Feasibility and Acceptability of the Cancer-Specific PRONTO Protocol for Nutritional Risk Screening in Outpatient Oncology Cancer Care: A Pilot Study

Abstract

Background: Malnutrition or its risk is common among patients with cancer (from 15% to 90%) and can negatively impact treatment outcomes and quality of life. Early detection and nutritional intervention are essential to improve clinical, health, and economic outcomes. This study evaluates the PRONTO (PROtocol for NuTritional risk in Oncology), a novel tool designed for the early identification of nutritional risk in patients with cancer. Objectives: To assess the feasibility of the PRONTO in detecting nutritional risk among newly diagnosed oncology patients. Methods: This cross-sectional, observational pilot study included 200 patients from two oncology centers in Madrid, Spain. The PRONTO was applied during the first oncology visit. Nutritional risk was assessed using PRONTO and nutritional status was evaluated with the Global Leadership Initiative on Malnutrition (GLIM) criteria. Tool acceptability was measured using the System Usability Scale (SUS) and Net Promoter Score (NPS) among participating oncologists. Results: The PRONTO identified 62.0% of patients at nutritional risk, while malnutrition was confirmed in 57.0% of patients using GLIM criteria. The PRONTO demonstrated high sensitivity (90.4%) and specificity (75.6%) compared to the GLIM. Oncologists rated the PRONTO highly, with a SUS score of 87.9 and an NPS of 9.1, indicating strong usability and recommendation potential. Conclusions: The PRONTO is a feasible and practical tool for early nutritional risk screening in oncology settings. Its simplicity and efficiency support its integration into routine clinical practice. The high prevalence of nutritional risk underscores the need for early screening to guide timely nutrition care. Further research with larger and diverse groups of patients and oncologists is needed to validate scalability and assess the impact of nutritional interventions on patient outcomes.

Keywords: PRONTO; cancer; nutritional risk; sarcopenia; screening; usability.

Figure 1

Phase 1 healthcare professional SUS and NPS results. (A) System Usability Scale (SUS). Mean score 87.9 ± 7.5 (95% CI: 83.6–92.2), indicating excellent usability (SUS > 80). The SUS is a validated 10-item questionnaire ranging from 0 to 100, where higher scores indicate better usability. (B) Net Promoter Score (NPS). Responses of 9–10 were categorized as promoters, 7–8 as passives, and 0–6 as detractors. The value of the index +85.7 was classified as excellent (NPS > 50).