EAL

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

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

Validate a malnutrition screening tool (MST) in oncology patients undergoing radiotherapy.

Inclusion Criteria:

All patients undergoing radiotherapy at the Wesley Cancer Care Centre and the East Coast Cancer Center, Queensland, Australia during a non-consecutive five-day study period.

Exclusion Criteria:

No exclusion criteria given.

Description of Study Protocol:

Recruitment

Recruitment procedures were not described in this article.

Design

Cross-sectional study and validity study
Each patient was interviewed by two dietitians. One performed SGA (Detsky AS, McLaughlin JR, Baker JP. JPEN. 1987; 11: 8-13) and classified patients as well-nourished, moderately or suspected of being malnourished, or severely malnourished.
The second dietitian assessed patients' risk of malnutrition using the MST. Results were analyzed using a contingency table to determine the sensitivity, specificity and predictive value of the MST. Analysis of variance and Chi-square analysis were done to determine associations between sex, age, number of radiotherapy treatments and nutritional status.
The study was approved by The Wesley Hospital Ethics Committee and informed written consent was obtained from all participants. The study conformed to the Helsinki Declaration.

Data Collection Summary:

Timing of Measurements

One time.

Dependent Variables

Patients' categorization as well-nourished or malnourished.

Independent Variables

SGA method of assessing nutritional status
MST method of assessing nutritional status.
MST Questions included:
- Have you lost weight recently without trying?
- If yes, how much weight (kg) have you lost?
- Have you been eating poorly because of a decreased appetite?

Description of Actual Data Sample:

Initial N: 106 patients agreed to participate (43% male, 57% female)
Attrition (final N): 106
Age: 59.9+13.5 years (15 years to 89 years)
Other relevant demographics: Cancer types: 32% breast; 19% prostate; 11% GI tract; 9% head and neck; 29% other (back, arm, leg, eye, cervix, vagina, uterus, bladder)
Location: Wesley Cancer Care Centre and the East Coast Cancer Center, Queensland, Australia.

Summary of Results:

Variables	SGA Measures and Confidence Intervals	MST Measures and Confidence Intervals	Statistical Significance of Group Difference
Malnutrition category	Well-nourished 89% (N=94). Moderately or suspected malnourished 11% (N=12). No significant association between SGA category and sex, age or number of radiotherapy treatments. Susceptibility not associated with cancer site.	Well-nourished, 72% (N=76). At risk of malnutrition, 28% (N=30). MST correctly identified 72% of patients as well nourished (true negatives); 11% of patients correctly identified as malnourished (true positives); 17% misclassified as malnourished (false positives).	MST has a sensitivity of 100% and a specificity of 81%. Positive predictive value is 0.4. Negative predictive value is 1.0.

Author Conclusion:

The ideal screening tool would be 100% specific and sensitive. As this is generally not achievable, the need to correctly classify all patients who are malnourished (sensitivity) takes precedence over misclassifying well-nourished patents (specificity). The MST is able to identify all malnourished patients with 100% specificity.

Funding Source:

Not-for-profit

Wesley Research Institute, Brisbane, QLD, Australia

Other non-profit:

Reviewer Comments:

The "subject" in this study was the MST, not the patients. A simple study that provides information about the accuracy of a simple screening tool for cancer patients.

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?	N/A
	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?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	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?	N/A
	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")?	Yes
4.	Was method of handling withdrawals described?		N/A
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	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%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	N/A
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	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?		Yes
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	Yes
	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.)	???
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	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?		N/A
	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?	N/A
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	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?	N/A
	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?	N/A
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?	Yes
	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?	Yes
	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)?	Yes
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	???
	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?	No
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