Describing Palliative Care Needs in Cancer Patients at Risk of Malnutrition: RESTORATION Study

To describe palliative care needs identified from the early stages of outpatient nutritional care among cancer patients at risk of, or already experiencing, malnutrition, and to examine the association between nutritional status and palliative care needs over time.

This observational cohort study included 93 cancer patients referred to a hospital-based outpatient nutrition clinic. Nutritional status was assessed using the Nutritional Risk Screening 2002 (NRS 2002) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Palliative care needs were evaluated using the Integrated Palliative Outcome Scale (IPOS) at baseline (T0), one month (T1), and two months (T2). Associations between malnutrition and IPOS scores were analyzed using Spearman correlations, trajectory-based classifications, and linear mixed-effects models.

At baseline, 81.7% of patients were malnourished, and the mean IPOS score was 19.9 (SD 7.8), indicating substantial multidimensional care needs. Malnutrition severity was significantly associated with higher baseline IPOS scores (P = .042). In the adjusted linear mixed-effects model, each one-grade increase in GLIM malnutrition severity was associated with a 19.0-point higher subsequent IPOS score (95% CI 11.5 to 26.5; P < .001). Over two months, four symptom trajectories emerged: sustained improvement (29.5%), transient improvement (22.9%), delayed improvement (36.1%), and no improvement (11.5%). Worsening nutritional status was significantly associated with increased palliative care needs over time (P = .032).

Malnutrition and unmet palliative care needs are highly prevalent in cancer patients, from the early stages of outpatient nutritional care. The association between nutritional status and multidimensional palliative care needs supports the need for integrated, multidisciplinary care approaches.

Oncology nurses are well-positioned to identify malnutrition, and palliative care needs early using validated tools. Integrating nutritional and palliative care assessments may support timely, person-centered interventions and improve care planning throughout the oncology pathway.