Introduction: Malnutrition is a frequent complication in cancer patients and can
negatively affect treatment outcome. Preliminary audit conducted at the Oncology
Clinic, National Cancer Institute (NCI), found that only 5.8% of outpatients underwent
nutrition screening using the Malnutrition Screening Tool (MST), and only 2.6% of
dietitian referrals were recorded. This audit aims to determine the rate of adherence
to nutritional screening, and to implement remedial measures for improved patient
care. Methods: This was a cross-sectional audit comprising three phases, namely
initial audit, remedial measures and re-audit. Criteria audited include screening
rate using MST and dietitian referral based on MST scores. Standards were set at
100% for both criteria. Data collected for initial audit were patients’ MST scores
records and total dietitian referral forms retrieved from Electronic Medical Records.
After initial audit, self-administered questionnaires for nurses and physicians were
developed to identify barriers. Measures implemented for change included patientadministered MST to shorten screening time, and procedure flowchart to facilitate
referral. After 6 months, a re-audit was conducted. Results: Total subjects for
initial audit and re-audit were 349 and 390, respectively. Initial audit and re-audit
showed screening rate using MST increased significantly from 6.3% to 79.5%, but
there was no significant change for the dietitian referral rate. Conclusion: This
clinical audit has led to a change in the policy in NCI outpatient clinics whereby
nurses directly schedule dietitian referrals without going through physicians for
patients with MST scores ≥2. Continuous audit and monitoring are necessary to
facilitate improvement in MST implementation for better outpatient care.
Introduction: Malnutrition in cancer patients affects the quality of life (QoL) of the patients and brings about adverse outcomes including morbidity and mortality. This study aims to determine the prevalence of malnutrition among cancer patients at the National Cancer Institute (NCI), Putrajaya.
Methods: A cross-sectional study was conducted among 97 respondents who were admitted to the NCI between August 2014 and January 2015. Information on socio-demographic characteristics, clinical characteristics, anthropometric measurements, dietary intake and biochemical data were obtained. The Malnutrition Screening Tool (MST) was used to identify malnutrition risk, while the Subjective Global Assessment (SGA) determined patients’ nutritional status.
Results: Approximately 61.9% and 43.5% of the patients were malnourished upon admission based on the MST and SGA scores, respectively. Four most common types of cancer among the malnourished patients were nasopharyngeal (NPC), lung, breast and colorectal cancer. About 56.9% and 21.6% of the malnourished patients, according to MST, were at Stage 4 and Stage 3 cancer, respectively. Meanwhile 69.7% of the malnourished respondents, based on SGA, were at Stage 4 cancer. Mean energy intake was 1463±577 kcal and protein intake was 54±22 g proteins.
Conclusion: Prevalence of malnutrition in hospitalised cancer patients in the NCI was high, depending on age, body mass index (BMI), tumour location and cancer stage. Early identification of malnutrition status is required for proper nutritional intervention.
Study site: National Cancer Institute (NCI) in Putrajaya, Malaysia