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Tangvik RJ, Skeie E, Haugen AS, Harthug S, Harris K. Is self-screening for 'at risk of malnutrition' feasible in a home setting? PLoS One 2024; 19:e0299305. [PMID: 38625912 PMCID: PMC11020964 DOI: 10.1371/journal.pone.0299305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/02/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Despite malnutrition being established as a well-known risk for postoperative complications, the lack of screening for nutritional risk remains a challenge. The aim of this study was to investigate whether self-screening for nutritional risk prior to surgery is feasible in a home setting and if it will increase number of patients screened for nutritional risk, and secondly, to compare their screening results with the "in-hospital assessments" conducted by healthcare professionals. MATERIALS AND METHODS This was a prospective study involving patients from six randomly selected surgical wards at two Norwegian hospitals as a part of the "Feasibility study of implementing the surgical Patient Safety Checklist the (PASC)". This checklist included a self-reported screening tool based on the Nutritional Risk Screening tool (NRS 2002) to identify "at risk of malnutrition" in patients that will undergo surgery the next 3 months or less. The original screening tool (NRS 2002) was used as a standard routine to identify "at risk of malnutrition" by healthcare professionals at hospital. The interrater reliability between these results was investigated using Fleiss multi rater Kappa with overall agreement and reported with Landis and Koch's grading system (poor, slight, fair, moderate, substantial, and almost perfect). RESULTS Out of 215 surgical patients in the home setting, 164 (76.7%) patients completed the self-reported screening tool. A total of 123 (57.2%) patients were screened in-hospital, of whom 96 (44.7%) prior to surgery and 96 (44.7%) were screened both at hospital (pre- and post-surgery) and at home. Self-screening at home improved malnutrition screening participation by 71.9% compared to hospital screening prior to surgery (165 (76.7%) and 96 (44.7%), respectively) and by 34.1% compared to pre- and postoperative in-hospital screening, 165 (76.7%) and 123 (57.2%), respectively). The degree of agreement between patients identified to be "at risk of malnutrition" by the self-reported screening tool and healthcare professionals was poor (κ = - 0.04 (95% CI: -0.24, 0.16), however, the degrees of agreement between the patients and healthcare professionals answers to the initial NRS 2002 questions "low BMI", "weight loss", and "reduced food intake" were almost perfect (κ = 1.00 (95% CI: 0,82, 1.18)), moderate (κ = 0.55 (95% CI: 0.34, 0.75)), and slight (κ = 0.08 (95% CI: - 0.10, 0.25) respectively. CONCLUSIONS Three out of four patients completed the self-screening form and the preoperative screening rate improved with 70%. Preoperatively self-screening in a home setting may be a feasible method to increase the number of elective surgical patients screened for risk of malnutrition. TRIAL REGISTRATION The trial is registered in ClinicalTrials.gov ID NCT03105713. https://classic.clinicaltrials.gov/ct2/show/NCT03105713.
