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Recommendations Summary

ONC: Malnutrition Screening Tools for 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: Malnutrition Screening Tools for Adult Oncology Patients

  Adult oncology patients should be screened using a malnutrition screening tool validated in the setting (inpatient or ambulatory/outpatient) in which the tool is intended for use.  Research indicates that the following tools are valid and reliable for identifying malnutrition risk in oncology patients.

  The following have been shown to be valid and reliable for identifying malnutrition risk in adult oncology patients in the inpatient setting:

  • Malnutrition Screening Tool (MST)
  • Malnutrition Screening Tool for Cancer Patients (MSTC)
  • Malnutrition Universal Screening Tool (MUST)

  The following has been shown to be valid and reliable for identifying malnutrition risk in adult oncology patients in the ambulatory/outpatient setting:

  • MST.

  Rating: Strong
  Imperative

  • Risks/Harms of Implementing This Recommendation

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

  • Conditions of Application

    There are no conditions which may limit the application of this recommendation.

  • Potential Costs Associated with Application

    Costs include staff time to complete screening.

  • Recommendation Narrative

    A total of seven studies were included in the evidence analysis for this recommendation:

    • Three positive-quality diagnostic, validity or reliability studies (Amaral  et al, 2008; Ferguson, Capra et al, 1999; Kim et al, 2011)
    • Two positive-quality cross-sectional studies (Ferguson, Bauer et al, 1999; Isenring et al, 2006)
    • One neutral-quality diagnostic, validity or reliability studies (Kirsh et al, 2003)
    • One neutral-quality cross-sectional study (Bauer et al,  2003).

    Seven validation studies provide evidence that the following tools were found to be valid and reliable for identifying malnutrition in adult oncology patients.

    • Ambulatory and acute caresettings: MST (Amaral et al, 2008; Ferguson et al, 1999; Ferguson, Capra et al, 1999; Isenring et al, 2006)
    • Acute care setting only: MSTC (Kim et al, 2011) and MUST (Amaral et al, 2008)
    • The MAG-MST (Bauer, Capra et al, 2003) and the two-item nutrition screen from the ZSDS (Kirsh et al, 2003) were not found to be valid and reliable for identifying malnutrition in adult oncology patients in acute care settings
    • Validity and reliability of the MSTC, MUST, MAG-MST and two-item nutrition screen from the ZSDS tools were not evaluated in adult oncology patients in the ambulatory setting
    • Criteria for effective malnutrition screening tools in clinical settings include validity and reliability, the speed and ease with which the tool can be administered and the tool's ability to be used by a variety of members of the Interdisciplinary Team. Tools included in the evidence analysis for this question met the additional criteria of being validated in ambulatory or inpatient oncology settings.
    • For further information regarding nutrition screening in other non-cancer populations within the EAL, see the Nutrition Screening Project.

  • Recommendation Strength Rationale

    Conclusion statement for the validity and reliability of malnutrition screening tools to assess nutritional status of adult oncology patients in ambulatory and acute care settings is Grade I.

  • 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).

  Which malnutrition screening tools have been found to be valid and reliable for identifying malnutrition risk in adult oncology patients in ambulatory and acute care settings?

  • References

    Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L. An evaluation of three nutritional screening tools in a Portuguese oncology centre. J Hum Nutr Diet. 2008; 21: 575-583.
    
    Bauer J, Capra S. Comparison of a malnutrition screening tool with subjective global assessment in hospitalised patients with cancer: Sensitivity and specificity. Asia Pac J Clin Nutr. 2003; 12(3): 257-260. 
    
    Ferguson ML, Bauer J, Gallagher B, Capra S, Christie DRH, Mason BR.  Validation of a malnutrition screening tool for patients receiving radiotherapy. Australasian Radiology. 1999; 43: 325-327.
    
    Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition. 1999 Jun; 15(6): 458-464.
    
    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.
    
    Kim JY, Wie GA, Cho YA, Kim SY, Kim SM, Son KH, Park SJ, Nam BH, Joung H. Development and validation of a nutrition screening tool for hospitalized cancer patients. Clin Nutr. 2011; 1-6. 
    
    Kirsh KL, Dugan C, Theobald DE, Passik SD. A chart review, pilot study of two single-item screens to detect cancer patients at risk for cachexia. Palliat Support Care. 2003 Dec; 1 (4): 331-335.

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

    None.