Nutrition 33 (2017) 297–303

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Nutrition
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Applied nutritional investigation

NUTRISCORE: A new nutritional screening tool for oncological

outpatients
Lorena Arribas M.Sc., R.D. a, *, Laura Hurto s M.Sc., R.D. a, Maria Jose
 Sendro
 s R.D. b,
 M.D. a, Neus Salleras R.D. c, Eduard Fort Pharm.D. a,
Inmaculada Peiro
nchez-Migallo
Jose Manuel Sa  n M.Sc., R.D. b
a  d’Oncologia (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
Clinical Nutrition Unit, Institut Catala
b
Clinical Nutrition and Dietetics Department, Institut Catala  d’Oncologia (ICO), Barcelona, Spain
c
Nutrition and Dietetics Department, Institut Catala  d’Oncologia (ICO), Girona, Spain

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: The aim of this study was to design a new nutritional screening tool (NUTRISCORE) to
Received 14 March 2016 detect nutritional risk in outpatients with cancer.
Accepted 22 July 2016 Methods: A multicenter, cross-sectional study was conducted. We randomly selected outpatients
receiving onco-specific, palliative, or symptomatic treatment for malignant neoplasms (including
Keywords: solid tumors and hematologic malignancies). These patients were assessed using the NUTRISCORE
Nutritional screening tool
tool, the Malnutrition Screening Tool (MST), and the Patient-Generated Subjective Global Assess-
Cancer
ment (PG-SGA) to detect risk for malnutrition. The new tool included questions regarding the
Sensitivity
Specificity cancer site and active treatment. Sensitivity, specificity, and positive and negative predictive values
Outpatients were calculated for NUTRISCORE and MST using the PG-SGA as a reference method.
Results: We evaluated 394 patients. According to NUTRISCORE, 22.6% were at risk for malnutrition.
The MST detected a risk in 28.2%, and the PG-SGA found that 19% were malnourished or at
nutritional risk. Using the PG-SGA as a reference method, the MST had a sensitivity of 84% and a
specificity of 85.6%, whereas NUTRISCORE exceeded these values, at 97.3% sensitivity and 95.9%
specificity. The better performance of NUTRISCORE as compared with MST was confirmed by the
receiver operating characteristic curve analysis, with area under the curve values of 0.95 (95%
confidence interval, 0.92–0.98) for NUTRISCORE and 0.84 (95% confidence interval, 0.79–0.89) for
the MST.
Conclusions: NUTRISCORE has been found to be a novel, fast, and valid nutritional screening tool for
outpatients with cancer. Its simplicity and high level of accuracy in detecting nutritional risk
facilitates its applicability.
Ó 2016 Elsevier Inc. All rights reserved.

Introduction of malnutrition has not been studied extensively, but some

Malnutrition is a problem that greatly affects patients with
cancer throughout the course of their illness, and it may be
present from the moment of diagnosis until the end of treat-
ment. It is estimated that
84% of patients have lost weight by
the time they are diagnosed, with just over half having lost >5%
of their body weight [1]. The prevalence of malnutrition varies
between oncology inpatients (44.1%) and outpatients (27.7%) [1].
Among patients with hematologic malignancies, the prevalence
* Corresponding author. Tel.: þ34 93 260 7751; fax: þ34 93 260 7144.
E-mail address: Larribas@iconcologia.net (L. Arribas).
studies report a 27% risk in patients who undergo hematopoietic
stem cell transplantation [2]. Numerous studies have demon-
strated the negative effect that malnutrition has on oncology
patients, reducing the tolerance and efficacy of their treatment
[3], increasing the risk for clinical and surgical complications [4],
and lengthening hospital stay with a concomitant increase in
health care costs [5,6]. Despite its importance, malnutrition
remains an unsolved and poor visibility problem for the pro-
fessionals in charge of caring for these patients.
Many cancer patients lose weight as a direct result of their
treatment, the side effects of which may include anorexia,
mucositis, nausea and/or vomiting, xerostomy, dysgeusia, and

http://dx.doi.org/10.1016/j.nut.2016.07.015
0899-9007/Ó 2016 Elsevier Inc. All rights reserved.
298 L. Arribas et al. / Nutrition 33 (2017) 297–303
diarrhea, all of which contribute to the deterioration of patients’
nutritional status [7]. Cancer cachexia is characterized by weight
loss associated with decreased caloric intake and metabolic
changes. This concept has been defined by expert consensus as a
multifactorial syndrome characterized by steady loss of skeletal
muscle mass (with or without loss of adipose tissue), which
cannot be completely reversed through conventional nutritional
support and which leads to a gradual functional deterioration
[8]. Early detection of malnutrition in the precachectic phase
could avert the progression of this syndrome to more advanced
stages.
The first step in the early detection of malnutrition is the
implementation of a screening tool to identify patients at
nutritional risk. A variety of instruments exist, such as Nutri-
tional Risk Screening [9], Malnutrition Universal Screening Tool
[10], Malnutrition Screening Tool (MST) [11,12], Short Nutritional
Assessment Questionnaire [13], and the Subjective Global
Assessment (SGA) [14]. Although most of the tools have been
designed for the general population, some have been validated
for oncology patients in both inpatient and outpatient settings
[15–17].
The Oncology Nutrition Dietetic Practice Group of the Amer-
ican Dietetic Association has adopted the Scored Patient-
Generated Subjective Global Assessment (PG-SGA) as a specific
nutritional assessment and screening tool for oncology patients
[18]; however, its use as a screening tool is limited by the need
for specially trained staff and the length of time needed to carry
out the assessment, estimated as w15 min [19].
To achieve efficiency gains among nutrition professionals
without unduly increasing workload, screening tools must be
accurate, fast, and simple [20]. The objective of nutritional
screening is to identify patients at high nutritional risk so that a
more thorough evaluation can be carried out specifically on
those most at risk. Although there are some tools in the litera-
ture, none is specifically designed to detect nutritional risk
among cancer outpatients. The rising number of oncology
outpatient treatments has created the need for a new tool that is
especially designed for the ambulatory setting. This new tool
needs to be fast and simple and should only detect those patients
at risk for malnutrition to minimize false positives to avoid
overwork and maximize the professional resources available.
The aim of the present study was to design a new nutritional
screening tool for oncology outpatients to detect nutritional risk.
Methods
Study design
This was a multicenter, cross-sectional study designed to validate the
NUTRISCORE tool (Fig. 1). Assessment of nutritional risk among outpatients was
performed at the Catalan Institute of Oncology, a public center working exclu-
sively in the field of cancer. To date, three centers in Catalonia (L’Hospitalet de
Llobregat–Barcelona, Girona, and Badalona) work in combination with three
public general university hospitals.
Participants
Adult outpatients (age 18 y) diagnosed with malignant neoplasm, including
solid tumors and hematologic malignancies, who visited the center for oncology
evaluation, treatment, or palliative and symptomatic care were eligible for the
study. Patients were excluded if they were unable to understand and speak
Spanish, had a definitive diagnosis of dementia, or lacked capacity to understand
the purpose of the study.
Due to the characteristics of the center, all patients included were in
onco-specific treatment, evaluation, follow-up after treatment, or palliative
care. Study participants presented different stages of cancer, from early
diagnosis to more advanced stages. Surgery may be present throughout the
treatment.
Recruitment to the study was designed to obtain a representative sample in
terms of tumor location and treatment groups within each hospital. Random
patient lists based on all diagnoses and treatments were generated by the
Research Data Management and Statistics Unit the day before study recruitment.
Patients from each list were approached randomly and asked if they would like to
participate.
Ethics
The study protocol was approved by the Hospital Universitari de Bellvitge
Ethics Committee for Clinical Research (PR285/12). All patients provided written
informed consent.
Development of the NUTRISCORE tool
The MST is a good nutritional screening test for the oncology patient, con-
sisting of two questions related to weight loss and decreased caloric intake. This
screening tool is recommended by the Spanish oncology societies (the Spanish
Society for Medical Oncology and the Spanish Society for Radiation Oncology), as
well as by the Spanish Society for Enteral and Parenteral Nutrition. However, in
our experience, its implementation in a comprehensive cancer center is not cost-
effective. The high number of false positives makes it difficult to provide nutri-
tional assessment to all patients due to the limited resources available [21].
Modifying the criteria to increase specificity would result in reduced sensitivity.
Moreover, adding a test to compensate for this lower sensitivity would introduce
greater complexity with the triage. Therefore, we decided to improve the test by
designing a new screening tool, increasing sensitivity and specificity. We have
used the MST as our basis and introduced specific timeframes for both questions
into the new tool. Our purpose was to improve the tool by incorporating two
differential items: tumor location and treatment.
Given that the tumor site [22] and the oncology treatment have an enormous
effect on nutritional status [11,12,23–27], we aimed to design a method that
considered these parameters. We organized an expert consensus meeting with
professionals from different dietetic and nutrition units from each center
belonging to the Catalan Institute of Oncology (L’Hospitalet de Llo-
bregat–Barcelona, Girona, and Badalona), with the participation of oncology,
hematology, and palliative care specialists, to define the key characteristics of
patients at high nutritional risk for all of the pathologies attended, considering
tumor site and treatment course in addition to other aspects. We also used data
available from the literature classifying the nutritional risk according to the
tumor location and the treatment [22].
Given that oncology treatment can affect metabolic and nutritional status
[28], some related considerations were taken into account:
 Patients were considered to be undergoing chemotherapy from the begin-
ning of their first cycle until 3 wk after the last, including during the periods
between cycles, even if treatment was delayed due to toxicity concerns.
 Patients were considered to be undergoing radiotherapy from the first
session until 2 wk after the last.
 With regard to hematopoietic stem cell transplantation, this treatment was
considered until 1 wk after hospital discharge after transplantation.
 Other treatments: This section of the tool considered monoclonal anti-
bodies against membrane receptors, tyrosine kinase inhibitors, mTOR
inhibitors, antiangiogenesis drugs, hormone therapy, and other treatments,
including for symptomatic care (e.g., corticoids, analgesia).
The PG-SGA tool [29] was used as the reference method of nutritional
screening to classify patients without (PG-SGA stage A) or with (PG-SGA stages
BþC) nutritional risk. For the purpose of comparison, we unified the classification
of PG-SGA B (moderately malnourished or at risk for malnutrition) and C
(severely malnourished). We are validating a screening tool that gives the risk of
malnutrition but does not tell whether the patient is malnourished; for that we
would need to perform a validated nutritional assessment. To be able to use
PG-SGA as a reference method to validate NUTRISCORE and for comparative
purposes, we could only classify patients as at risk or not at risk for malnutrition.
Because NUTRISCORE was designed to categorize oncology outpatients
according to the presence of nutritional risk using a scoring system, patients who
obtained 5 points were considered at risk, whereas those who scored <5 were
not. These results were obtained from a pilot study (unpublished) using the cutoff
point that maximized the area under the curve of 0.94 comparing our screening
with the reference method (PG- SGA).
Assessment of the NUTRISCORE
A trained dietitian carried out face-to-face interviews when patients atten-
ded routine visits at any time during the course of their disease over an 8-mo
study period. Although NUTRISCORE is a tool for use by any health professional,
 L. Arribas et al. / Nutrition 33 (2017) 297–303 299

we used a trained dietitian in the present study to assure an accurate validation
with the reference method. The interviewer evaluated nutritional risk using
three different tools: first with the new tool NUTRISCORE, then with the MST, and
finally with the PG-SGA as the reference method.
Weight and height were registered. Patients were weighed wearing
lightweight clothing and barefoot in an upright position if possible; if patients
were unable to stand on the scale, a sitting scale was used. All scales were
regularly calibrated. For the measurement of height, patients were barefoot in
an upright position if possible; if not possible, height was estimated by
doubling the arm span measurement (from the patient’s sternal notch to the
end of the longest finger) [30]. These values were recorded along with weight
loss, changes in dietary intake, and current symptoms, along with data from
the patient’s electronic health record: age, sex, diagnosis, treatment, and al-
bumin levels.

Fig. 1. NUTRISCORE (novel nutritional screening tool). GI, gastrointestinal.

300 L. Arribas et al. / Nutrition 33 (2017) 297–303

Table 1 Data analysis was performed using the SPSS software v.20 (SPSS Inc, Chicago,
Patient characteristics IL, USA) and R Software version 3.2.3 used to evaluate diagnostic tests. Statistical
significance was reported at the conventional P < 0.05 level.
Variables N (% or  SD)
Male 217 (55.1)
Female 177 (44.9) Results
Age (y) 61.55  12.09
Height (cm) 164.3  9.6
Weight (kg) 71.4  13.9 General characteristics of study participants
BMI (kg/m2) 26.3  4.87
Site (diagnosis), N (%) Of 400 eligible patients, 394 were recruited; 6 patients
Abdominal and pelvic: liver, biliary tract, renal, 74 (18.8) declined to participate in the study. Detailed characteristics of
gynecologic
the study participants are shown in Table 1. The mean age was
Head and neck 49 (12.4)
Colorectal 38 (9.6) 61.5  12.1 y in the study group, which consisted of 217 (55.1%)
Lymphomas that compromised GI tract 3 (0.8) men and 177 women (44.9%). The study population included
Leukemia and other lymphomas 46 (11.7) patients with different types of solid tumors (87.5%) and hema-
Breast 57 (14.5)
tologic malignancies (12.5%).
Prostate 31 (7.9)
Lung 41 (10.4)
At the time of screening, 83% of the patients reported no
CNS 15 (3.8) weight loss or a loss of <5% of their basal body weight in the
Upper GI tract (esophagus, gastric, pancreas, intestinal) 39 (9.9) previous 3 mo; 67 patients (17%) had lost >5% in that time
Others 1 (0.3) period.
Treatment, N (%)
Only chemotherapy 142 (36)
Only radiation therapy 74 (18.8)
Comparison for classifying risk for malnutrition
Concomitant chemotherapy and radiotherapy 37 (9.4)
Hematopoietic stem cell transplantation 28 (7.1)
Other treatments, or exclusively symptomatic treatment 113 (28.7) Table 2 presents the classification of the risk for malnutrition
CNS, central nervous system; GI, gastrointestinal according to NUTRISCORE and the other screening methods
used.
The PG-SGA classified 19% of the patients as malnourished or
Statistical analysis at risk for malnutrition (stages BþC); 14 of these patients were
severely malnourished. This proportion was higher for the MST,
Sample size was based on the correlation between screening tools in patients
with 28.2% of the patients classified as being at risk for malnu-
with different types of cancer. A sample size of 394 patients was the number
needed to detect a significant 0.7 correlation between screening tools and a trition. The new screening tool (NUTRISCORE) found that 22.6%
proportion of malnourished patient around 0.3, with a significance level of 0.05 of patients were at risk for malnutrition. When looking at the
and a statistical power of 0.8. tumor sites as grouped according to nutritional risk (low, mod-
For qualitative variables, frequency and proportions were used and compared erate, high; Table 2), the highest proportion of patients at risk for
by c2 test, with Yate’s correction. For quantitative variables, means and SD values
are presented and compared with Student’s t test or analysis of variance, as
malnutrition in the three categories was observed for the MST.
appropriate. The NUTRISCORE and the PG-SGA classified about the same
Sensitivity, specificity, and positive and negative predictive values were proportion of patients with tumor sites with low and moderate
calculated for the NUTRISCORE and MST using the PG-SGA as a reference method. risk (12% and 17%, respectively) as being at risk for malnutrition,
The performance of NUTRISCORE and MST in relation to the PG-SGA was checked
whereas a higher proportion was observed for the NUTRISCORE
by the receiver operating characteristic curve analysis based on the area under
the curve (AUC). (49.5%) compared with the PG-SGA (34.1%) among the patients.
To compare the time (in minutes) required for the application of each nutri- According to the cancer treatment, patients undergoing
tional screening tool, we conducted a comparison of means (Student’s t test). concomitant chemotherapy or hematopoietic stem cell trans-
The overall agreement between pairs of nutritional screening tools the plantation presented a greater risk for malnutrition, as evaluated
k coefficient was assessed. The value of k was classified as <0.2 k 0.0, denoting
poor agreement between both tools; <0.4 k 0.2, fair agreement; <0.6 k 0.4,
by all three methods (Table 2).
moderate agreement; <0.8 k 0.6, good agreement; and 0.8, almost excellent Time taken to conduct the NUTRISCORE compared with the
agreement [31]. PG-SGA was quicker for our test: 0.33 (SD  0.21) min were used

Table 2
Risk for malnutrition according to tool, tumor site, and treatment

NUTRISCORE*,y MST*,y PG-SGA*,y,z

n % (95% CI) n % (95% CI) n % (95% CI)

All patients at risk for malnutrition 89 22.6 (18.5–26.7) 111 28.2 (23.7–32.6) 75 19 (15.2–22.9)
According to tumor site
Site associated with low nutritional risk 18 12 (6.8–17.2) 33 22 (15.3–28.7) 18 12 (6.8–17.2)
Site associated with moderate nutritional risk 26 17 (11–23) 32 20.9 (14.4–27.4) 26 17 (11–23)
Site associated with high nutritional risk 45 49.5 (39.1–59.8) 46 50.5 (40.2–60.9) 31 34.1 (24.3–43.9)
According to treatment
Chemotherapy 26 18.3 (11.9–24.7) 39 27.5 (20.1–34.8) 27 19 (12.5–25.5)
Radiation therapy 12 16.4 (7.9–25) 9 12.3 (4.7–19.9) 5 6.8 (1–12.7)
Concomitant chemotherapy and radiotherapy 24 64.9 (49.3–80.5) 23 62.2 (46.3–78) 16 43.2 (27.1–59.4)
Hematopoietic stem cell transplantation 15 53.6 (34.8–72.4) 24 85.7 (72.5–98.9) 15 53.6 (34.8–72.4)
Other treatments or symptomatic treatment 12 10.5 (4.9–16.2) 16 14 (7.6–20.4) 12 10.6 (4.9–16.2)

