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

Context: The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the Federation of the French Cancer C entres (FNCLCC), the 20 French Cancer Centres and specialists from French P ublic Universities, General Hospitals and Private Clinics. The main objecti ve is the development of clinical practice guidelines to improve the qualit y 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. Objective s: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the nutritional eval uation of cancer patients Methods: Data were identified by searching Medlin e and personal reference lists of members of the expert groups. Once the gu idelines were defined the document was submitted for review to 83 independe nt reviewers, and to the medical committees of the 20 French Cancer Centres . Results: The main recommendations for the nutritional evaluation of cance r patients are: 1) Clinical and anthropometric evaluation should measure he ight, 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 Gastroi ntestinal disorders and energetic needs should be assessed. 2) Nutritional intervention is recommended for all patients with a weight loss of 10% or m ore. 3) A multidimensional assessment can be performed using three validate d nutritional and clinical scales: the Subjective Global Assessment, the Sc ored PG-SGA and the Mini Nutritional assessment. 4) The predictive value of biological factors (albumin) is not sufficient individually, risk scales c ombining several factors should be used the Prognostic Inflammatory and Nut ritional Index (PINI), the Nutritional Risk Index (NRI) the Prognostic Nutr itional Index (Mullen) or the Sadan. 5) Minimal nutritional assessment shou ld include clinical data, patient interview, height, current weight, ideal weight and weight change. Gi The efficacy of the nutrional management shoul d be followed by assessing weight, and the presence of oedema and ascitis. The ratio of calorie to nitrogen intake should be calculated regularly.