Nutritional Risk and Unmet Nutritional Need in Ambulatory Patients Undergoing Systemic Anti-Cancer Therapies

Malnutrition is highly prevalent among cancer patients receiving systemic anti-cancer therapy (SACT) and is associated with poor treatment tolerance, reduced quality of life, and increased mortality. Despite recommendations, nutritional screening in the outpatient setting is inconsistently implemented and the prognostic significance of nutritional risk identified using a validated screening tool is still unclear. This study aimed to determine the prevalence of nutritional risk among patients receiving SACT, whether their nutritional needs were being met with dietetic input, and to examine associations with clinical outcomes, including treatment toxicity, dose reduction, hospital admission, and overall survival.

In this prospective observational study, adult outpatients receiving SACT were invited to complete the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), a nutritional screening tool. Nutritional risk using PG-SGA SF scores was assessed in relation to treatment toxicity, dose reduction, and hospital admission using multivariable regression models and survival was evaluated using Cox proportional hazards models, both adjusted for age, sex, metastatic disease, and performance status.

Of 169 participants, 24.9% were at nutritional risk, PG-SGA SF score 4-8, and 10.7% at high risk ≥ 9, yet only 5.3% were in receipt of dietetic care. Higher PG-SGA SF scores were independently associated with increased treatment toxicity (OR: 1.2, 95% CI: 1.1-1.3, p = 0.003) and SACT dose reductions (OR: 1.2, 95% CI: 1.0-1.3, p = 0.040). Nutritional risk was not significantly associated with 30-day hospital admissions but was independently associated with overall survival (HR: 1.1, 95% CI: 1.0-1.2, p = 0.004).

Nutritional risk identified using the PG-SGA SF independently predicted treatment toxicity, dose reduction, and survival in those receiving SACT. Despite over one-third of those meeting the criteria for dietetic intervention, only 5.3% were receiving dietetic care, indicating a substantial gap between dietetic need and provision. These results support implementation of routine screening, referral pathways, and a dedicated dietetic service integrated into oncology outpatient services.