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Post‐procedural considerations

After taking a measurement of height it is useful to check with the patient that the figure obtained is approximately the height that is expected. However, it is important to consider that patients may report a loss in height with increasing years. Cumulative height loss from age 30 to 70 years may be about 3 cm for men and 5 cm for women; by age 80 years it increases to 5 cm for men and 8 cm for women (Sorkin et al. [260]).

Consideration must be given to the patient's weight and whether this reflects a change in their clinical condition. The weight may be being used as part of a nutritional screening or assessment of BMI.

After taking a measurement of weight it is useful to check with the patient that the figure obtained is what they would expect or whether there have been significant changes over time.

A person identified at risk of malnutrition should be referred to a registered dietitian and undergo a full nutritional assessment. Subjective global assessment (SGA) and patient generated subjective global assessment (PG‐SGA) are comprehensive assessment tools that need more time and expertise to carry out than most screening tests. The most important feature of using any screening tool is that patients identified as requiring nutritional assessment or intervention have a nutritional care plan initiated. People can be signposted to reliable, evidence‐based published and online resources to support them in making dietary changes to improve their nutritional intake (Shaw [255]).

If the person is assessed as being overweight or obese then this can be discussed with the patient with respect to appropriate lifestyle changes. Advice and ongoing support may be needed for the patient to successfully lose weight and increase physical activity. Ideally body weight should be in the optimal range. This range varies depending on age and ethnicity so individuals may need specific advice regarding their own target (NHS Choices [193]).

Assessment and recording tools

Nutrition screening

The Royal Marsden Nutrition Screening Tool (RMNST) (Table 27.8)

Table 27.8 The Royal Marsden Nutrition Screening Tool (RMNST)

Question	If the answer to the question is yes then score
1 Has the patient experienced unintentional weight loss in the last 3 months? (> 7 kg in men or > 5.5 kg in women) If not, unintentional weight loss less than the above	10 5
2 Does the patient look underweight?	5
3 Has the patient had a reduced food intake (less than 50% of meals) in the last 5 days (this may be due to mucositis, dysphagia, nausea, bowel obstruction, vomiting)?	5
4 Is the patient experiencing symptoms that are affecting food intake, e.g. mucositis, nausea, vomiting, diarrhoea, constipation?	3
Total score	Maximum 23

Score	Action
0–4	Low risk of malnutrition. Reassure.
5–9	Moderate risk of malnutrition. Explore difficulties and provide appropriate support and resources.
Over 10	High risk of malnutrition. Refer to a registered dietitian for full assessment and care plan.

Calculation of body mass index

Body mass index (BMI) or comparison of a patient's weight with a chart of ideal bodyweight gives a measure of whether the patient has a normal weight, is overweight or underweight, and may be calculated from weight and height using the following equation:

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Tables and online programs are available to allow the rapid and easy calculation of BMI (NHS Choices [193]). Calculation of BMI allows comparison with desirable ranges of BMI, indicating whether people are under‐ or overweight. These comparisons, however, are not a good indicator of whether the patient is at risk nutritionally, as an apparently normal weight can mask severe muscle wasting, for example in sarcopenia and cachexia. Changes in food intake and disease state also influence nutritional risk.

Measurement of waist circumference

The waist circumference measurement for men and women at which there is an increased relative risk for heart disease, type 2 diabetes and cancer is defined in Table 27.9.

Table 27.9 Waist circumference measurement for men and women at which there is an increased relative risk for heart disease, type 2 diabetes and cancer

	Increased risk	Substantially increased risk
Men	≥94 cm	≥102 cm
Women	≥80 cm	≥88 cm

In some populations (e.g. in persons of Asian descent), waist circumference may be a better indicator of risk than BMI. In very obese patients (those with a BMI > 35 kg/m²), waist circumference has added little to the predictive power of disease risk (National Obesity Forum [188]).

Assessment of bowel habits following treatment for cancer

Some key questions about bowel function can be used to assess whether a person requires a referral to a gastroenterologist for further investigation and management. The questions in Box 27.6 have been devised to identify people with persistent gastrointestinal symptoms following pelvic radiotherapy who would benefit from specialist assessment and advice from a gastroenterologist (Pelvic Radiation Disease Association [223]).

Box 27.6

Questions to identify people with persistent gastrointestinal symptoms following pelvic radiotherapy

Following pelvic radiotherapy does your patient: