Supportive Care in Cancer

, Volume 18, Supplement 2, pp 17–27 | Cite as

Nutritional screening tools in daily clinical practice: the focus on cancer

  • Michèle Leuenberger
  • Silvia Kurmann
  • Zeno StangaEmail author
Special Article



Malnutrition is a common and under-recognized problem in cancer patients. It has been correlated to a large number of physical, psychological, and clinically relevant adverse effects in oncology patients, including impaired tolerance to anticancer therapy, adverse reactions, and reduced quality of life. Consequently, tailored strategies to identify patients at nutritional risk are essential to implement nutritional support effectively and to reduce cancer morbidity.

Purpose of a nutritional screening tool

A screening tool should be an easy, standardized, rapid, noninvasive, and cost-effective diagnostic tool to identify cancer patients at nutritional risk in daily clinical practice. If patients at risk for malnutrition are identified early, many cases may be treated or prevented, with beneficial effects on patient outcome and subsequent reductions of health care costs.

Screening tools

This article discusses the Malnutrition Universal Screening Tool, the Nutritional Risk Screening, the Mini Nutritional Assessment—Short Form®, the scored Patient-Generated Subjective Global Assessment (PG-SGA), and the Malnutrition Screening Tool (MST) in an oncology setting.


Clinical institutions should implement an appropriate and validated screening tool and assessment protocol, which should contain an action plan. To date, the MST and the PG-SGA are the best validated screening tools for use in oncology patients. The PG-SGA is an assessment tool with screening components, whereas the MST is a pure screening tool and, therefore, quick and easy to use for trained as well as untrained staff. Further validation of all nutrition screening tools is needed, as well as further research to evaluate the benefits of nutrition screening and support with regard to outcomes.


Nutritional screening tools Daily clinical practice Cancer Oncology patients Malnutrition 


Conflict of interest

None to declare.


