the administration and staff of CHUK for their assistance with data collection for this project. I acknowledge the financial support from King Faisal Hospital foundation which helped me to carry out this research. Special thanks to my supervisors: Tadios MEKONENN ASRES, Dr Dawit WORKU ASSA Dr Diomede NTASUMBUMUYANGE, Dr Thomas RANDALL for their invaluable advice and efforts that made this study possible. Your guidance is something I will always remember. Lastly, I thank all the participants in my research for their cooperation and contribution. May God bless you all. References Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional risk screening and assessment. J Clin Med. 2019;8(7):1–19. Serón-Arbeloa C, Labarta-Monzón L, Puzo-Foncillas J, Mallor-Bonet T, LafitaLópez A, Bueno-Vidales N, et al. Triagem e avaliação da desnutrição. Nutrients. 2022;14(12):1–30. Richards J, Arensberg MB, Thomas S, Kerr KW, Hegazi R, Bastasch M. Impact of early incorporation of nutrition interventions as a component of cancer therapy in adults: A review. Nutrients. 2020;12(11):1–19. Opanga Y, Kaduka L, Bukania Z, Mutisya R, Korir A, Thuita V, et al. Nutritional status of cancer outpatients using scored patient generated subjective global assessment in two cancer treatment centers, Nairobi, Kenya. BMC Nutr. 2017;3(1):1–7. Abhishek G, Vinay K, Kanika R, Sarin J. A Study to evaluate the effectiveness of patient tailored nutritional intervention on fatigue & nutritional status among cancer patients at OPD of selected Hospital, Ambala, Haryana. Int J Sci Res Publ. 2019;9(6):p9049. Das U, Patel S, Dave K, Bhansali R. Assessment of nutritional status of gynecological cancer cases in India and comparison of subjective and objective nutrition assessment parameters. South Asian J Cancer. 2014;3(1):38–42. De Melo Silva FR, De Oliveira MGOA, Souza ASR, Figueroa JN, Santos CS. Factors associated with malnutrition in hospitalized cancer patients: A croossectional study. Nutr J [Internet]. 2015;14(1):1–8. Available from: http://dx.doi.org/10.1186/s12937-015-0113-1 Etsegenet A. Assessment Of Malnutrition and Inflammatory Status in Cervical Cancer Patients Attending Tikur Anbessa Specialized Hospital. J Clin Med. 2021;86(18):611–20. Gupta D, Vashi PG, Lammersfeld CA, Braun DP. Role of nutritional status in predicting the length of stay in cancer: A systematic review of the epidemiological literature. Ann Nutr Metab. 2011;59(2–4):96–106. Bisch S, Nelson G, Altman A. Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology. Nutrients. 2019;11(5):1–9. Williams DGA, Ohnuma T, Krishnamoorthy V, Raghunathan K, Sulo S, Cassady BA, et al. Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery. Perioper Med. 2020;9(1):1–9. Obermair A, Simunovic M, Isenring L, Janda M. Nutrition interventions in patients with gynecological cancers requiring surgery. Gynecol Oncol [Internet]. 2017;145(1):192–9. Available from: http://dx.doi.org/10.1016/j.ygyno.2017.01.028 Chen Z, Zhong M, Xu Z, Ye Q, Xie W, Gao S, et al. Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients. Front Nutr. 2022;9(April):1–13. Santoso JT, Canada T, Latson B, Alladi K, Lucci JA, Coleman RL. Prognostic nutritional index in relation to hospital stay in women with gynecologic cancer. Obstet Gynecol. 2000;95(6):844–6. Kathiresan ASQ, Brookfield KF, Schuman SI, Lucci JA. Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients. Arch Gynecol Obstet. 2011;284(2):445–51. Etsegenet A. Assessment Of Malnutrition and Inflammatory Status in Cervical Cancer Patients Attending Tikur Anbessa Specialized Hospital. J Clin Med. 2021;86(18):611–20. Khaskheli M, Baloch S, Khaskheli S, Durrani RZ, Jhatial N, Shah SGS. Stages of Gynaecological Cancers at the Time of First Presentation at a Large Cancer Hospital in Pakistan: An Observational Study. Dubai Med J. 2023;6(4):274–9. Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A. Malnutrition among gynaecological cancer patients. Eur J Clin Nutr. 2007;61(5):642–6. El-Sherif A, El-Sherif S, Taylor AH, Ayakannu T. Ovarian Cancer: Lifestyle, Diet and Nutrition. Nutr Cancer [Internet]. 2020;0(0):1–16. Available from: https://doi.org/10.1080/01635581.2020.1792948 D’Almeida CA, Peres WAF, de Pinho NB, Martucci RB, Rodrigues VD, Ramalho A. Prevalence of Malnutrition in Older Hospitalized Cancer Patients: A Multicenter and Multiregional Study. J Nutr Heal Aging [Internet]. 2020;24(2):166–71. Available from: http://dx.doi.org/10.1007/s12603-020-1309-4 Bozzetti F, Mariani L, Lo Vullo S, Amerio ML, Biffi R, Caccialanza R, et al. Nutritional risk in oncology: A study of 1, 453 cancer outpatients. Support Care Cancer. 2012;20(8):1919–28. Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files APPENDICES.docx Table1Ngaboniza.docx Table2Ngaboniza.docx Table3Ngaboniza.docx Table4Ngaboniza.docx Table5Ngaboniza.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Feb, 2026 Reviews received at journal 15 Feb, 2026 Reviews received at journal 14 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers invited by journal 28 Jan, 2026 Editor invited by journal 02 Jan, 2026 Editor assigned by journal 01 Jan, 2026 Submission checks completed at journal 01 Jan, 2026 First submitted to journal 31 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8490095","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582489321,"identity":"2b915d9b-54c9-443d-b5ce-3bcc92de2811","order_by":0,"name":"Eugene Ngabonziza","email":"","orcid":"","institution":"Rwanda Military Refarral and Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eugene","middleName":"","lastName":"Ngabonziza","suffix":""},{"id":582489322,"identity":"56de3bd3-801b-4a45-87a1-4005512979a0","order_by":1,"name":"Samson HABIMANA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBACAwYehgMwzoHEPzZAirHxAE71aFoYDzxsSAPRDQS1wADzwYcNhyHW4dNizn724KEbNXfk5dtPJxxI3HHebm37YaAtNTbRuLRY9uQlHM459sxww5ncDQcSz9xO3nYmEajlWFpuAy6HHcgxOJzDdphxAwNQSwLb7WSzA0AtjA2HcWs5/wao5d9h+/n9b0FaziWbnX9IQMsNoC25bYcTG26AHNZ2wM7sBiFbbrxLOJzbdzh5ww2QLWeSE8xuAG1JwOeX87mHP+d8O2w7vz9388cfFXb2ZufTHz74UGODUwsGSASrTCBWOQjYk6J4FIyCUTAKRgYAAIM9eB/dq15wAAAAAElFTkSuQmCC","orcid":"","institution":"University of Rwanda, College of Medicine and Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Samson","middleName":"","lastName":"HABIMANA","suffix":""},{"id":582489323,"identity":"dc66177a-57c1-4430-919e-ac998a076d84","order_by":2,"name":"Kenneth RUZINDANA","email":"","orcid":"","institution":"Kigali University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kenneth","middleName":"","lastName":"RUZINDANA","suffix":""},{"id":582489324,"identity":"27523e1e-5121-4001-9676-d163466ee872","order_by":3,"name":"Blaise DUSHIMIYIMANA","email":"","orcid":"","institution":"Kigali University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Blaise","middleName":"","lastName":"DUSHIMIYIMANA","suffix":""},{"id":582489325,"identity":"8139487f-3a64-417a-9b67-cc7d70c7cbac","order_by":4,"name":"Odile MUREKATETE","email":"","orcid":"","institution":"Rwanda Military Refarral and Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Odile","middleName":"","lastName":"MUREKATETE","suffix":""},{"id":582489326,"identity":"71ac8621-b737-4538-9348-925bf8434783","order_by":5,"name":"Diomede NTASUMBUMUYANGE","email":"","orcid":"","institution":"Kigali University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Diomede","middleName":"","lastName":"NTASUMBUMUYANGE","suffix":""},{"id":582489327,"identity":"a8daa685-ea9f-41ad-aef0-da2a2976dca9","order_by":6,"name":"Thomas RANDAL","email":"","orcid":"","institution":"Rwanda Military Refarral and Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"RANDAL","suffix":""},{"id":582489328,"identity":"0692fb77-96cd-4121-8328-f004b1fa64cc","order_by":7,"name":"Tadios MEKONENN ASRES","email":"","orcid":"","institution":"Rwanda Military Refarral and Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tadios","middleName":"MEKONENN","lastName":"ASRES","suffix":""},{"id":582489329,"identity":"0221988a-dec5-481b-a7fb-4c05a7c9e30d","order_by":8,"name":"Dawit KASSA WORKU","email":"","orcid":"","institution":"Kigali University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dawit","middleName":"KASSA","lastName":"WORKU","suffix":""}],"badges":[],"createdAt":"2025-12-31 13:23:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8490095/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8490095/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101518079,"identity":"9fff2270-2063-4092-9acf-f80ec27b3fb0","added_by":"auto","created_at":"2026-01-30 16:26:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":98311,"visible":true,"origin":"","legend":"\u003cp\u003eType of cancer\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/a43924f771bcc8659247b118.png"},{"id":101517817,"identity":"da27ab3b-dc18-4f85-9d22-d9fc52ef4601","added_by":"auto","created_at":"2026-01-30 16:25:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16914,"visible":true,"origin":"","legend":"\u003cp\u003eFIGO stage\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/b7b5b927270ea47aa5ae7577.png"},{"id":101517969,"identity":"484a8cac-5984-4013-8f84-9e60561b8a0f","added_by":"auto","created_at":"2026-01-30 16:26:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":113217,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of malnutrition among patients with gynecological cancers (PGSGA score for malnutrition)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/5f5713f0569aeb3491c9a373.png"},{"id":101518120,"identity":"68339a05-8187-4bdb-8062-7d20f2da8166","added_by":"auto","created_at":"2026-01-30 16:26:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":733826,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/c59258e2-638e-41f3-8e3c-8d4c6ee40606.pdf"},{"id":101518006,"identity":"c544471c-48e3-4afe-a9ae-3fa68800c63b","added_by":"auto","created_at":"2026-01-30 16:26:07","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":269285,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDICES.docx","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/2b626ee4a4817f4fb18e37a4.docx"},{"id":101517941,"identity":"81f7a794-3d4b-4d4d-832c-59d6a41c4735","added_by":"auto","created_at":"2026-01-30 16:25:56","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":30284,"visible":true,"origin":"","legend":"","description":"","filename":"Table1Ngaboniza.docx","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/da35a88a0bf836e587cf1eab.docx"},{"id":101517886,"identity":"49bcf0c2-716a-46ef-9829-cf94f5530d78","added_by":"auto","created_at":"2026-01-30 16:25:48","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":33870,"visible":true,"origin":"","legend":"","description":"","filename":"Table2Ngaboniza.docx","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/d39af86fc3504252aea2d263.docx"},{"id":101517966,"identity":"40435a7a-b2c9-4f75-a709-78e91ef2f491","added_by":"auto","created_at":"2026-01-30 16:26:01","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":35073,"visible":true,"origin":"","legend":"","description":"","filename":"Table3Ngaboniza.docx","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/69e3a2188fed7cc2fb41c84a.docx"},{"id":101517863,"identity":"cf4a78d0-fa9e-43f6-9ba6-e037b1388df4","added_by":"auto","created_at":"2026-01-30 16:25:45","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":37922,"visible":true,"origin":"","legend":"","description":"","filename":"Table4Ngaboniza.docx","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/dfc584f226e4f3f426316dc4.docx"},{"id":101518076,"identity":"d61e9b69-4c2c-4bb2-a461-908bba172ea8","added_by":"auto","created_at":"2026-01-30 16:26:23","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":15868,"visible":true,"origin":"","legend":"","description":"","filename":"Table5Ngaboniza.docx","url":"https://assets-eu.researchsquare.com/files/rs-8490095/v1/9584c87d646e63c986efa1c1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRisk of Malnutrition and Impact on Treatment Outcomes Among Gynecological Cancer Patients in Two Cancer Centers, Kigali, Rwanda\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMalnutrition is an independent risk factor that negatively affects patient\u0026rsquo;s clinical outcomes, body function and autonomy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It has been defined as \u0026ldquo;a state resulting from lack of intake or uptake of nutrition that led to altered body composition and body cell mass that led to reduced physical and mental functions with impaired clinical outcomes of disease\u0026rdquo; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAfter a gynecological cancer diagnosis, patients should be examined to identify those who are at high risk for malnutrition to implement nutritional intervention for better outcomes. Nutritional interventions were found to improve body weight and body mass index, protein and energy intake, quality of life and response to cancer treatments (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Nutritional screening and subsequent assessment should be done for all cancer patients for better treatment outcomes. Malnutrition has a negative impact on cancer treatment if no intervention is done to correct this status. It has been associated with increased hospital length of stay, readmission, cost of care and increased risk of post operative infections (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). To mitigate bad outcomes, practitioners within the field of global oncology should screen and provide nutritional intervention for those at risk. Several studies have shown that in oncology patient population, the prevalence of malnutrition or those at risk of malnutrition ranges 20\u0026ndash;80% (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Some studies have been done in Africa to assess the nutritional status of cancer patients and found that the risks for malnutrition are cancer itself, treatment modalities for cancer and poor nutritional profile (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDiverse sets of methods are available for assessing nutritional status in cancer patients each with its strength and weakness (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These include anthropometric measurement\u003c/p\u003e \u003cp\u003e(weight change, arm circumference, triceps skin fold), quantitative biochemical essays\u003c/p\u003e \u003cp\u003e(serum albumin, transferrin, Nitrogen balance studies), subjective global assessment (SGA), patient generated SGA(PS-SGA). The utility of these screening tools has been evaluated for their ability to detect clinical outcomes, complications, length of hospital stay and survival (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrior research has demonstrated that nutritional status is a key factor affecting recovery after surgery for gynecological cancer, and that pre- and post-operative assessment of nutritional status is of key importance (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Post-surgically, both oral and enteral nutritional interventions have been shown to be safe and seem to reduce the length of hospital stay, postoperative complications, and immunological parameters (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Nutritional risk has been shown to correlate with risk of surgical site infection among gynecological patients (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) as well as length of hospital stay (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In one study, abnormal preoperative albumin, a marker for nutritional status, was shown to predict blood loss, morbidity, and mortality in gynecological cancer surgery (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In another study, malnutrition in gynecological cancer patients was linked to postoperative complications, hospital re-admission, reoperations, ICU admission, and cancer recurrence (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the clear link between nutritional status and surgical outcomes, there has been limited research attempting to assess nutritional status of gynecological cancer patients globally in low-resource settings or design sustainable interventions to address this need. This study aimed to examine the nutritional status of gynecological cancer patients and determine the surgical outcomes among those undergoing surgical management in 2 tertiary cancer centers in Rwanda.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eStudy aim\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe general objective is to examine the relationship between nutritional status and clinical outcomes among gynecological cancer patients undergoing\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\u003c/div\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eArea of Study and Period\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e The study was conducted at Kigali University Teaching Hospital (CHUK) and Rwanda Military Hospital (RMH), both of which provide comprehensive surgical care for women with gynecologic malignancies. Patients presenting at these hospitals for their first visit with a diagnosis of gynecological cancer were incorporated into the study. The study was conducted over a period of six months, from December 2023 to May 2024, with data collection concluding in June 2024.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \n\u003ch3\u003eStudy design and procedures\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis was a cross-sectional prospective study conducted in tertiary hospitals. After the diagnosis of gynecological cancers, nutritional status assessments were conducted as part of a comprehensive assessment to prepare patients for treatment. Nutritional Risk Screening (NRS) 2002 was used to screen all new patients for malnutrition risk. If malnutrition risk was detected, clinicians further assessed patients using the Scored Patient Generated Subjective Global Assessment (PG-SGA). NRS 2002 and PG-SGA are validated tools for the assessment of oncology patients. Anthropometric measurements, including weight, height, and BMI calculation, were evaluated after cancer diagnosis. Basic biomarkers such as hemoglobin, serum creatinine, and albumin, collected as part of standard care practices, were extracted from patient records. Based on these measures, patients were classified into one of three groups: malnourished, at risk of malnourishment, or adequately nourished. Treatment outcomes included those related to surgery and postsurgical outcomes, chemotherapy, and radiation therapy. For all types of cancer treatment, the rate of hospital readmission for treatment complications was evaluated in relation to categories of malnutrition.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eSelection Criteria\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003ePatients consulting at the two hospitals and fulfilling the following criteria were included:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eVoluntary participation in the study.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAbility to consent based on cognitive status, and over the age of 18.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNewly diagnosed with gynecological cancer.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNo prior treatment for the current gynecological cancer.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eData were collected using a pre-designed data collection form, incorporating patient demographics, type of cancer, stage of cancer, risk factors for malnutrition, category of malnutrition, objective biomarkers, nutritional intervention, and treatment complications.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample Size\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe sample size was calculated using a formula, considering a malnutrition frequency of 30% and a 95% confidence interval, with a precision of 5%. The estimated sample size was 278 individuals, and this target was successfully met.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eStudy data were entered using EpiData 3.1 software and analyzed using SPSS statistics software. Descriptive statistics compared PG-SGA categories and biomarker measurements, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided) considered statistically significant. Data was extracted from data collection forms and medical records into a password-protected Excel spreadsheet stored on a secure computer. Personal health information was removed from the spreadsheet, leaving individual patients identifiable by study ID number only. This de-identified spreadsheet was used for research purposes and analyzed using SAS or R. Descriptive analysis included central tendency measures (mean, median, mode) and dispersion measures (standard deviation, range) for continuous variables, with frequencies and proportions for categorical data. Sophisticated visualization tools, such as bar graphs, pie charts, and histograms, were used to elucidate data trends. Comparative analysis utilized cross-tabulation and chi-squared tests to delineate associations between nutritional status and demographic variables. Multivariate analysis further elucidated the interplay between nutritional status and outcomes. Statistical significance for associations was considered at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe median age of the patients was 54 years, ranging from 18 to 81 years. The age distribution showed that the majority (48.16%) were between 46\u0026ndash;65 years, while 23.53% were over 65 years, 19.85% were between 35\u0026ndash;45 years, and only 8.46% were under 35 years. Regarding nutritional status, 11.4% of the patients were undernourished, 61.03% had a normal BMI, 20.96% were overweight, and 6.62% were obese. Parity data indicated that 51.84% had more than four children, 41.91% had between one and four children, and 6.25% were nulliparous. Additionally, 41.54% of the patients reported alcohol consumption, while 58.46% did not (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e{Insert Table\u0026nbsp;1}\u003c/p\u003e \u003cp\u003eCervical cancer was found to be the most prevalent, affecting 50% of the patients (136 out of 272). The Ovarian cancer, histologically confirmed, comprising 24.63% of cases (67 patients). Endometrial cancer accounts for 11.76% (32 patients), while vulvar cancer represents 6.99% (19 patients). Gestational trophoblastic neoplasia (GTN) is present in 5.51% of the patients (15 patients), and vaginal cancer is the least common, affecting 1.1% (3 patients) [Figure 1, appendix 1].\u003c/p\u003e \u003cp\u003eFor types of gynecological cancers stage III was the most common, affecting 33.5% of patients (91 out of 272). This is followed by stage I, which accounts for 32.3% of cases (88 patients), and stage II, representing 23.2% (63 patients). Stage IV is the least common, with 11% of patients (30 patients) diagnosed at this advanced stage (Fig.\u0026nbsp;2, appendix 1).\u003c/p\u003e \u003cp\u003eMost patients, 67% (182 out of 272), had normal nutritional status, 21% (56 patients) had moderate malnutrition, and 12% (34 patients) had severe malnutrition and the results show that the prevalence of malnutrition is 33% among patients with gynecological cancers (Fig.\u0026nbsp;3, appendix 1).\u003c/p\u003e \u003cp\u003eMalnutrition was associated with the age of the patient where patients with severe and moderate malnutrition were found to be older with a median age of 64 years and 61.5 years respectively compared to those with normal nutritional status with median age of 52 years. Body mass index (BMI) also showed statistical significance for detection of malnutrition where patients with severely and moderately malnourished had lower BMI compared to those with normal nutritional status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Hemoglobin levels for malnourished patients were lower at 11.1g/dl compared to 13 g/dl in well-nourished group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Serum albumin levels were significantly lower in the severely and moderately malnourished groups compared to the group with normal nutritional status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [Table\u0026nbsp;2].