Nutrition risk screening when cancer treatment starts, with a dietitian plan for everyone who screens positive

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.

The 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.

The 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.