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Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREE II instrument



To evaluate the quality of published clinical practice guidelines (CPGs) regarding the nutritional risk screening and assessment of cancer patients and to identify high-quality CPGs for clinical healthcare professionals.


Guidelines for the nutritional risk screening and assessment of cancer patients were comprehensively searched in eight electronic databases, including The Lancet, PubMed, Cochrane Library, Excerpta Medica dataBASE (EMBASE), Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), and Wan Fang Data, through August 2020. Six relevant guideline databases, including the National Comprehensive Cancer Network (NCCN), the National Guideline Clearinghouse (NGC), the Guideline International Network (GIN), the New Zealand Guidelines Group (NZGG), the China Guideline Clearinghouse (CGC), and Medlive, and relevant nutrition society websites, were also searched through August 2020. The methodological quality of the included CPGs was appraised independently by three assessors using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II) tool.


Seven CPGs were located, and the domain with the highest percentage was “clarity of presentation” (85.44%), while the domain with the lowest percentage was “applicability” (40.26%). From the AGREE II results, two guidelines were rated as “strongly recommended,” three were assessed as “recommended with modifications,” and two were deemed as “not recommended.”


Considering that the two “strongly recommended” guidelines were developed within the American and European contexts, translation, validation, and cultural adaptation are recommended prior to implementing these guidelines in other countries or healthcare contexts to improve their effectiveness and sensitivity for local cancer patients.

Trial registration

PROSPERO registration of the study protocol: CRD42020177390 (July 5, 2020)

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HJZ and LJD contributed equally to this work. HJZ and LJD led the study conception and design. HJZ, MHW, and JWH contributed to the data collection, review of the guidelines, and interpretation of the data. TW and SZJ examined the data. HJZ and LJD drafted and revised the manuscript. JYT and TW contributed to the study conception and design, and supported the data analysis and manuscript revision. JXC, LY, and FL supported the guideline review andrevised the manuscript.

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Correspondence to Jing-Yu Tan.

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Zhou, HJ., Deng, LJ., Wang, T. et al. Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREE II instrument. Support Care Cancer 29, 2885–2893 (2021).

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  • Cancer
  • Nutritional risk screening
  • Nutritional assessment
  • Guidelines