Introduction: Malnutrition is an independent risk factor for poor surgical outcomes, early chemotherapy discontinuation, and increased mortality. We evaluated the feasibility of outpatient malnutrition screening in patients with suspected gynecologic malignancy. We estimated the prevalence of malnutrition using Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (AND-ASPEN) criteria in patients undergoing surgery for newly-diagnosed ovarian carcinoma (OC).
Methods: Patients scheduling a new clinic appointment for suspected gynecologic malignancy from 2/2018-2/2019 completed the Malnutrition Screening Tool via phone. Patients with positive screening test were recommended expedited Nutrition consultation. To estimate the prevalence of malnutrition in patients with newly-diagnosed OC, formal malnutrition evaluation by a Registered Dietician was ordered during hospitalization for all patients undergoing surgery (primary cytoreduction and interval cytoreduction) for newly-diagnosed OC.
Results: Of 187 outpatients screened, 29 (16%) had a positive malnutrition screen. Eleven of 29 (38%) were willing to schedule outpatient Nutrition appointment; four were evaluated. Two (1% of all outpatients screened) were diagnosed with malnutrition. 107 patients underwent surgery for primary OC; 70 received Nutrition consult. Only 3 of 70 (4%) were formally diagnosed with malnutrition using AND-ASPEN criteria.
Conclusion: Outpatient screening of patients with suspected gynecologic malignancy for malnutrition is feasible. However, the prevalence of malnutrition detected through outpatient screening and in the newly-diagnosed OC population is surprisingly low, suggesting that outpatient screening at time of initial consultation may not be ideal timing. Improving access to dietitians during chemotherapy and later in the cancer course when malnutrition is likely more prevalent may be beneficial.
Keywords: Malnutrition; Nutrition; Ovarian, fallopian tube, and peritoneal cancer; Quality improvement.