Late referral of cancer patients with malnutrition to dietitians: a prospective study of clinical practice

  • Cliona M. LortonEmail author
  • O. Griffin
  • K. Higgins
  • F. Roulston
  • G. Stewart
  • N. Gough
  • E. Barnes
  • A. Aktas
  • T. D. Walsh
Original Article



Malnutrition (MN) in cancer is common but underdiagnosed. Dietitian referrals may not occur until MN is established. We investigated cancer patient characteristics (demographics, nutritional status, and nutrition barriers) on referral to oncology dietitians. We also examined referral practices and prevalence of missed referral opportunities.


This was a naturalistic multi-site study of clinical practice. Data from consecutive referrals were collected in inpatient and outpatient settings. Demographics, nutritional status (weight, body mass index (BMI), weight loss in the preceding 3–6 months, oral intake, nutrition barriers), referral reasons, and use of screening were recorded. Missed opportunities for earlier referral were also noted.


Two hundred patients were included (60% male, 51% inpatients). Half had gastrointestinal and hepatobiliary cancers. The majority were on antitumor treatment. Two-thirds had lost ≥ 5% body weight. Forty percent were overweight or obese. Seventy percent had ≥ 2 nutritional barriers. Most common nutrition barriers were anorexia, nausea, and early satiety. Greater weight loss and lower food intake were associated with ≥ 2 barriers. Weight loss was the most common referral reason. Screening was used in 35%. Referrals should have occurred sooner in nearly half (45%, n = 89).


Cancer patients were referred late to a dietitian, with multiple nutritional barriers. Most referrals were for established weight loss (WL). WL may be masked by pre-existing obesity. Almost half had missed earlier referral opportunities; screening was infrequent. Over one-quarter should have been re-referred sooner. There is a clear need for clinician education. Future research should investigate the optimal timing of dietitian referral and the best nutrition screening tools for use in cancer.


Cancer Dietitian Malnutrition Referral Symptoms Weight loss 



Study participants and dietitians.

Assisted with devising study concept and critically reviewed the study proposal: Dr. Martina Coen, Dr. Clare Corish, Catherine Corrigan, Roisin Gowan, Orla Haughey, Sinead Knox, Pauline Ui Dhuibhir

Critically reviewed the study proposal and facilitated dietitians’ involvement in study: Sinead Feehan, Una Gilligan, Dr. Lorraine Walsh

Collected data: Geraldine Guiry

Assisted with data entry: Shauna Kielthy

Provided guidance on and assistance with literature review: Fiona Lawler

Provided advice on statistical techniques: Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin

Technical editing and proofreading: Kunal Kadakia, Aidan O’Donoghue, Niamh O’Donoghue, Gail M O’Neill

Compliance with ethical standards

Ethical approval was granted by the research ethics committee at each hospital. Waiver of written consent was approved at three sites (Tallaght University Hospital, St. Vincent’s University Hospital, and St. Vincent’s Private Hospital). At two sites, written consent was sought (St. Luke’s Radiation Oncology Network and the Mater Private Mid-Western Regional Oncology Centre).

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Academic Department of Palliative MedicineOur Lady’s Hospice & Care ServicesDublinIreland
  2. 2.Trinity College DublinDublinIreland
  3. 3.St Vincent’s University HospitalDublinIreland
  4. 4.Tallaght University HospitalDublinIreland
  5. 5.St Luke’s Radiation Oncology NetworkDublinIreland
  6. 6.St Vincent’s Private HospitalDublinIreland
  7. 7.Mater Private Mid-Western Radiation Oncology CentreLimerickIreland
  8. 8.Department of Supportive Oncology, Levine Cancer InstituteAtrium HealthCharlotteUSA
  9. 9.University College DublinDublinIreland

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