\u003c/p\u003e \u003cp\u003e{Insert Table\u0026nbsp;2}\u003c/p\u003e \u003cp\u003eOvarian cancer patients have a high rate of malnutrition (56.72%), followed by endometrial cancer (46.88). Cervical cancer, vulvar cancer GTN and vagina cancer had lower rates of malnutrition. There was no statistical significance between those with normal nutritional status and those with malnutrition in each type of gynecological cancer. When considering cancer stages, malnutrition increases with stage progression: stage I (20.45%), stage II (9.52%), stage III (49.45%), and stage IV (70%). These results indicate that malnutrition is more prevalent in advanced cancer stages and specific cancer types like ovarian and endometrial (Table\u0026nbsp;3). Patients in stage III cancer were 3.8 times more likely to have malnutrition compared to those in stage I (OR\u0026thinsp;=\u0026thinsp;3.8, 95% CI: 1.96\u0026ndash;7.37, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and those in stage IV cancer were 9 times more likely to have malnutrition compared to those in stage I (OR\u0026thinsp;=\u0026thinsp;9.07, 95% CI: 3.55\u0026ndash;23.16, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients with ovarian cancer are 8.5 times more likely to have malnutrition compared to those with GTN (OR\u0026thinsp;=\u0026thinsp;8.52, 95% CI: 1.78\u0026ndash;40.74, p\u0026thinsp;=\u0026thinsp;0.007) and those with endometrial cancer are 5.7 times more likely to have malnutrition compared to those with GTN (OR\u0026thinsp;=\u0026thinsp;5.73, 95% CI: 1.11\u0026ndash;29.64, p\u0026thinsp;=\u0026thinsp;0.037)\u003c/p\u003e \u003cp\u003e{Insert Table\u0026nbsp;3}\u003c/p\u003e \u003cp\u003eThe study on risk factors for malnutrition among gynecological cancer patients in Rwanda identifies several significant associations. Patients over 65 years had a higher prevalence of malnutrition (54.69%) followed by those below 35years (47.83%) with the least being 46\u0026ndash;65 (27.48%) and 35\u0026ndash;45 (14.81. Parity also influenced malnutrition risk, with nulliparous women having higher odds by being 2.9 times more likely to have malnutrition compared to women with more than 4 children (OR\u0026thinsp;=\u0026thinsp;2.95, 95% CI: 1.05\u0026ndash;8.25, p\u0026thinsp;=\u0026thinsp;0.039). Chronic disease presence, alcohol consumption and economic category did not show significant associations with malnutrition (p\u0026thinsp;=\u0026thinsp;0.682, p\u0026thinsp;=\u0026thinsp;0.674 and p\u0026thinsp;=\u0026thinsp;0.107, respectively). Malnutrition was strongly associated with postoperative morbidity, where patients with malnutrition were 12 times more likely to have postoperative morbidity compared to those who did not have malnutrition (OR\u0026thinsp;=\u0026thinsp;12, 95% CI: 5.23\u0026ndash;27.51, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [Table\u0026nbsp;4]. These post operative comorbidities include hospital readmission, length of hospital stay, fascia dehiscence, surgical site infection, re-operation among others. Patients with advanced cervical cancer from stage II to IV have been analyzed for post operative morbidity since their treatment is concurrent chemoradiation.\u003c/p\u003e \u003cp\u003e{Insert Table\u0026nbsp;4}\u003c/p\u003e \u003cp\u003eThe multivariable logistic regression analysis showed that cancer type and stage of cancer are the independent risk factors of malnutrition; and malnutrition is associated with higher chance of postoperative morbidity (Table\u0026nbsp;5).\u003c/p\u003e\u003cp\u003e{Insert Table\u0026nbsp;5}\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study provides an in-depth analysis of the clinical and nutritional status of patients with gynecological cancers in Rwanda, highlighting significant findings related to age, nutritional status and malnutrition risk factors among patients with gynecological cancers. The median age of the patients was 54 years, with a broad age distribution: 48.16% were between 46\u0026ndash;65 years, 23.53% were over 65 years, 19.85% were between 35\u0026ndash;45 years, and only 8.46% were under 35 years. The median age in the current study is comparable to the one reported among patients with cervical cancer in Ethiopia by Assefa et al. (2022) who reported a mean age of 52.4 years (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The same age distribution was reported from other lower- and middle-income countries (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The median age in the current study is different from those reported from middle and high-income countries among gynecological cancer patients who are often diagnosed at a slightly younger age and this might be attributed to differences in healthcare access and screening practices namely advanced screening and healthcare infrastructure distribution (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding cancer types, cervical cancer was the most prevalent, affecting 50% of patients, followed by ovarian cancer (24.63%), endometrial cancer (11.76%), vulvar cancer (6.99%), gestational trophoblastic neoplasia (5.51%), and vaginal cancer (1.1%). This aligns with other studies\u0026rsquo; findings where cervical and ovarian cancers are often the most common gynecological cancers (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe analysis of nutritional status showed significant variations among different stages of cancer and types of cancer. Patients with severe malnutrition were older and had poorer nutritional indicators, including lower BMI, hemoglobin levels, and serum albumin compared to those with normal nutritional status. This finding is consistent with global literature indicating that advanced cancer stages and poor nutritional status are associated with worse outcomes and higher morbidity (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of malnutrition in the current study was found to be 33% which is low compared to the one reported from the study done by Melo Silva et al. (2015) in Brazil, reported the prevalence of malnutrition to be 71.1% among general hospitalized patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The prevalence of malnutrition in the current study is also low compared to that reported by Das et al. (2014) from India who reported that the prevalence of malnutrition was 88.3% among patients with gynecological cancers (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The findings of the current study are in accordance with the findings from the study done from three centers in Kenya by Opanga et al. (2017) who assessed the nutritional status of patients with cancers also using the PGSGA tool and reported the prevalence of malnutrition to be 30% in their study participants (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The findings of the current study are also in accordance with the findings from the study done by Almeida et al. (2020) who reported that 33% of the patients with cancer were malnourished (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The results of the current study are different from those of reported from the study conducted on gynecological cancer patients in Australia reported that 20% were classified in PG-SGA category B (moderate malnutrition), 80% in category A (normal nutrition status), and none in category C (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The elevated rate of malnutrition in Rwanda, compared to developed countries, can be attributed to a high incidence of preexisting malnutrition and late diagnosis of cancers.\u003c/p\u003e \u003cp\u003eCervical cancer patients had the highest prevalence of normal nutritional status, while ovarian cancer patients had higher rates of moderate and severe malnutrition. These findings highlight the variability in nutritional impact based on cancer type, consistent with the results of other studies which reported that different cancers affect nutritional status differently due to their metabolic demands and treatment effects (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The results of the current study are in accordance with the results from the study done by Laky et al. (2007) who reported that patients with ovarian cancers had a high rate of malnutrition compared to patients with other cancer types (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The results of the current study were different from the results of the study done by Das et al. (2014) who reported that the type of gynecologic cancer was not associated with nutritional status (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study also identified several risk factors for malnutrition. Younger patients (under 35 years) had a higher prevalence of malnutrition compared to older age groups, and nulliparous women had a higher likelihood of malnutrition compared to women with more children. This higher prevalence of malnutrition among younger patients and nulliparous women with gynecological cancer may be due to a combination of cancer type, higher metabolic demands, treatment side effects, psychological stress, hormonal differences, and varying levels of social support and health awareness (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The results of the current study are different from the results of the study done by Melo Silva et al. (2015) who reported that older patients (\u0026gt;\u0026thinsp;65 years) had more risk of malnutrition among cancer patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The findings of the current study align with research suggesting that younger age is associated with higher nutritional risk in cancer patients (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The results of the current study are different from the results of the study done by Das et al. (2014) who reported that age was not associated with high risk of malnutrition among patients with gynecologic cancers (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Our results are also different from those reported by Bozzetti et al. (2012) in their study who found that age did not correlate with risk of malnutrition (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Malnutrition was strongly associated with postoperative morbidity, with significantly higher odds for those with malnutrition experiencing postoperative morbidity, which is consistent with the literature indicating that malnutrition which exacerbates the postoperative complications should be routinely screened (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultivariable logistic regression analysis confirmed that cancer type and stage of cancer are significant predictors of malnutrition among patients with gynecological cancer where patients in advanced stage and those with ovarian and endometrial cancers are more likely to have malnutrition. This suggests that the severity and progression of the disease, along with specific cancer types, likely exacerbate nutritional deficiencies and metabolic demands as reported by previous researchers (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Malnutrition was also found to be a significant predictor of postoperative morbidity among patients with gynecological cancers. This finding is supported by the findings from the study done by Kathiresan et al. (2011) who reported that malnutrition was associated with higher rates of post-operative complications, reinforcing the importance of nutritional monitoring and management in cancer care (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e "},{"header":"CONCLUSION AND RECOMMENDATION","content":"\u003ch2\u003eConclusion\u003c/h2\u003e\n\u003cp\u003eOur study reveals that malnutrition is a significant issue among gynecological cancer patients, with 21% experiencing moderate malnutrition and 12% severe malnutrition making a total prevalence of malnutrition of 33%. Malnutrition was found to be more prevalent in patients with advanced-stage cancer and was found to be associated with post-operative morbidity in patients with gynecological cancers. Key factors associated with malnutrition included cancer stage and type of cancer highlighting the need for targeted nutritional interventions. \u003c/p\u003e\n\u003ch2 id=\"_Toc42557\"\u003eRecommendations\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003eRegular nutritional assessments should be conducted for all gynecological cancer patients, particularly focusing on younger and nulliparous women, to identify those at higher risk of malnutrition early in their treatment journey.