# Symptom Burden and Dietary Changes Among Older Adults with Cancer: A Cross-Sectional Study
## 4 Discussion  
Older patients with cancer are a diverse group of people. Guidelines recommend considering biological and not chronological aging as well as health status when stratifying cancer patients for treatment [19]. The G8 screening tool is able to identify frail older patients. In addition to items on mobility, the neuropsychological situation, and medication intake, the screening primarily covers nutritional status (three question items, [13]). However, using the G8, we identified more than four out of five patients (87%) as frail, and patients mainly showed a decrease in points in nutrition items. This merits combining the G8 with established tools used for malnutrition screening. Recognizing the risk of malnutrition in older patients is important. Malnourished older patients are more prone to developing disease-associated complications, which in turn leads to longer hospitalization and poorer outcomes [20]. Accordingly, the European Society for Clinical Nutrition and Metabolism (ESPEN) recommends (1) routine and regular malnutrition screening for all patients diagnosed with cancer and argues for (2) repeated screening and more specific assessments for patients with a high-risk profile [4]. In 2016, the Global Leadership Initiative on Malnutrition (GLIM) established the \"GLIM criteria\", a well-defined definition of malnutrition. These criteria comprise low BMI, non-volitional weight loss, reduced muscle mass, inflammation, disease burden, and decreased food intake [21]. The NRS-2002 covers a major part of these criteria and is also recommended by the German Society for Nutritional Medicine for screening inpatients [22]. Therefore, we combined the NRS-2002 with the G8 for our study. While the German Society for Nutritional Medicine estimates that around half of all older people are at risk of malnutrition [23], our data demonstrates that more than two out of three older cancer patients are at risk. This higher risk of malnutrition fits the previous data of [PERSON] et al. [3], who described malnutrition in 71% of cancer patients. The risk of malnutrition is also higher in our cohort of older individuals compared to data from a previous study. While [PERSON] et al. reported an overall risk of malnutrition of 37% in oncological patients and specifically described a risk of 44% in patients with hematological neoplasm [12], we observed a risk of 70% (all patients) and 74% (hematological neoplasm) respectively. As both studies used the NRS-2002 to assess the risk of malnutrition, this demonstrates that older people are an even more vulnerable patient group benefiting from nutritional screening. Reflecting the risk of malnutrition in patients with solid tumors and hematological neoplasms, we observed a trend toward a higher risk of malnutrition in the latter. This is not surprising since different cancer entities are associated with an entity-specific risk, as each \begin{table}
\begin{tabular}{c c c c} \hline \hline \multirow{2}{*}{**Age Cohort**} & **Symptom** & **Symptom** & \multirow{2}{*}{_p_**-Value**} \\  & **Positive** & **Negative** & \\  & [N] & [N] & \\ \hline \multicolumn{4}{c}{**Odynophaga**} \\ \hline \textless{}75 a & 17 & 173 & 0.4308 \\ \hline \(\geq\)75 a & 13 & 97 & \\ \hline \multicolumn{4}{c}{**Constipation**} \\ \hline \textless{}75 a & 44 & 145 & \\ \hline \(\geq\)75 a & 36 & 74 & \\ \hline \multicolumn{4}{c}{**Abdominal discomfort**} \\ \hline \textless{}75 a & 27 & 163 & \\ \hline \(\geq\)75 a & 11 & 99 & \\ \hline \multicolumn{4}{c}{**Emesis**} \\ \hline \textless{}75 a & 11 & 179 & \\ \hline \(\geq\)75 a & 6 & 104 & \\ \hline \hline \end{tabular}
\end{table} 
Table 7: _Cont._oncological treatment modality is characterized by a specific pattern of side effects (e.g., locoregional--radiation therapy/surgery, systemic--oral mucositis, [24,25]).