  1. 1.
    Fearon K, Barber M, Moses AG (2001) The cancer cachexia syndrome. Surg Oncol Clin N Am 10:109–126PubMedGoogle Scholar
  2. 2.
    Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, Bolder U, Frieling T, Guldenzoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zurcher G, Bauer P, Lochs H (2006) The German hospital malnutrition study. Clin Nutr 25:563–572CrossRefPubMedGoogle Scholar
  3. 3.
    Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M, EuroOOPS Study Group (2008) EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 27:340–349CrossRefPubMedGoogle Scholar
  4. 4.
    Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L (2008) An evaluation of three nutritional screening tools in a Portuguese oncology centre. J Hum Nutr Diet 21:575–583CrossRefPubMedGoogle Scholar
  5. 5.
    Ravasco P, Monteiro-Grillo I, Marques Vidal PM, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668CrossRefPubMedGoogle Scholar
  6. 6.
    Iff S, Leuenberger M, Sterchi A, Stanga Z (2008) Nutritional management study: screening part. Clin Nutr 3(suppl1):154, AbstractGoogle Scholar
  7. 7.
    Marin Caro MM, Gomez Candela C, Castillo Rabaneda R, Lourenço Nogueira T, Garcia Huerta M, Loria Kohen V, Villarino Sanz M, Zamora Auñon P, Luengo Perez L, Robledo Saenz P, Lopez-Portabella C, Zarazaga Monzon A, Espinosa Rojas J, Nogues Boqueras R, Rodriguez Suarez L, Celaya Perez S, Pardo Masferrer J (2008) Nutritional risk evaluation and establishment of nutritional support in oncology patients according to the protocol of the Spanish Nutrition and Cancer Group. Nutr Hosp 23:458–468PubMedGoogle Scholar
  8. 8.
    Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K (2002) Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol 28:396–400CrossRefPubMedGoogle Scholar
  9. 9.
    Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF (2005) Prognostic significance of subjective global assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 59:35–40CrossRefPubMedGoogle Scholar
  10. 10.
    Gupta D, Lis CG, Granick J, Grutsch JF, Vashi PG, Lammersfeld CA (2006) Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol 59:704–709CrossRefPubMedGoogle Scholar
  11. 11.
    Ottery FD (1994) Cancer cachexia: prevention early diagnosis und management. Cancer Pract 2:123PubMedGoogle Scholar
  12. 12.
    McWhirter JP, Pennington CR (1994) Incidence and recognition of malnutrition in hospital. BMJ 308:945–948PubMedGoogle Scholar
  13. 13.
    Gallagher-Allred CR, Voss AC, Finn SC, McCamish MA (1996) Malnutrition and clinical outcome: the case for medical nutrition therapy. J Am Diet Assoc 96:361–366CrossRefPubMedGoogle Scholar
  14. 14.
    Correia MI, Waitzberg 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
  15. 15.
    Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497CrossRefPubMedGoogle Scholar
  16. 16.
    Huhmann MB, Cunningham RS (2005) Importance of nutritional screening in treatment of cancer-related weight loss. Lancet Oncol 6:334–343CrossRefPubMedGoogle Scholar
  17. 17.
    Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y (2006) Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol 29:183–188CrossRefPubMedGoogle Scholar
  18. 18.
    ASPEN Board Directors and the Clinical Guidelines Task Force (2002) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 26:1SA–138SACrossRefGoogle Scholar
  19. 19.
    Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22:415–421CrossRefPubMedGoogle Scholar
  20. 20.
    Elia M, Zellipour L, Stratton RJ (2005) To screen or not to screen for adult malnutrition? Clin Nutr 24:867–884CrossRefPubMedGoogle Scholar
  21. 21.
    Green SM, Watson R (2005) Nutritional screening and assessment tools for use by nurses: literature review. J Adv Nurs 50:69–83CrossRefPubMedGoogle Scholar
  22. 22.
    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(6):458–464CrossRefPubMedGoogle Scholar
  23. 23.
    Powell-Tuck J, Hennessy EM (2003) A comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients. Clin Nutr 22:307–312CrossRefPubMedGoogle Scholar
  24. 24.
    Kyle UG, Genton L, Pichard C (2005) Hospital length of stay and nutritional status. Curr Opin Clin Nutr Metab Care 8:397–402CrossRefPubMedGoogle Scholar
  25. 25.
    Ravasco P, Monteiro-Grillo I, Marques Vidal PM, Camilo ME (2004) Cancer: disease and nutrition are key determinants of patients' quality of life. Support Care Cancer 12:246–252CrossRefPubMedGoogle Scholar
  26. 26.
    Malnutrition Advisory Group (MAG) (2000) MAG—guidelines for detection and management of malnutrition. British Association for Parenteral and Enteral Nutrition, RedditchGoogle Scholar
  27. 27.
    Stratton RJ, Hackston A, Longmore D, Dixon R, Proce 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
  28. 28.
    Elia M (2003) The MUST report: nutritional screening of adults: a multidisciplinary responsibility. BAPEN (MAG), MaidenheadGoogle Scholar
  29. 29.
    Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M (2006) ‘Malnutrition Universal Screening Tool’ predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 95:325–330CrossRefPubMedGoogle Scholar
  30. 30.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z (2003) Nutritional risk screening (NRS-2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336CrossRefPubMedGoogle Scholar
  31. 31.
    Wenger C, Hischier T, Rhyner A, Iff S, Sterchi AB, Stanga Z (2008) Ernährungsmanagement: Einführung in zwei universitären Fachkliniken. Aktuel Ernaehr Med 33:296–301CrossRefGoogle Scholar
  32. 32.
    Kondrup J, Johansen N, Plum LM, Bak L, Larsen IH, Martinsen A, Andersen HR, Bærnthsen H, Bunch E, Lauesen N (2002) Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 21:461–468CrossRefPubMedGoogle Scholar
  33. 33.
    Johansen N, Kondrup J, Plum LM, Bak L, Nørregaard P, Bunch E, Bærnthsen H, Andersen JR, Højlund Larsen I, Martinsen A (2004) Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr 23:539–550CrossRefPubMedGoogle Scholar
  34. 34.
    Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: the mini nutritional assessment as part of the geriatric evaluation. Nutr Rev 54:59–65CrossRefGoogle Scholar