\u003c/li\u003e\n \u003cli\u003eInitiate specialized nutritional support programs for patients with advanced-stage cancer and those experiencing postoperative morbidity, as they are at a significantly higher risk of severe malnutrition.\u003c/li\u003e\n \u003cli\u003eIncorporate dietitians and nutritionists into the oncology care team to provide tailored nutritional counseling and interventions, aiming to improve serum albumin levels and overall nutritional status.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, E.N. and S.H.; methodology, K.N., B.D,O.M. and D.K.W.; validation, D.N.,T.R.,T.M.A, A.M., E.N. and S.H.; formal analysis, E.N. and S.H.; investigation E.N. and S.H.; resources, B.D,O.M. and D.K.W.; data curation, B.D,O.M. and D.K.W.; writing\u0026mdash;original draft preparation, B.D,O.M. and D.K.W.; writing\u0026mdash;review and editing, K.N., B.D,O.M. and D.K.W.; visualization, E.N. and S.H.; supervision, D.K.W. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eLimitations:\u003c/strong\u003e Inability to exclude all potential confunders\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRecommendations:\u003c/strong\u003e Conduct studies with multiple logistic regression to control for all potential confounders.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. Meanwhile,the study protocol was approved by the Institutional Review Board of College of Medicine and Health Sciences, University of Rwanda, with reference number 480/CMHS IRB/2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are contained within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Institutional Review Board of College of Medicine and Health Sciences, University of Rwanda, with reference number 480/CMHS IRB/2023. All research was performed in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest. \u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc42535\"\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study conducted for the certificate in gynecological oncology would not have been possible without the combined efforts and support of many individuals, to whom I am deeply grateful. I extend my heartfelt thanks and appreciation to the Almighty God, for abundant blessings, guidance, protection, and intercession throughout my studies and work.\u003c/p\u003e\n\u003cp\u003eI am thankful to the Government of Rwanda, specifically the Ministry of Education, for the scholarship provided through the University of Rwanda, College of Medicine and Health Sciences, Faculty of Medicine, in collaboration with the Ministry of Health through the Human Resource for Health program. My gratitude also goes to Rwanda Military Hospital for their daily support.\u003c/p\u003e\n\u003cp\u003eI appreciate the administration and staff of CHUK for their assistance with data collection for this project.\u003c/p\u003e\n\u003cp\u003eI acknowledge the financial support from King Faisal Hospital foundation which helped me to carry out this research.\u003c/p\u003e\n\u003cp\u003eSpecial thanks to my supervisors: Tadios MEKONENN ASRES, Dr Dawit WORKU ASSA Dr Diomede NTASUMBUMUYANGE, Dr Thomas RANDALL for their invaluable advice and efforts that made this study possible. Your guidance is something I will always remember.\u003c/p\u003e\n\u003cp\u003eLastly, I thank all the participants in my research for their cooperation and contribution. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMay God bless you all.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eReber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional risk screening and assessment. J Clin Med. 2019;8(7):1\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSer\u0026oacute;n-Arbeloa C, Labarta-Monz\u0026oacute;n L, Puzo-Foncillas J, Mallor-Bonet T, LafitaL\u0026oacute;pez A, Bueno-Vidales N, et al. Triagem e avalia\u0026ccedil;\u0026atilde;o da desnutri\u0026ccedil;\u0026atilde;o. Nutrients. 2022;14(12):1\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichards J, Arensberg MB, Thomas S, Kerr KW, Hegazi R, Bastasch M. Impact of early incorporation of nutrition interventions as a component of cancer therapy in adults: A review. Nutrients. 2020;12(11):1\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOpanga Y, Kaduka L, Bukania Z, Mutisya R, Korir A, Thuita V, et al. Nutritional status of cancer outpatients using scored patient generated subjective global assessment in two cancer treatment centers, Nairobi, Kenya. BMC Nutr. 2017;3(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbhishek G, Vinay K, Kanika R, Sarin J. A Study to evaluate the effectiveness of patient tailored nutritional intervention on fatigue \u0026amp; nutritional status among cancer patients at OPD of selected Hospital, Ambala, Haryana. Int J Sci Res Publ. 2019;9(6):p9049.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDas U, Patel S, Dave K, Bhansali R. Assessment of nutritional status of gynecological cancer cases in India and comparison of subjective and objective nutrition assessment parameters. South Asian J Cancer. 2014;3(1):38\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Melo Silva FR, De Oliveira MGOA, Souza ASR, Figueroa JN, Santos CS. Factors associated with malnutrition in hospitalized cancer patients: A croossectional study. Nutr J [Internet]. 2015;14(1):1\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s12937-015-0113-1\u003c/span\u003e\u003cspan address=\"10.1186/s12937-015-0113-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEtsegenet A. Assessment Of Malnutrition and Inflammatory Status in Cervical Cancer Patients Attending Tikur Anbessa Specialized Hospital. J Clin Med. 2021;86(18):611\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta D, Vashi PG, Lammersfeld CA, Braun DP. Role of nutritional status in predicting the length of stay in cancer: A systematic review of the epidemiological literature. Ann Nutr Metab. 2011;59(2\u0026ndash;4):96\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBisch S, Nelson G, Altman A. Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology. Nutrients. 2019;11(5):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams DGA, Ohnuma T, Krishnamoorthy V, Raghunathan K, Sulo S, Cassady BA, et al. Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery. Perioper Med. 2020;9(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObermair A, Simunovic M, Isenring L, Janda M. Nutrition interventions in patients with gynecological cancers requiring surgery. Gynecol Oncol [Internet]. 2017;145(1):192\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.ygyno.2017.01.028\u003c/span\u003e\u003cspan address=\"10.1016/j.ygyno.2017.01.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Z, Zhong M, Xu Z, Ye Q, Xie W, Gao S, et al. Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients. Front Nutr. 2022;9(April):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantoso JT, Canada T, Latson B, Alladi K, Lucci JA, Coleman RL. Prognostic nutritional index in relation to hospital stay in women with gynecologic cancer. Obstet Gynecol. 2000;95(6):844\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKathiresan ASQ, Brookfield KF, Schuman SI, Lucci JA. Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients. Arch Gynecol Obstet. 2011;284(2):445\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEtsegenet A. Assessment Of Malnutrition and Inflammatory Status in Cervical Cancer Patients Attending Tikur Anbessa Specialized Hospital. J Clin Med. 2021;86(18):611\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhaskheli M, Baloch S, Khaskheli S, Durrani RZ, Jhatial N, Shah SGS. Stages of Gynaecological Cancers at the Time of First Presentation at a Large Cancer Hospital in Pakistan: An Observational Study. Dubai Med J. 2023;6(4):274\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A. Malnutrition among gynaecological cancer patients. Eur J Clin Nutr. 2007;61(5):642\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Sherif A, El-Sherif S, Taylor AH, Ayakannu T. Ovarian Cancer: Lifestyle, Diet and Nutrition. Nutr Cancer [Internet]. 2020;0(0):1\u0026ndash;16. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/01635581.2020.1792948\u003c/span\u003e\u003cspan address=\"10.1080/01635581.2020.1792948\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Almeida CA, Peres WAF, de Pinho NB, Martucci RB, Rodrigues VD, Ramalho A. Prevalence of Malnutrition in Older Hospitalized Cancer Patients: A Multicenter and Multiregional Study. J Nutr Heal Aging [Internet]. 2020;24(2):166\u0026ndash;71. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1007/s12603-020-1309-4\u003c/span\u003e\u003cspan address=\"10.1007/s12603-020-1309-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBozzetti F, Mariani L, Lo Vullo S, Amerio ML, Biffi R, Caccialanza R, et al. Nutritional risk in oncology: A study of 1, 453 cancer outpatients. Support Care Cancer. 2012;20(8):1919\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8490095/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8490095/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis 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\u0026ndash;81), with nearly half (48.2%) aged 46\u0026ndash;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%).\u003c/p\u003e \u003cp\u003eBody 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 \u0026mdash; 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%).\u003c/p\u003e \u003cp\u003eMultivariable 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.\u003c/p\u003e","manuscriptTitle":"Risk of Malnutrition and Impact on Treatment Outcomes Among Gynecological Cancer Patients in Two Cancer Centers, Kigali, Rwanda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 16:23:41","doi":"10.21203/rs.3.rs-8490095/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-17T13:42:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T13:38:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-14T19:04:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85946469751359331579759926871217996508","date":"2026-02-09T17:04:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T10:47:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158357880252774529101247936861090561651","date":"2026-02-07T01:37:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220818064072906829349689626165243234395","date":"2026-02-06T20:48:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125266098415439573848626834513758424919","date":"2026-01-31T03:10:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145017655767445144782042615495397285778","date":"2026-01-29T03:17:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T18:25:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-02T15:55:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-02T03:21:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-02T03:20:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-12-31T13:15:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3473b874-1ed6-4e49-974d-2263677a308a","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T16:23:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 16:23:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8490095","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8490095","identity":"rs-8490095","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}