The incidence of the risk of malnutrition in adult medical oncology outpatients and commonly‐associated symptoms
Authors: Renshaw G.L. , Barrett R.A. , Chowdhury S. 
Published: July 2008

Background:  Weight loss as a result of cancer and treatment is commonly associated with a poor prognosis (Nitenberg & Raynard, 2000). This weight change can also impact on tolerance to chemotherapy with greater risk of toxicities (Tian et al., 2007) and many chemotherapy side effects have significant nutritional implications. However, there is a paucity of research on the incidence of malnutrition in outpatients with cancer. This study aimed to assess the risk of malnutrition, and ascertain the prevalence of symptoms that could potentially impact on nutritional status in the oncology outpatient setting.

Methods:  Patients attending medical oncology outpatients at any stage of the treatment pathway were recruited at a London NHS Trust. All adult patients (228) who were receiving chemotherapy, hormonal therapy or symptom control were invited to participate. Patients receiving radiotherapy were excluded due to the different side effect profile. Nutrition risk was determined using the Trust Validated Nutrition Screening Tool (NST), which incorporated questions on unintentional weight loss and appetite reduction in the previous 3–6 months, height, usual and current weight and body mass index (BMI). All participants were asked to complete a short questionnaire to ascertain information on current symptoms. Ethical approval was not required as this work was deemed part of service evaluation.

Results:  Two hundred and seven patients participated; the mean age was 58 years (115 male, 92 female). Using the NST score the incidences of risk of malnutrition for the cancer types were upper gastrointestinal 83% (24/29), lung/mesothelioma 76% (31/41), gynaecological 73% (20/27), breast 60% (27/45), colorectal 50% (17/34) and urological 45% (15/31). The mean (SD) body mass index was 5.7 kg m−2; 15.0–65.4 kg m−2. The mean (SD) weight loss in the previous 3–6 months for all tumour types was 12.9%, with a wide range of a weight loss of 49.4% to a weight gain of 44%. The prevalence of symptoms that may potentially have impacted on nutritional status are shown in Table 1.

 Percentage of patients reporting symptoms with the potential to impact on nutritional status

Incidence (%)
Symptoms with the potential to impact on nutritional status

80–100
Fatigue, Anxiety

60–79
Early satiety, reduced appetite, pain, shortness of breath

40–59
Dry mouth, taste changes, constipation, weight loss, diarrhoea, nausea, increased appetite

<40
Sore mouth, weight gain, vomiting, heartburn, dysphagia

Discussion:  This study demonstrated that routine nutritional screening, as recommended by NICE (2006), is vital in medical oncology outpatients. It highlighted the need for dedicated dietetic time in the oncology outpatient setting to provide nutritional assessment and dietetic intervention as appropriate. This is additionally pertinent in light of the highlighted incidence of symptoms, many of which can further impact on nutritional status, which if left to further decline, is likely to impact of treatment tolerance and outcome.

Conclusion:  Medical oncology outpatients are at risk of malnutrition and dietetic involvement is essential to prevent the development of further nutrition related problems during treatment. A further study is planned using this study design in clinical oncology outpatients in order to ascertain the similarities and differences in malnutrition risk and symptom prevalence in those patients undergoing radiotherapy.

References  National Institute of Clinical Excellence (NICE). (2006) Nutrition support in adults. Clinical guideline 32. National Institute of Clinical Excellence.

Nitenberg, G. & Raynard, B. (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit. Rev. Oncol. Hematol. 34, 137–168.

Tian, J., Chen, Z., & Hang, L. (2007)Effects of nutritional and psychological status in gastrointestinal cancer patients on tolerance of treatment. World J. Gastroenterol. 13, 4136–4140.