Recommendations Summary

ONC: Screening for Malnutrition Risk and Referral of Adult Oncology Patients 2013

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    ONC: Screening for Malnutrition Risk and Re-Screening of Adult Oncology Patients

    All adult patients should be screened for malnutrition risk on entry into oncology services. Early identification and management of malnutrition risk improves and protects nutrition status and quality of life (QoL), which leads to improved outcomes. Re-screening should be repeated routinely throughout treatment to facilitate referral as needed. 

    Rating: Consensus
    Imperative

    ONC: Referral of Adult Oncology Patients Identified at Malnutrition Risk to the RDN

    If an adult oncology patient has been identified at screening to be at risk for malnutrition, the patient should be referred to a registered dietitian nutritionist (RDN) for evaluation. If indicated, the RDN conducts a nutrition assessment and provides medical nutrition therapy (MNT) including the nutrition care process: Nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring and evaluation. Management of malnutrition risk improves and protects nutrition status and quality of life (QoL), which leads to improved outcomes. 

    Rating: Consensus
    Conditional

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      The recommendation ON: Referral of Adult Oncology Patients Identified at Malnutrition Risk to an RDN applies to all adult oncology patients identified at screening to be at risk for malnutrition.

    • Potential Costs Associated with Application

      Costs include staff time to complete screening and referral.

    • Recommendation Narrative

      Screening Adult Oncology Patients for Malnutrition Risk

      Timely screening for nutrition impact symptoms and identification of malnutrition can facilitate referral for nutrition management and lead to improved outcomes (Kruizenga et al, 2005). Screening tools should be quick, easy to use, valid and reliable for the patient population or setting. Screening and re-screening should occur within an appropriate time-frame for the setting (Skipper et al, 2012).

      The screening tool should be a valid identifier of malnutrition risk in adult oncology patients who would benefit from nutrition assessment and intervention by an RDN.

      This tool should be able to detect a measurable adverse effect on body composition, function or clinical outcome (Stratton et al, 2004).

      Screening and assessment in the oncology population has been shown to improve outcomes in oncology patients. Nutrition intervention enables these patients to complete treatment regimens intended to give the best control of disease with fewer treatment interruptions [Ravasco et al, 2005 (J Clin Oncol); Ravasco et al, 2005 (Head Neck) 2005; Isenring et al, 2006, 2007].

      For more information about screening tools found to be effective in identifying oncology patients at malnutrition risk, click here.

    • Recommendation Strength Rationale

      Consensus.

    • Minority Opinions

      None.

  • Supporting Evidence

    The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

    • References
    • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

      Isenring EA, Bauer JD, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc. 2007 Mar; 107 (3): 404-412. PMID: 17324657.

      Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr. 2005 Nov; 82 (5): 1, 082-1, 089. PMID: 16280442. 

      Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005 Mar 1; 23 (7): 1, 431-1, 438. Epub 2005 Jan 31.

      Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005 Aug; 27 (8): 659-668. PMID: 15920748. 

      Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J. Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr. 2012 May; 36 (3): 292-298. Epub 2011 Nov 1.

      Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr. 2004; 92(5):799-808.