* Significant differences according to site (MST: c2 ¼ 31.407, P < 0.001; PG-SGA: c2 ¼ 21.549, P < 0.001; NUTRISCORE: c2 ¼ 49.908, P < 0.001).
y
Significant differences according to treatment (MST: c2 ¼ 91.219, P < 0.001; PG-SGA: c2 ¼ 48.170, P < 0.001; NUTRISCORE: c2 ¼ 59.220, P < 0.001).
z
PG-SGA stages at risk: BþC.
 L. Arribas et al. / Nutrition 33 (2017) 297–303
Table 3
Validity of the NUTRISCORE
PG-SGA Total, n
Malnourished, n Well nourished, n
NUTRISCORE
At risk 73 13 86
Without risk 2 306 308
MST
At risk 63 46 109
Without risk 12 273 285
AUC, area under the curve; NPV, negative predictive value; PPV, positive predictive value
* The two AUC are significantly different with P ¼ 0.001754.
for NUTRISCORE, whereas for the PG-SGA 3.27 (SD 0.69) min
were required.
Validity of the NUTRISCORE
Using the PG-SGA as a reference method, the MST had a
sensitivity of 84% and a specificity of 85.6%. NUTRISCORE
exceeded these values at 97.3% sensitivity and 95.9% specificity
(Table 3). This better performance of NUTRISCORE was
confirmed by the receiver operating characteristic curve analysis,
with AUC values of 0.95 (95% confidence interval [CI], 0.92–0.98)
for NUTRISCORE and 0.84 (95% CI, 0.79–0.89) for the MST.
The agreement between NUTRISCORE and the PG-SGA was
high, with a k index of 0.88 (P < 0.0001; 95% CI, 0.82–0.94)
compared with a k of 0.59 (P < 0.0001; 95% CI, 0.50–0.68) bet-
ween the MST and the PG-SGA.
Discussion
In the present study, we developed a new nutritional
screening tool for cancer outpatients called the NUTRISCORE.
When compared with the PG-SGA as a reference, the new tool
demonstrated better sensitivity and specificity. Moreover,
application of NUTRISCORE requires very little time.
To our knowledge, none of the nutritional screening tools
published and validated to date have been designed specifically
for cancer outpatients. Some have been designed specifically for
cancer inpatients. One group validated a tool through an equa-
tion that considered changes in intake, weight loss, functional
state, and body mass index (BMI) [29]. Compared with the
PG-SGA, it showed sensitivity of 94% and specificity of 84.2%.
Recently, a new screening tool was proposed that classified risk
for malnutrition into three stages, taking into account gastroin-
testinal symptoms as well as changes in oral intake, BMI, and
weight loss [32]. However, no details on the sensitivity or spec-
ificity of the screening method were provided. A new nutritional
screening method for hospitalized cancer patients has been
published with four items: weight loss, subjective assessment of
low weight, changes in intake, and the presence of symptoms
that influence intake [33]. This tool had a sensitivity of 93% and a
specificity of 53% compared with the PG-SGA, the method of
reference.
The multidisciplinary clinical guidelines on nutrition man-
agement for cancer patients [34], published in Spain in 2008 as a
result of a consensus process between Spanish societies of
nutrition and oncology (Spanish Society for Enteral and Paren-
teral Nutrition, Spanish Society for Medical Oncology, and
Spanish Society for Radiation Oncology), recommend using the
MST as the screening tool of choice to detect nutritional risk in
cancer patients. As reflected in a previous study [35], the MST is
301
Sensitivity Specificity PPV % NPV % AUC*
% (95% CI) % (95% CI) (95% CI) (95% CI)
97.3 (91–100) 95.9 (93–98) 84.8 (76–92) 99 (98–100) 0.95 (CI 0.92–0.98)
84 (74–91) 85.6 (81–89) 57.7 (48–67) 95.7 (93–98) 0.84 (CI 0.79–0.89)
considered a good method of nutritional screening for cancer
outpatients, and it is one of the most commonly used in
oncology. Although studies show it to be highly specific, in our
experience, implementing this nutritional screening tool in our
comprehensive cancer centers made it difficult to provide
nutritional services for all the patients identified as being at
nutritional risk because of the high number of false positives
and the limited resources available to our centers’ nutrition
teams. The false positives are probably attributable to the early
detection and diagnoses of cancer as well as the combination of
conventional antineoplastic treatments with new, targeted
therapies that make a smaller nutritional effect. Using the MST as
a basis, we designed a specific nutritional screening tool for
cancer outpatients.
NUTRISCORE considers information on weight loss and
changes in food intake in a specific period of time, in addition to
tumor site and type of treatment. To our knowledge, these
