{"entity":{"id":"idea-upgrade-nutrition-risk-screening-at-treatment-start","kind":"idea","name":"Nutrition risk screening when cancer treatment starts, with a dietitian plan for everyone who screens positive","aka":[],"tldr":"Weight loss and poor eating during cancer treatment are common and often missed. A European guideline strongly recommends checking intake and weight from diagnosis, and in a randomised trial of hospital patients with cancer at nutritional risk, tailored nutrition support lowered 30-day deaths from 19.9 to 14.1 per cent. Of 100 Italian centres surveyed, 31 assessed every patient.","summary":"The guideline. The ESPEN practical guideline on clinical nutrition in cancer opens with the recommendation \"to regularly evaluate nutritional intake, weight change, and body mass index (BMI), beginning with cancer diagnosis and repeated depending on the stability of the clinical situation\", graded as a strong recommendation.\n\nThe trial. In a preplanned secondary analysis of the Swiss multicentre EFFORT trial, 506 inpatients whose main admission diagnosis was cancer and who were at nutritional risk on the NRS 2002 screen were randomised to protocol-guided individual nutritional support or standard hospital food. Thirty-day mortality was 14.1 per cent against 19.9 per cent (adjusted odds ratio 0.57, 95 per cent confidence interval 0.35 to 0.94), and function and quality of life also improved; each additional point of nutritional risk predicted higher mortality over 180 days. This is one trial, in hospital inpatients, analysed as a subgroup, which is why the grade is moderate; outpatient evidence for screening itself is weaker.\n\nThe measured gap. Of 165 Italian oncology centres surveyed by CIPOMO, 100 responded: 67 routinely assessed nutrition at diagnosis but only 31 did so for every patient, 69 per cent used a validated screening tool, and systematic reassessment during treatment was reported by 15 per cent.","asOf":"2026-10-20","links":[{"label":"Muscaritoli et al., ESPEN practical guideline: Clinical Nutrition in cancer (Clin Nutr 2021)","url":"https://doi.org/10.1016/j.clnu.2021.02.005"},{"label":"Bargetzi et al., Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of the EFFORT randomized trial (Ann Oncol 2021)","url":"https://doi.org/10.1016/j.annonc.2021.05.793"},{"label":"Grosso et al., Evaluating the Gaps in Nutritional Care for Cancer Patients: the CIPOMO national survey (Nutrients 2026)","url":"https://doi.org/10.3390/nu18162593"}],"tags":["protocol-upgrade","upgrade:proven-unevenly-used","evidence:moderate"],"related":["idea-nl-dietitian-in-every-mdt","idea-pdac-enzyme-replacement-prescribing-by-default"],"cancers":[],"sections":["supportive-care","nutrition-lifestyle"],"technologies":["nutrition-screening-mnt","oncology-nutrition"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["malnutrition-screening","cachexia"],"trials":[],"people":[],"bottlenecks":["b-cachexia-supportive"],"keyPapers":["paper-muscaritoli-clin-nutr","paper-schuetz-lancet"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A validated nutrition screen recorded at the first treatment visit and repeated at each cycle, with automatic dietitian referral for a positive screen, reduces unplanned weight loss, treatment interruptions and unplanned admissions in the screened population.","rationale":"Malnutrition develops in the gap between appointments and is easiest to treat early. Screening costs a set of scales and two minutes; the evidence gap is in outpatients, which is exactly where most treatment now happens.","test":"A cluster-randomised trial in outpatient chemotherapy units of routine screening with automatic dietitian referral against current practice, with unplanned weight loss of 5 per cent or more and completion of planned treatment as co-primary endpoints.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-upgrade-nutrition-risk-screening-at-treatment-start/","neighbours":{"idea":[{"id":"idea-nl-dietitian-in-every-mdt","kind":"idea","name":"A dietitian in every gastrointestinal and head and neck tumour board","route":"/ideas/idea-nl-dietitian-in-every-mdt/"},{"id":"idea-pdac-enzyme-replacement-prescribing-by-default","kind":"idea","name":"Pancreatic enzyme replacement by default: prescribe at diagnosis, audit the rate, and run the trial that settles survival","route":"/ideas/idea-pdac-enzyme-replacement-prescribing-by-default/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"},{"id":"nutrition-screening-mnt","kind":"technology","name":"Oncology nutrition assessment and medical nutrition therapy","route":"/technologies/nutrition-screening-mnt/"}],"term":[{"id":"cachexia","kind":"term","name":"Cancer cachexia","route":"/terms/cachexia/"},{"id":"malnutrition-screening","kind":"term","name":"Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)","route":"/terms/malnutrition-screening/"}],"bottleneck":[{"id":"b-cachexia-supportive","kind":"bottleneck","name":"Cachexia, toxicity and the limits of the patient","route":"/bottlenecks/b-cachexia-supportive/"}],"paper":[{"id":"paper-muscaritoli-clin-nutr","kind":"paper","name":"ESPEN practical guideline: Clinical Nutrition in cancer","route":"/key-papers/paper-muscaritoli-clin-nutr/"},{"id":"paper-schuetz-lancet","kind":"paper","name":"Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial","route":"/key-papers/paper-schuetz-lancet/"}]}}