New tool improves nutritional status screening in kids with cancer

A generic tool for nutritional screening in children with cancer are underpowered and fail to account for different types of cancer, staging, and treatment intensity, according to a recent Singapore study.

Instead, using a tool tailored specifically to this population, taking into consideration the above factors, as well as promoting collaboration between doctors, nurses, and dietitians, improves the detection of at-risk patients, the timeliness of intervention, and patient nutritional status.

“Using our existing resources, we transformed a general nutrition screening process to one that focuses on children with cancer, who are known to be at high risk for malnutrition at diagnosis and during treatment,” the researchers said.  

Forming a multidisciplinary team, the researchers first established that there was a problem of missed or late referrals of paediatric cancer patients with high malnutrition risk at the KK Women’s and Children’s Hospital. Root-cause analysis revealed that that existing tool used was generic and did not assess risk according to disease trajectory and treatment.

To address the problem, the team applied the screening tool for childhood cancer (SCAN) to the hospital, first validating it in the local population, training nurses to administer it, and finally implementing the tool, along with maximizing efficiency by incorporating it into patient electronic medical records (EMR) and streamlining referrals to the dietitian.

After the intervention was deployed to the clinics, there was a substantial spike in the referrals to dietitians. At baseline, the median percentage of patients at high malnutrition risk referred was 33 percent, which jumped to 83 percent following implementation. [BMJ Open Qual 2021;10:e000944]

Moreover, after implementation, only 6.5 percent of patients admitted had malnutrition, down from 17.4 percent before the intervention (p<0.001).

Dietitian involvement likewise improved. At baseline, only 36.4 percent of patients were successfully screened to be at high risk and subsequently seen by the dietitian; this percentage increased to 85.7 percent after implementation (p=0.005).

After SCAN, almost all (97.6 percent) patients who needed dietary consultation were seen by the dietitian within 48 hours, up significantly from 53.3 percent before intervention (p<0.001). Overall, the timeliness of dietitian intervention also significantly improved, shortening from a median of 3 days to 1 day (p=0.01).

In turn, patients had better nutritional status after SCAN implementation. They saw a 2.5-percent weight increase at 1 month and 4.47-percent at 3 months, significantly better than during the preimplementation period when there were 0-percent (p=0.001) and 2.02-percent (p<0.001) weight changes at the respective time intervals.

“We will aim to make incremental improvement to our nutrition protocol for this patient population by first planning to enhance the EMR system by setting up an automatic prompt to the dietetic service a list of patients requiring dietetic intervention,” the researchers said.

“Our long-term aim is to design, together with the multidisciplinary team, a clinical pathway for children with cancer,” they added.