Chapter 27: Living with and beyond cancer
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Evidence‐based approaches
Screening of nutritional status is a method for identifying those at nutritional risk. It is generally aimed at identifying those who are at risk of under‐nutrition. It is a requirement for all patients on admission to hospital and at their first outpatient appointment (NICE [196]). Information obtained from nutritional screening then allows a suitable nutritional assessment to be undertaken on those who are at medium or high risk with the aim of providing the appropriate advice and support to improve or maintain nutritional status. Nutritional assessment is usually undertaken by a healthcare professional who has the relevant expertise, such as a registered dietitian or nutrition nurse.
Nutrition screening usually involves the use of a nutrition screening tool, which focuses on aspects such as weight loss and comparison with normal body weight, for example the Malnutrition Universal Screening Tool (MUST) (British Association of Parenteral and Enteral Nutrition [BAPEN] [30]). Some screening tools are cancer specific such as the Royal Marsden Nutrition Screening Tool (Shaw et al. [256]) and these may include questions on symptoms that affect dietary intake. Screening for over‐nutrition can be undertaken using calculation of body mass index (BMI) from measurements of height and weight and the measurement of waist circumference (NHS Choices [193]). Waist circumference can indicate central (abdominal) adiposity, a risk factor for metabolic syndrome and associated conditions including type 2 diabetes.
Indications
Use of the holistic needs assessment gives people an opportunity to identify if they have any particular needs with respect to eating or drinking. If specific questions or issues are raised with respect to eating and drinking it may be appropriate to address these without the need for nutrition screening. For example, the person may have specific questions about foods or the optimal balance of their diet. However, if it is uncertain what support is required then screening tools can be used to identify risk of under‐ or over‐nutrition. In addition, it may be helpful to screen for bowel symptoms arising as a consequence of cancer treatment.
