Advertisement

Supportive Care in Cancer

, Volume 14, Issue 11, pp 1152–1156 | Cite as

Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy

  • Elisabeth IsenringEmail author
  • Giordana Cross
  • Lynne Daniels
  • Elizabeth Kellett
  • Bogda Koczwara
Short Communication

Abstract

Goals of work

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 patients receiving chemotherapy.

Patients and methods

An observational, cross-sectional study was conducted at an Australian public hospital in 50 oncology outpatients receiving chemotherapy. Inter-rater reliability was assessed in a subsample of 20 patients.

Main results

According to PG-SGA global rating, the prevalence of malnutrition was 26%. The MST was a strong predictor of nutritional risk relative to the PG-SGA (100% sensitivity, 92% specificity, 0.8 positive predictive value, 1.0 negative predictive value). MST inter-rater reliability was acceptable with agreement by administration staff/nursing staff/patient and the dietitian in 18/20 cases (kappa=0.83; p0.001).

Conclusion

The MST has acceptable relative validity, inter-rater reliability, sensitivity, and specificity to identify chemotherapy outpatients at risk of malnutrition and, hence, is an acceptable nutrition screening tool in this patient population.

Keywords

Dietetics Nutrition screening Oncology Cancer Chemotherapy 

Notes

Acknowledgements

We would like to thank Silvia Hui, Kanita Kunaratnam, Kellie Wright, and Lydia Yuen for assisting with data collection as part of the requirements for the Master of Nutrition and Dietetics.

References

  1. 1.
    Ollenschlager G, Viell B, Konkol K, Burger B (1991) Tumor anorexia: causes, assessment, treatment. Recent Results Cancer Res 121:20–27Google Scholar
  2. 2.
    Shike M (1996) Nutrition management for the cancer patient. Hematol Oncol Clin N Am 10:221–234CrossRefGoogle Scholar
  3. 3.
    Bokhorst-de van der Schueren MA, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ (1999) The impact of nutritional status on the prognosis of patients with advanced head and neck cancer. Cancer 86:519–527CrossRefGoogle Scholar
  4. 4.
    Correia MI, Waitzburg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22:235–239CrossRefPubMedGoogle Scholar
  5. 5.
    Ottery FD (1995) Supportive nutrition to prevent cachexia and improve quality of life. Semin Oncol 22:98–111PubMedGoogle Scholar
  6. 6.
    Isenring E, Bauer J, Capra S (2003) The scored Patient Generated-Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr 57:305–309CrossRefPubMedGoogle Scholar
  7. 7.
    Isenring E, Capra S, Bauer J (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal, head or neck area. Br J Cancer 91:447–452CrossRefPubMedGoogle Scholar
  8. 8.
    Ravasco P, Monterio-Grillo I, Vidal P, Camilo M (2005) Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 23:1431–1438CrossRefPubMedGoogle Scholar
  9. 9.
    The American Dietetic Association (1994) ADA’s definitions for nutrition screening and nutrition assessment. J Am Diet Assoc 94:838–839CrossRefGoogle Scholar
  10. 10.
    Ferguson M, Capra S (1998) Nutrition screening practices in Australian hospitals. Aust J Nutr Diet 55:157–161Google Scholar
  11. 11.
    Ferguson M, Capra S, Bauer J, Banks M (1999) Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 15:458–463CrossRefPubMedGoogle Scholar
  12. 12.
    Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:S15–S19PubMedGoogle Scholar
  13. 13.
    McWhirter JP, Pennington CR (1994) Incidence and recognition of malnutrition in hospital. Br Med J 308:945–948Google Scholar
  14. 14.
    Ottery FD (2000) Patient generated subjective global assessment. In: McCallum P, Polisena C (eds) The clinical guide to oncology nutrition. The American Dietetic Association, Chicago, IL, USA, pp 11–23Google Scholar
  15. 15.
    Detsky AS, McLaughlin JR, Baker JP, Johnson N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13PubMedCrossRefGoogle Scholar
  16. 16.
    Bauer J, Capra S, Ferguson M (2002) Use of the scored patient generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56:779–785CrossRefPubMedGoogle Scholar
  17. 17.
    Persson C, Sjoden P, Glimelius B (1999) The Swedish version of the patient generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers. Clin Nutr 18:71–77CrossRefPubMedGoogle Scholar
  18. 18.
    Jones JM (2002) The methodology of nutritional screening and assessment tools. J Hum Nutr Diet 15:59–71CrossRefPubMedGoogle Scholar
  19. 19.
    Ferguson M, Bauer J, Gallagher B, Capra S, Christie DRH, Mason BR (1999) Validation of a malnutrition screening tool for patients receiving radiotherapy. Australas Radiol 43:325–327CrossRefPubMedGoogle Scholar
  20. 20.
    Raja R, Lim AV, Lim P, Lim G, Chan P, Vu CK (2004) Malnutrition screening in hospitalised patients and its implication on reimbursement. Int Med J 34:176–181CrossRefGoogle Scholar
  21. 21.
    National Health and Medical Research Council (2003) Clinical practice guidelines for the management of overweight and obesity in adults. Commonwealth of Australia. Canberra, AustraliaGoogle Scholar
  22. 22.
    Bannerman E, Miller MD, Daniels LA, Cobiac L, Giles LC, WHitehead C, Andrews GR, Crotty M (2002) Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing. Public Health Nutr 5:655–662CrossRefPubMedGoogle Scholar
  23. 23.
    Agresti A, Coull B (1998) Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 52:119–126CrossRefGoogle Scholar
  24. 24.
    Segura A, Pardo J, Jara C, Zugazabeitia L, Curulla J, de las Penas R, Garcia-Cabrera E, Azuara M, Casado J, Gomez-Candela C (2005) An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advance or metastatic cancer. Clin Nutr 24:801–814CrossRefPubMedGoogle Scholar
  25. 25.
    Ottery FD (1994) Cancer cachexia: prevention, early diagnosis and management. Cancer Pract 2:123–131PubMedGoogle Scholar
  26. 26.
    Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, King C, Elia M (2004) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool’ (MUST) for adults. Br J Nutr 92:799–808CrossRefPubMedGoogle Scholar
  27. 27.
    Rubestein LZ, Harker JO, Salva A, Guigoz Y, Vellas B (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol Ser A Biol Sci Med Sci 56:M366–M372Google Scholar
  28. 28.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Elisabeth Isenring
    • 1
    • 3
    Email author
  • Giordana Cross
    • 1
    • 2
  • Lynne Daniels
    • 1
  • Elizabeth Kellett
    • 2
  • Bogda Koczwara
    • 2
  1. 1.Flinders UniversityAdelaideAustralia
  2. 2.Flinders Medical CentreAdelaideAustralia
  3. 3.NHMRC Training Fellowship App. ID No. 324777, Department of Nutrition and Dietetics, F1 Medical Flats, School of MedicineFlinders UniversityAdelaideAustralia

Personalised recommendations