  35. 35.
    Vellas B, Guigoz Y, Baumgartner M, Garry PJ, Lauque S, Albarede JL (2000) Relationships between nutritional markers and the mini-nutritional assessment in 155 older persons. J Am Geriatr Soc 48:1300–1309PubMedGoogle Scholar
  36. 36.
    Mini Nutritional Assessment. Forms available at
  37. 37.
    De Groot CP, van Staveren WA (2002) Survey in Europe on nutrition and the elderly, a concerted action. Undernutrition in the European SENECA studies. Clin Geriatr Med 18:699–708CrossRefPubMedGoogle Scholar
  38. 38.
    Vells B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL (1999) The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15:116–122CrossRefGoogle Scholar
  39. 39.
    Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 56:M366–M372PubMedGoogle Scholar
  40. 40.
    Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC (2005) Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and the Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr 38:322–327CrossRefPubMedGoogle Scholar
  41. 41.
    Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, Garry P (2006) Overview of the MNA—its history and challenges. J Nutr Health Aging 10:456–463PubMedGoogle Scholar
  42. 42.
    Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:9–13Google Scholar
  43. 43.
    Barbos-Silva MC, de Barros AJ (2002) Subjective global assessment: part 2. Review of its adaptations and utilization in different clinical specialties. Arq Gastroenterol 39:248–252Google Scholar
  44. 44.
    Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:S15–S19PubMedGoogle Scholar
  45. 45.
    Persson C, Sjoden PO, 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
  46. 46.
    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
  47. 47.
    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
  48. 48.
    Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo M (2003) Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol) 15:443–450Google Scholar
  49. 49.
    Read JA, Crockett N, Volker DH, Mac Lennan P, Choy ST, Beale P, Clarke SJ (2005) Nutrition assessment in cancer: comparing the mini-nutrition assessment (MNA) with the scored patient-generated subjective global assessment (PGSGA). Nutr Cancer 53:51–56CrossRefPubMedGoogle Scholar
  50. 50.
    Kubrak C, Jensen L (2007) Critical evaluation of nutrition screening tools recommended for oncology patients. Cancer Nurs 30:E1–E6CrossRefPubMedGoogle Scholar
  51. 51.
    Sungurtekin H, Sungurtekin U, Hanci V, Erdem E (2004) Comparison of two nutrition assessment techniques in hospitalized patients. Nutrition 20:428–432CrossRefPubMedGoogle Scholar
  52. 52.
    Christensson L, Unosson M, Ek AC (2002) Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care. Eur J Clin Nutr 56:810–818CrossRefPubMedGoogle Scholar
  53. 53.
    Kyle UG, Kossovsky MP, Karsegard VL, Pichard C (2006) Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr 25:409–417CrossRefPubMedGoogle Scholar
  54. 54.
    Detsky AS, Smalley PS, Chang J (1994) The rational clinical examination. Is this patient malnourished? JAMA 271:54–58CrossRefPubMedGoogle Scholar
  55. 55.
    Jeejeebhoy KN (1990) Assessment of nutritional status. Saunders, PhiladelphiaGoogle Scholar
  56. 56.
    Slaviero KA, Read JA, Clarke SJ, Rivory LP (2003) Baseline nutritional assessment in advanced cancer patients receiving palliative chemotherapy. Nutr Cancer 46:148–157CrossRefPubMedGoogle Scholar
  57. 57.
    Thoresen L, Fjeldstad I, Krogstad K, Kaasa S, Falkmer UG (2002) Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool. Palliat Med 16:33–42CrossRefPubMedGoogle Scholar
  58. 58.
    Laky B, Janda M, Cleghorn G, Obermair A (2008) Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr 87:1678–1685PubMedGoogle Scholar
  59. 59.
    Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P (2006) ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 25:224–244CrossRefPubMedGoogle Scholar
  60. 60.
    Ferguson ML, Bauer J, Gallagher B, Capra S, Christie DR, Mason BR (1999) Validation of a malnutrition screening tool for patients receiving radiotherapy. Australas Radiol 43(3):325–327CrossRefPubMedGoogle Scholar
  61. 61.
    Bauer J, Capra S (2003) Comparison of a malnutrition screening tool with subjective global assessment in hospitalised patients with cancer—sensitivity and specificity. Asia Pac J Clin Nutr 12(3):257–260PubMedGoogle Scholar
  62. 62.
    Roulston F, McDermott R (2009) Comparison of three validated nutritional screening tools in the oncology setting. Proc Nutr Soc 67:E260CrossRefGoogle Scholar
  63. 63.
    Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z (2010) Nutritional risk screening predicts complications on colorectal cancer surgery? Br J Surg 97:92–97Google Scholar
  64. 64.
    Bozzetti F (2009) Screening the nutritional status in oncology: a preliminary report on 1000 outpatients. Support Care Cancer 17:279–284CrossRefPubMedGoogle Scholar
  65. 65.
    Gupta D, Lammersfeld CA, Vashi PG, Dahlk SL, Lis CG (2008) Can subjective global assessment of nutritional status predict survival in ovarian cancer? J Ovarian Res 1(1):5CrossRefPubMedGoogle Scholar
  66. 66.
    Schiesser M, Müller S, Kirchhoff P, Breitenstein S, Schäfer M, Clavien P-A (2008) Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr 27:565–570CrossRefPubMedGoogle Scholar
  67. 67.
    Toliusiene J, Lesauskaite V (2004) The nutritional status of older men with advanced prostate cancer and factors affecting it. Support Care Cancer 12:716–719CrossRefPubMedGoogle Scholar
  68. 68.
    Von Mayenfeldt M (2005) Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs 9:S33–S34CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Michèle Leuenberger
    • 1
  • Silvia Kurmann
    • 1
  • Zeno Stanga
    • 1
    • 2
    Email author
  1. 1.Division of Endocrinology, Diabetes and Clinical Nutrition, Department of General Internal MedicineBern University HospitalBernSwitzerland
  2. 2.Department of General Internal MedicineUniversity of Bern and Bern University HospitalBernSwitzerland

Personalised recommendations