ONC: Malnutrition Screening and Nutrition Assessment of Adult Oncology Patients (2012)


Isenring E, Cross G, Daniels L, Kellett E, Koczwara B. Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Support Care Cancer. 2006 Nov; 14(11): 1152-1156. Epub 2006 Apr 19.

PubMed ID: 16622648
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

To determine the relative validity of the Malnutrition Screening Tool (MST) compared with a full nutrition assessment by the scored Patient Generated Subjective Global Assessment (PG-SGA) and to assess MST inter-rater reliability in outpatients receiving chemotherapy.

Inclusion Criteria:

All adult patients attending an outpatient chemotherapy unit at an Australian public hospital.

Exclusion Criteria:

Patients were excluded if they were:

  • Less than 18 years old
  • Identified as inappropriate by nursing or medical staff (due to acute medical condition or cognitive impairment)
  • Non-English speaking.
Description of Study Protocol:


Adult patients receiving outpatient chemotherapy at an Australian public hospital between May and June 2005.



Blinding Used

Convenience sample of consecutive patients.


Data collection to assess malnutrition risk by the Malnutrition Screening Tool as compared with the Patient Generated Subjective Global Assessment.

Statistical Analysis

  • Contingency tables used for sensitivity, specificity and predictive value
  • Adjusted Wald method used for confidence intervals
  • Kappa scores for inter-rater reliability of the MST.
Data Collection Summary:

Timing of Measurements

Data collected over eight weeks, May to June, 2005.

Patient Reported Data

  • Weight history
  • Height
  • Malnutrition Screening Tool (appetite, recent unintentional weight loss)
  • PG-SGA Part One (weight history, nutrition impact symptoms, nutrition intake, functional capacity). 

Measured or Objective Data

  • Age
  • Gender
  • Diagnosis
  • Medical treatment protocol
  • Actual weight
  • Weight history ( if documented)
  • PG-SGA Part Two (diagnosis, age, metabolic stress, subcutaneous fat loss, muscle wasting, fluid status and global clinician assessment).

Inter-rater reliability

  • Researcher one performed MST on all subjects, tested by a comparison to a subset of 20 patients screened by either nursing or administrative staff or patient themselves
  • Researcher two performed PG-SGA on all subjects with no comparison group.


Description of Actual Data Sample:


  • Initial N: 51, one patient did not provide consent
  • Attrition (final N): 50 (18 male, 32 female)
  • Age: 59.1±13.8 years
  • Ethnicity: Unknown other than located in Australia.

Other Relevant Demographics

Types of cancer included:

  • Breast, N=19
  • Gastrointestinal, N=14
  • Lymphoma, N=7
  • Head and neck, N= 3
  • Ovarian, N=2
  • Lung, N= 2
  • Other (leukemia, multiple myeloma, cervical), N=3.


  • Weight: 72.7±13.8kg
  • BMI: 26.5±4.5kg/m2



Summary of Results:



PG-SGA Positive Malnutrition Risk

PG-SGA Negative Malnutrition Risk


MST Classified Risk True

13 (26%)

34 (68%)

100% sensitivity
(95% CI)

MST Classified Risk False

 3 (6%)

 0 (0%)

 92% specificity
(95% CI)

Predictive Value




Other Findings

Inter-rater reliability for MST compared to subset was 18 out of 20 (κ=0.83, P<0.001). Inter-rater reliability evaluated agreement between the administrative staff, nursing staff, patient and dietitian.


Author Conclusion:

The MST has acceptable relative validity, inter-rater reliability, sensitivity and specificity relative to the scored PG-SGA to identify chemotherapy outpatients at risk of malnutrition and is therefore an acceptable nutrition screening tool.

Funding Source:
Reviewer Comments:
  • This was a brief and somewhat small study on relatively healthy outpatients despite their cancer diagnosis and treatment
  • Clinician completed the weight and weight history of the PG-SGA. This portion is usually completed by the patient
  • Overall, well done and confirms using MST in another adult patient treatment population.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? Yes
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) Yes
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? Yes
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? Yes
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? No
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? No
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? Yes
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? Yes
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? No
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? No
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes