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Malnutrition screening tools in gastrointestinal cancer: A systematic review of concurrent validity.

Department of Surgery Western Health, The University of Melbourne, Melbourne, Australia; Department of Nutrition and Dietetics, Western Health, Footscray, Australia. Electronic address: irene.deftereos@unimelb.edu.au. Department of Surgery Western Health, The University of Melbourne, Melbourne, Australia; Department of Internal Medicine, Western Health, Footscray, Australia. Department of Nutrition and Dietetics, Western Health, Footscray, Australia. Department of Surgery Western Health, The University of Melbourne, Melbourne, Australia; Department of Colorectal Surgery, Western Health, Footscray, Australia; Western Health Chronic Disease Alliance, Western Health, Footscray, Australia. Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia; Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Australia.

Surgical oncology. 2021;:101627
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Abstract

OBJECTIVE Malnutrition is a significant problem in gastrointestinal (GI) cancer, and accurate screening and identification is essential to ensure appropriate nutrition intervention. This study aims to determine current evidence for concurrent validity of malnutrition screening tools in GI cancer. METHODS A systematic review was undertaken according to PRISMA guidelines, using four databases. Studies investigating the concurrent validity of malnutrition screening tools against a reference standard of Patient Generated Subjective Global Assessment (PG-SGA) or Subjective Global Assessment (SGA) in adult patients with GI cancer were identified. Screening, quality assessment using the QUADAS-2 checklist, and data extraction were performed by two independent reviewers. Concurrent validity ratings were applied using predefined criteria. RESULTS Six studies investigating concurrent validity of the Nutrition Risk Index (NRI), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST) and Nutrition Risk Screening 2002 criteria (NRS-2002) were included. There was variation in concurrent validity ratings ranging from poor-good for all tools, depending on treatment type, stage and population characteristics. CONCLUSION Recommendations regarding the use of one tool over another could not be made. However, in the absence of a clear recommendation specific to GI cancer, screening tools that are well validated in general clinical populations should be utilised. The MST can be recommended based on validity data against the PG-SGA and SGA from other oncology populations. If indicated, malnutrition screening should then be followed by thorough nutritional assessment.