ONC: Malnutrition Screening and Nutrition Assessment of Adult Oncology Patients (2012)
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.
All adult patients attending an outpatient chemotherapy unit at an Australian public hospital.
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.
Recruitment
Adult patients receiving outpatient chemotherapy at an Australian public hospital between May and June 2005.
Design
Cross-sectional.
Blinding Used
Convenience sample of consecutive patients.
Intervention
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.
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.
- 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.
Anthropometrics
- Weight: 72.7±13.8kg
- BMI: 26.5±4.5kg/m2
Location:
Australia.
Variables |
PG-SGA Positive Malnutrition Risk |
PG-SGA Negative Malnutrition Risk |
Sensitivity/Specificity |
MST Classified Risk True |
13 (26%) |
34 (68%) |
100% sensitivity |
MST Classified Risk False |
3 (6%) |
0 (0%) |
92% specificity |
Predictive Value |
80% |
100% |
|
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.
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.
- 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
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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 | |