aspects have never been included in existing screenings, despite
being important factors that can condition nutritional status
[36]. With regard to weight loss, in the present sample, 83% of
patients had not lost >5% of their body weight in the previous
3 mo, if they had lost any weight at all. All nutritional screenings
published until now have weight as an easy parameter to mea-
sure without consideration of other circumstances such as
imbalance in hydration status. We have used this same param-
eter to be able to compare it with the rest of the nutritional
screenings available. However, adding the tumor site and treat-
ment may take into account signs of imbalance in the hydration
status to some extent.
Beyond the overall proportion of patients with risk for
malnutrition according to the screening method (MST, 28.2%;
NUTRISCORE, 22.6%; and PG-SGA stages BþC, 19%), the type of
treatment and tumor site significantly condition nutritional
status and future risk for malnutrition. Sites in the head and
neck, upper gastrointestinal tract, and some lymphomas are
associated with a high nutritional risk [1,27], whereas locations
in the lung and most locations in the abdomen and pelvic area
present a moderate risk. Some studies that focused on the same
tumor site and werse treated with radiation [37], chemotherapy
[38], or combinations of both [39–41] present different figures on
malnutrition, demonstrating the importance of this factor when
evaluating nutritional risk. Although none of the existing
screening methods consider both of these aspects, an analysis of
our tool demonstrated significant differences with the MST and
the PG-SGA according to the tumor site and treatment (P < 0.05).
Moreover, and unlike other methods, ours did not include BMI
because this measure does not take into account the influence of
other non-nutritional factors such as edema or ascites.
Although it would have been interesting to also include
tumor stage, we wanted to use easy parameters in order to
302 L. Arribas et al. / Nutrition 33 (2017) 297–303
complete the nutritional screening as simply as possible.
Furthermore, it is often difficult to retrieve reliable information
on tumor stage as it may change during the course of treatment
and diagnosis. As such, we chose to add only tumor location and
treatment as easier parameters for the purpose of screening,
leading us to obtaining better sensitivity and specificity.
As compared with the reference (PG-SGA) tool, NUTRISCORE
has better screening features than MST, reaching sensitivity
and specificity of 97.3% and 95.9%, respectively, and an AUC of
0.95. In the present patient population, these parameter from
NUTRISCORE resulted in reasonably good predictive values for
the risk for malnutrition (positive predictive value, 84.8%; 73/86).
In addition to its good performance, NUTRISCORE is a quick and
simple screening tool that is useful at a clinical level. It is easy to
implement for any health professional involved in patient
treatment, as are other existing methods including the MST and
Nutritional Risk Screening, although the later was not assessed
in the present study. In our case, the dietitian was highly trained
for the purpose of the study, and we had some data available
before the nutritional assessment so we were aware that the
time needed to perform the nutritional assessment was quicker
than the time cited in the literature for other tools [19].
Our study had a few limitations. One of the main limitations
was the potential effect on the results, the clinical situation, and
the patients’ level of cooperation that may have been generated
from the need for patients to respond to three different and
consecutive nutritional screening tools. Another limitation is
interviewer bias as the interviewer was a single, trained dietitian
with broad experience in cancer patients. As already noted, the
reproducibility of the screening by health professionals with no
specific training in oncology nutrition has not been assessed in
the present study.
Conclusion
NUTRISCORE proved to be a novel, fast, and valid nutritional
screening tool for cancer patients, performing excellently in the
ambulatory setting. Its simplicity and high level of accuracy in
detecting nutritional risk facilitates its applicability. Further
studies are currently evaluating the implementation of this new
screening method by other types of health professionals to better
characterize its reproducibility.
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