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Affiliation(s)
- Randi J. Tangvik
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway
| | - Eli Skeie
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Health and Social Services, Kvam Municipality, Norheimsund, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion Acute and Critical Illness, OsloMet–Oslo Metropolitan University, Oslo, Norway
| | - Stig Harthug
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristin Harris
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Roberts S, Marshall AP, Bromiley L, Hopper Z, Byrnes J, Ball L, Collins PF, Kelly J. Patient-Led, Technology-Assisted Malnutrition Risk Screening in Hospital: A Feasibility Study. Nutrients 2024; 16:1139. [PMID: 38674830 PMCID: PMC11055004 DOI: 10.3390/nu16081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Andrea P. Marshall
- School of Nursing and Midwifery, Griffith University, Southport, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Leisa Bromiley
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Zane Hopper
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia;
- School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, QLD 4072, Australia;
| | - Peter F. Collins
- Faculty of Medicine and Health, Sydney Nursing School/Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia;
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jaimon Kelly
- Centre for Online Health, The University of Queensland, Woolloongabba, QLD 4102, Australia;
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia
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Xie B, Sun Y, Sun J, Deng T, Jin B, Gao J. Applicability of five nutritional screening tools in Chinese patients undergoing colorectal cancer surgery: a cross-sectional study. BMJ Open 2022; 12:e057765. [PMID: 35623749 PMCID: PMC9150165 DOI: 10.1136/bmjopen-2021-057765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify the most appropriate nutritional risk screening tool for patients undergoing colorectal cancer surgery, five nutritional screening tools, including the Nutritional Risk Screening 2002 (NRS 2002), Short Form of Mini Nutritional Assessment (MNA-SF), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST) and Nutritional Risk Index (NRI), were employed to evaluate the nutritional risk at admission and short-term clinical outcome prediction. DESIGN A cross-sectional study. SETTING A comprehensive affiliated hospital of a university in Shenyang, Liaoning Province, China. PARTICIPANTS 301 patients diagnosed with colorectal cancer were continuously recruited to complete the study from October 2020 to May 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Within 48 hours of hospital admission, five nutritional screening tools were used to measure the nutritional risk and to determine their relationship with postoperative short-term clinical outcomes. RESULTS The nutritional risk assesed by the five tools ranged from 25.2% to 46.2%. Taking the Subject Global Assessment as the diagnostic standard, MNA-SF had the best consistency (κ=0.570, p<0.001) and MST had the highest sensitivity (82.61%). Multivariate Logistic regression analysis after adjusting confounding factors showed that the NRS 2002 score ≥3 (OR 2.400, 95% CI 1.043 to 5.522) was an independent risk factor for postoperative complications and was the strongest predictor of postoperative complications (area under the curve 0.621, 95% CI 0.549 to 0.692). The scores of NRS 2002 (r=0.131, p<0.001), MNA-SF (r=0.115, p<0.05) and NRI (r=0.187, p<0.05) were poorly correlated with the length of stay. There was no correlation between the five nutritional screening tools and hospitalisation costs (p>0.05). CONCLUSIONS Compared with the other four nutritional screening tools, we found that NRS 2002 is the most appropriate nutritional screening tool for Chinese patients with colorectal cancer.
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Affiliation(s)
- Bingxin Xie
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yefei Sun
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Sun
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tingting Deng
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Baodi Jin
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jia Gao
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Gascón-Ruiz M, Casas-Deza D, Torres-Ramón I, Zapata-García M, Alonso N, Sesma A, Lambea J, Álvarez-Alejandro M, Quílez E, Isla D, Arbonés-Mainar JM. Comparation of different malnutrition screening tools according to GLIM criteria in cancer outpatients. Eur J Clin Nutr 2021; 76:698-702. [PMID: 34620998 DOI: 10.1038/s41430-021-01021-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/06/2021] [Accepted: 09/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many studies have assessed different malnutrition screening tools in oncologic patients. However, very few have been carried out using the new GLIM criteria for malnutrition. The objective of our study is to compare the most recommended screening tools with respect to the new GLIM criteria for malnutrition in cancer patients. METHODS Observational, cross-sectional, and single-center study carried out at the Medical Oncology Department at the Lozano Blesa Hospital in Zaragoza. We recruited 165 patients with tumors of the upper-gastrointestinal-tract, colorectal, and head-and-neck region undergoing outpatient treatment. All of them received MST, MUST, Nutriscore, MNA and CONUT screening tools, as well as the GLIM diagnostic criteria, which was used as the gold standard. RESULTS MNA-SF showed the best sensitivity (0.99) and lowest specificity while CONUT had the best specificity (0.89) and lowest sensitivity to detect cancer-related malnutrition. We observed high variability in the diagnostic capabilities of Nutriscore when tumor location was considered, reducing sensitivity in patients with colorectal cancer compared to those with tumors of the upper-gastrointestinal-tract or head-and-neck location (0.25, 0.83, and 0.91 respectively). The highest index of agreement between the screening tools was found between MST, MUST and Nutriscore tests. Regarding the GLIM criteria, the highest agreement index was presented by MUST tool (0.66), while CONUT presented the lowest (0.12). CONCLUSIONS Selecting the screening tool according to the type of cancer and its location may allow us to optimize its use and increase its performance, exploiting the advantages of each of them in the different populations.
