Nutritional Risk Screening in Cancer Patients: The First Step Toward Better Clinical Outcome

Abstract

Disease-related malnutrition is highly prevalent among cancer patients, with 40–80% suffering from it during the course of their disease. Malnutrition is associated with numerous negative outcomes such as: longer hospital stays, increased morbidity and mortality rates, delayed wound healing, as well as decreased muscle function, autonomy and quality of life. In cancer patients, malnutrition negatively affects treatment tolerance (including anti-cancer drugs, surgery, chemo- and radiotherapy), increases side effects, causes adverse reactions, treatment interruptions, postoperative complications and higher readmission rates. Conversely, anti-cancer treatments are also known to affect body composition and impair nutritional status. Tailoring early nutritional therapy to patients' needs has been shown to prevent, treat and limit the negative consequences of malnutrition and is likely to improve overall prognosis. As the optimisation of treatment outcomes is top priority and evidence for nutritional therapy is growing, it is increasingly recognized as a significant intervention and an autonomous component of multimodal cancer care. The proactive implementation of nutritional screening and assessment is essential for patients suffering from cancer - given the interaction of clinical, metabolic, pharmacological factors with systemic inflammation; and suppressed appetite with accelerated muscle protein catabolism. At the same time, a nutritional care plan must be established, and adequate individualized nutritional intervention started rapidly. Screening tools for nutritional risk should be validated, standardized, non-invasive, quick and easy-to-use in daily clinical practice. Such tools must be able to identify patients who are already malnourished, as well as those at risk for malnutrition, in order to prevent or treat malnutrition and reduce negative outcomes. This review investigates the predictive value of commonly used screening tools, as well as the sensitivity and specificity of their individual components for improving clinical outcomes in oncologic populations. Healthcare professionals' awareness of malnutrition in cancer patients and the pertinence of early nutritional screening must be raised in order to plan the best possible intervention and follow-up during the patients' ordeal with the disease.

A European survey on the practice of nutritional interventions in head–neck cancer patients undergoing curative treatment with radio(chemo)therapy

“…In 65% of cases, respondents claimed to use validated screening tools (e.g. MUST, MNA, MST, NRS 2002 [ 9 ], other) to identify malnutrition risk in HNC patients undergoing radio(chemo)therapy. Clinicians reported that they would use prophylactic nutritional support in 85% of cases suffering from severe dysphagia during any treatment course; placement of a feeding tube directly into the stomach/jejunum (i.e.…”

“…We also explored if any validated nutrition screening tools (e.g. MUST, MNA, MST, NRS 2002 as summarized by Reber and colleagues [ 9 ], other) were routinely used to identify malnutrition risk and which criteria guided the choice to commence prophylactic nutrition.…”

The Geriatric Nutritional Risk Index Predicts Postoperative Outcomes in Bladder Cancer: A Propensity Score-Matched Analysis

“…5,23 While these screening tools are relevant for the prognosis of various cancers, most of them are subjective and their validation in oncology patients remains inadequate. 24 In contrast, the GNRI has the advantage of using objective variables that are easy to obtain. Although the original GNRI classification uses 4 groups, we decided to divide the patients into 2 groups using a cutoff value of 98 based on previous studies.…”

Diet-microbiome interactions in cancer treatment: Opportunities and challenges for precision nutrition in cancer

“…While there are several different malnutrition assessment tools available, including, Malnutrition Screening Tool (MST), NUTRISCORE, and Patient-Generated Subjective Global Assessment (PG-SGA), unfortunately, there is no current consensus on which screening tool to use for cancer patients specifically. 49 , 50 Furthermore, the dietary assessment tools such as Food Frequency Questionnaires (FFQs), Healthy Eating Index (HEI), Food Diaries, 24-hour recall, and short dietary screeners are designed for healthy populations and do not include questions specifically designed for cancer patients. Cancer patients represent a unique population with special nutritional needs, which may require specific evaluation tools on dietary intake assessment.…”