[Good clinical practice in nutritional management in cancer patients: malnutrition and nutritional assessment]

Abstract

Context: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.

Objectives: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the nutritional evaluation of cancer patients.

Methods: Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 83 independent reviewers, and to the medical committees of the 20 French Cancer Centres.

Results: The main recommendations for the nutritional evaluation of cancer patients are: 1) Clinical and anthropometric evaluation should measure height, current weight, ideal weight, weight lost and rate of loss, and Body Mass Index. Social and economic data, details of previous history, current treatment and clinical examination results should also be collected. Gastrointestinal disorders and energetic needs should be assessed. 2) Nutritional intervention is recommended for all patients with a weight loss of 10% or more. 3) A multidimensional assessment can be performed using three validated nutritional and clinical scales: the Subjective Global Assessment, the Scored PG-SGA and the Mini Nutritional assessment. 4) The predictive value of biological factors (albumin) is not sufficient individually, risk scales combining several factors should be used: the Prognostic Inflammatory and Nutritional Index (PINI), the Nutritional Risk Index (NRI), the Prognostic Nutritional Index (Mullen) or the Sadan. 5) Minimal nutritional assessment should include clinical data, patient interview, height, current weight, ideal weight and weight change. 6) The efficacy of the nutrional management should be followed by assessing weight, and the presence of oedema and ascitis. The ratio of calorie to nitrogen intake should be calculated regularly.