Early and Frequent Nutritional Screening Key for Elders with Cancer

The burden of cancer continues to rise and is expected to become a leading barrier to increased life expectancy. With up to 80% of people with cancer experiencing malnutrition, the key message from a new report on a National Institutes of Health (NIH) Pathways to Prevention workshop is simple: screen everyone with cancer for risk of malnutrition.

This is particularly important for older adults because the risk of cancer increases with age—half of cancer diagnoses occur in adults older than age 65. In addition, older adults are at greater risk for malnutrition, too.

Highlights from the NIH Pathways to Prevention Program: Nutrition as Prevention for Improved Cancer Health Outcomes workshop identify an important practice gap: “While malnutrition is common among people with cancer, nutritional screening and interventions are not yet standard parts of outpatient cancer care in the United States. Health care providers and decision-makers need to know more about when and how to prevent or treat cancer-associated malnutrition.”

Screen for Nutritional Risk Early and Often

One easy way to help identify malnutrition is to use a malnutrition screening tool. The NIH workshop report recommends that “Screening for nutritional status, risk, and body composition using validated and standard measurement approaches with defined cutpoints to identify malnutrition should be routinely integrated throughout the care process and across all cancer care settings.”

Everyone should be screened for malnutrition risk after a cancer diagnosis and then during and after cancer treatments.

This means screening everyone for risk of malnutrition after they are diagnosed with cancer and then repeating screening during and after cancer treatments. One often-used tool is the Malnutrition Screening Tool (MST), which is reported as a “valid and reliable tool for identifying malnutrition risk in adult oncology patients in outpatient settings.” The MST is a quick two-question screener related to weight loss and appetite and is endorsed by healthcare professional organizations, including the Academy of Nutrition and Dietetics.

Refer Patients at Malnutrition Risk to a Registered Dietitian Nutritionist

The NIH workshop report also recommended patients identified as at-risk for malnutrition should be referred to a Registered Dietitian Nutritionist (RDN) for a more in-depth nutritional assessment and intervention. A nutritional assessment helps identify nutrition-related problems/causes by considering factors including nutritional intake, nutritional impact symptoms, anthropometric measures, medical tests, and nutrition-focused physical exam results. When nutrition problems are identified, RDNs can provide cancer patients with medical nutrition therapy (MNT), which is defined as treatment based on nutrition and can help patients recover more quickly and spend less time in the hospital. Referral to an RDN is important because, as the NIH workshop report explained, “Neither nutritional screening nor medical nutrition therapy are standard components of outpatient oncology care, where 90% of cancer patients are treated in the United States.”

Include Nutrition in Cancer Care Quality Improvement Programs

The lack of nutritional screening and MNT in ambulatory cancer care is an opportunity for quality improvement; implementing Quality Improvement Programs (QIPs) can promote patient-centered care, improve care processes, and help practitioners meet their quality measure performance goals including in healthcare payment models such as the Oncology Care Model.

To date there are few published nutrition-focused QIPs in cancer care, particularly in ambulatory care. However, in the hospital a secondary analysis of at-risk/malnourished cancer patients in a comprehensive nutrition-focused QIP documented statistically significant reductions in 30-day readmissions and lengths of hospital stay and potential cost savings of $3,800 per patient. A similar nutrition-focused QIP with home health patients (a large percentage of whom had cancer), post hospital/skilled nursing facility discharge, documented significant reductions in 90-day hospitalizations and overall healthcare resources use.

The NIH workshop focused on nutrition as prevention for improved cancer health outcomes. Its recommendations emphasize the importance of better educating healthcare professionals and patients with cancer on the risks of malnutrition, the need for early and frequent nutritional screening, and the importance of nutritional assessment by an RDN and interventions when risk for or malnutrition is identified.

Nutrition and Cancer Resources

  • Optimal nutrition care to improve outcomes for oncology patients continuing education program
  • Optimal multidisciplinary approaches in the nutrition care of oncology patients continuing education program
  • PRONTO (Protocol for Nutritional Risk in Oncology): a standardized approach for healthcare professionals treating patients with cancer healthcare professional video
  • Good nutrition can have a positive effect on your cancer journey patient infographic

Mary Beth Arensberg, PhD, RDN, LDN, FAND is the director of health policy and programs for the Abbott Nutrition division of Abbott.

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