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Affiliation(s)
- Marta Gascón-Ruiz
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain. .,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain.
| | - Diego Casas-Deza
- Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain.,Gastroenterology and Hepatology Department, University Hospital Miguel Servet, Av. Isabel la Católica 1-3, 50009, Zaragoza, Spain
| | - Irene Torres-Ramón
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - María Zapata-García
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Natalia Alonso
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Andrea Sesma
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Julio Lambea
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - María Álvarez-Alejandro
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Elisa Quílez
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Jose M Arbonés-Mainar
- Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain.,Translational Research Unit, Miguel Servet University Hospital, Instituto Aragonés de Ciencias de la Salud (IACS), Av. Isabel la Católica 1-3, 50009, Zaragoza, Spain.,Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Health Institute Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
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5
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Bullock AF, Greenley SL, Patterson MJ, McKenzie GAG, Johnson MJ. Patient, family and carer experiences of nutritional screening: a systematic review. J Hum Nutr Diet 2021; 34:595-603. [PMID: 33316101 PMCID: PMC8246934 DOI: 10.1111/jhn.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite recommendations for nutritional risk screening of all inpatients, outpatients and care home residents, as well as work to assess clinician's experiences and the validity of tools, little attention has been paid to the experiences of patients undergoing nutritional screening. This review aims to synthesise systematically the current evidence regarding nutritional risk screening with respect to the experiences and views of patients, their families and carers. METHODS A systematic search was performed in MEDLINE, Embase, PsychINFO, CINAHL, Web of Science and British Nursing Database (inception - July 2019); with screening terms related to malnutrition, screening tools and experience. Titles, abstracts and full-text papers were independently reviewed by two reviewers and then quality-appraised. Qualitative papers and quantitative surveys were included. A narrative review of surveys and a thematic framework synthesis of interviews were used to identify themes. RESULTS Nine studies, including five qualitative interview papers, were included. Qualitative and quantitative study results were combined using a matrix chart to allow comparison. Surveyed participants reported processes of nutritional screening as acceptable. Three key themes emerged from qualitative data: (i) experience of nutritional screening; (ii) misunderstanding of malnutrition: of causes, role of screening and poor self-perception of risk; and (iii) barriers to and opportunities for change. CONCLUSIONS Although the screening process is acceptable, patients' misunderstanding and poor knowledge regarding causes and consequences of malnutrition result in reduced risk perception and disbelief or disregard of nutritional screening results. Findings should inform policy and clinical practice, as well as highlight the known paucity of data regarding the effectiveness of screening on clinical outcomes.
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Affiliation(s)
- A. F. Bullock
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - S. L. Greenley
- Academy of Primary CareHull York Medical SchoolUniversity of HullHullUK
| | - M. J. Patterson
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - G. A. G. McKenzie
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - M. J. Johnson
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
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Kiss N, Loeliger J, Findlay M, Isenring E, Baguley BJ, Boltong A, Butler A, Deftereos I, Eisenhuth M, Fraser SF, Fichera R, Griffin H, Hayes S, Jeffery E, Johnson C, Lomma C, van der Meij B, McIntyre C, Nicholls T, Pugliano L, Skinner T, Stewart J, Bauer J. Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia. Nutr Diet 2020; 77:416-425. [PMID: 32803904 PMCID: PMC7540290 DOI: 10.1111/1747-0080.12631] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/30/2022]
Abstract
This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer‐related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence‐based guidelines, systematic reviews and meta‐analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as “at risk” of malnutrition or with a high‐risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment; people identified as “at risk” of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer‐related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer‐related malnutrition and sarcopenia should be individualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer‐related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenelle Loeliger
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Anna Boltong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Butler
- GP Liaison, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery Western Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition and Dietetics, Western Health, Melbourne, Victoria, Australia
| | - Michelle Eisenhuth
- Nutrition and Dietetics Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Fichera
- Nutrition and Dietetics Departments, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hayley Griffin
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Jeffery
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Catherine Johnson
- Gastrointestinal Cancer Service, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Chris Lomma
- Medical Oncology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Barbara van der Meij
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Dietetics and Food Services, Mater Health, Brisbane, Queensland, Australia
| | - Carolyn McIntyre
- School of Medical and Health Science, Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Tracey Nicholls
- Department of ENT Otolaryngology Head and Neck Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lina Pugliano
- Medical Oncology, Northern Cancer Institute, Sydney, New South Wales, Australia
| | - Tina Skinner
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Jane Stewart
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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De Groot LM, Lee G, Ackerie A, van der Meij BS. Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria. Nutrients 2020; 12:nu12082287. [PMID: 32751724 PMCID: PMC7468976 DOI: 10.3390/nu12082287] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
Background: A valid malnutrition screening tool (MST) is essential to provide timely nutrition support in ambulatory cancer care settings. The aim of this study is to investigate the validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria as compared to the reference standard, the Patient-Generated Subjective Global Assessment (PG-SGA). Methods: Cross-sectional observational study including 246 adult ambulatory patients with cancer receiving in-chair intravenous treatment at a cancer care centre in Australia. Anthropometrics, handgrip strength and patient descriptive data were assessed. Nutritional risk was identified using MST and PG-SGA SF, nutritional status using PG-SGA and GLIM. Sensitivity (Se), specificity (Sp), positive and negative predictive values and kappa (k) were analysed. Associations between malnutrition and 1-year mortality were investigated by Cox survival analyses. Results: A PG-SGA SF cut-off score ≥5 had the highest agreement when compared with the PG-SGA (Se: 89%, Sp: 80%, k = 0.49, moderate agreement). Malnutrition risk (PG-SGA SF ≥ 5) was 31% vs. 24% (MST). For malnutrition according to GLIM, the Se was 76% and Sp was 73% (k = 0.32, fair agreement) when compared to PG-SGA. The addition of handgrip strength to PG-SGA SF or GLIM did not improve Se, Sp or agreement. Of 100 patients who provided feedback, 97% of patients found the PG-SGA SF questions easy to understand, and 81% reported that it did not take too long to complete. PG-SGA SF ≥ 5 and severe malnutrition by GLIM were associated with 1-year mortality risk. Conclusions: The PG-SGA SF and GLIM criteria are accurate, sensitive and specific malnutrition screening and assessment tools in the ambulatory cancer care setting. The addition of handgrip strength tests did not improve the recognition of malnutrition or mortality risk.
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Affiliation(s)
- Lynette M. De Groot
- Dietetics and Foodservices, Mater Health, Brisbane, 4101 QLD, Australia; (L.M.D.G.); (A.A.)
- Mater Research Institute, University of Queensland, Brisbane, 4101 QLD, Australia
| | - Gahee Lee
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226 QLD, Australia;
| | - Antoinette Ackerie
- Dietetics and Foodservices, Mater Health, Brisbane, 4101 QLD, Australia; (L.M.D.G.); (A.A.)
| | - Barbara S. van der Meij
- Dietetics and Foodservices, Mater Health, Brisbane, 4101 QLD, Australia; (L.M.D.G.); (A.A.)
- Mater Research Institute, University of Queensland, Brisbane, 4101 QLD, Australia
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226 QLD, Australia;
- Correspondence:
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8
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Kiss N, Bauer J, Boltong A, Brown T, Isenring L, Loeliger J, Steer B, Findlay M. Awareness, perceptions and practices regarding cancer-related malnutrition and sarcopenia: a survey of cancer clinicians. Support Care Cancer 2020; 28:5263-5270. [PMID: 32103357 DOI: 10.1007/s00520-020-05371-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cancer-related malnutrition and sarcopenia have severe negative consequences including reduced survival and reduced ability to complete treatment. This study aimed to determine the awareness, perceptions and practices of Australian oncology clinicians regarding malnutrition and sarcopenia in people with cancer. METHODS A national cross-sectional survey of Australian cancer clinicians was undertaken between November 2018 and January 2019. The 30-item online purpose-designed survey was circulated through professional organizations and health services. RESULTS The 111 participants represented dietetic (38%), nursing (34%), medical (14%) and other allied health (14%) clinicians. Overall, 86% and 88% clinicians were aware of accepted definitions of malnutrition and sarcopenia, respectively. Perception of responsibility for identification of these conditions varied across participants, although 93% agreed this was a component of their role. However, 21% and 43% of clinicians had limited or no confidence in their ability to identify malnutrition and sarcopenia, respectively. Common barriers to the identification and management of malnutrition were access to the tools or skills required and a lack of services to manage malnourished patients. Common barriers to identification of sarcopenia were lack of confidence and lack of services to manage sarcopenic patients. Enablers for identification and management of malnutrition and sarcopenia were variable; however, training and protocols for management ranked highly. CONCLUSION While awareness of the importance of cancer-related malnutrition and sarcopenia are high, participants identified substantial barriers to delivering optimal nutrition care. Guidance at a national level is recommended to strengthen the approach to management of cancer-related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia. .,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Anna Boltong
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Liz Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Jenelle Loeliger
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
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9
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Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting. J Acad Nutr Diet 2019; 120:1210-1215. [PMID: 31892501 DOI: 10.1016/j.jand.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 10/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening. OBJECTIVE The aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments. DESIGN/PARTICIPANTS A single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland. MAIN OUTCOME MEASUREMENTS The primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian. STATISTICAL ANALYSIS Concurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient. RESULTS The ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found. CONCLUSION Patient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.
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10
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Calderon C, Carmona-Bayonas A, Beato C, Ghanem I, Hernandez R, Majem M, Rosa Diaz A, Higuera O, Mut Lloret M, Jimenez-Fonseca P. Risk of malnutrition and emotional distress as factors affecting health-related quality of life in patients with resected cancer. Clin Transl Oncol 2018; 21:687-691. [PMID: 30284234 DOI: 10.1007/s12094-018-1954-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study analyzes the prevalence of malnutrition, depression, anxiety, and somatization and which factor has the biggest effect on quality of life (QoL) in individuals with resected cancer. METHODS A prospective study was conducted among 747 participants. Participants completed the EORTC-QLQ30, MST, and BSI-18 questionnaires. RESULTS Prevalence for risk of malnutrition, depression, anxiety, and somatization were 36.4%, 35.5%, 35.2%, and 48.8%, respectively. Hierarchical multiple regression analyses revealed that malnutrition risk, somatization, depression, and anxiety accounted for 50.8% of the variance in functional scale, 45.3% in symptom scale, and 52.2% in global health. Malnutrition, somatization, depression, and anxiety displayed high explanatory power on all health-related QoL (HRQoL) scales. CONCLUSION The risk of malnutrition and psychological symptoms is strongly associated with HRQoL in cancer patients; thus, medical oncologists should develop effective interventions that contribute to lowering the risk of malnutrition and psychological distress, thereby improving subjects' HRQoL before initiating adjuvant chemotherapy.
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Affiliation(s)
- C Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - A Carmona-Bayonas
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - C Beato
- Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - I Ghanem
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - R Hernandez
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - M Majem
- Department of Medical Oncology, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain
| | - A Rosa Diaz
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - O Higuera
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - M Mut Lloret
- Department of Medical Oncology, Hospital Universitario Son Espases, Mallorca, Spain
| | - P Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain.
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