Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of a Screening Tool for Early Identification of Malnutrition in Patients with Head and Neck Cancer

  • Surgery
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

The purpose of this study was to evaluate the impact of the Malnutritional Universal Screening Tool (MUST) assessment on effects of postoperative surgical site infection (SSI) and length of hospitalization stay (LOS) for patients undergoing oncologic resection for head and neck cancers. A pre-posttest design was used to evaluate the effects of preoperative nutritional screening on postoperative SSI and LOS rates in patients undergoing oncologic resection. A purposive sampling was used to recruit participants for the study. Pre- and post-implementation data were collected over a period of 8 weeks. All patients in the post-implementation group were assessed using the MUST and pre-surgery nutritional optimization was instituted. All participants were monitored for incidences of SSI until discharge. Of the 36 patients in the post-implementation group, 23(63.9%) had a MUST score of moderate to high and 13 (36.1%) had a score of low risk. There was a statistical significance observed between the pre-and post-implementation groups, with both postoperative surgical site infection (SSI) reduced from 50% to 22% and length of hospitalization stay from 28 to 17 days (p = 0.014) between the groups. Patients who were non-smokers (p = 0.010) and without reconstruction after surgery (p = 0.007) were less likely to develop postoperative SSI. Use of the MUST for preoperative nutritional screening has demonstrated that it is a feasible and easy to implement tool for assessment of malnutrition and it has demonstrated positive outcomes in reduction of both postoperative SSI and length of hospitalization stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Almeida AI, Correia M, Camilo M, Ravasco P. Nutritional risk screening in surgery: valid, feasible, easy! Clin Nutr. 2012;31:203–11. https://doi.org/10.1016/j.clnu.2011.10.003.

    Article  Google Scholar 

  2. Amaral TF, Antunes A, Cabral S, Alvest P, Kent-Smith L. An evaluation of three nutritional screening tools in a Portuguese oncology center. J Hum Nutr Diet. 2008;21:575–83. https://doi.org/10.1111/j.1365-277x.2008.00917.

    Article  CAS  PubMed  Google Scholar 

  3. Bapen. (2003). The Malnutrition Universal Screening Tool. Retrieved from http://www.bapen.org.uk/pdfs/must/must_full.pdf

  4. Boleo-Tome C, Monteiro-Grillo I, Camilo M, Ravasco P. Validation of the Malnutrition Universal Screening Tool (MUST) in cancer. Br J Nutr. 2012;108:343–8.

    Article  CAS  Google Scholar 

  5. Borges NP, Silva DA, Cohen C, Filho PF, Medeiros FJ. Comparison of the nutritional diagnosis, obtained through different methods and indicators in patients with cancer. Nutr Hosp. 2009;24(1):51–5.

    Google Scholar 

  6. Davidson W, Isenring E, Brown T, Riddle B. Nutritional management of patients with head and neck cancers: integrating research into practice. Cancer Forum. 2006;30(3):183–7.

    Google Scholar 

  7. Davies M. Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9:S64–73.

    Article  Google Scholar 

  8. De Luis DA, Izaola O, Cuellar L, Terroba MN, Martin T, Aller R. High dose of arginine enhanced nutrition in postsurgical head and neck cancer patients. A randomized clinical trial. Eur Rev Med Pharmacol Sci. 2009;13(4):279–83.

    PubMed  Google Scholar 

  9. Falwee MN, Schilf A, Boufflers E, Cartier C, Bachmann P, Pressoir M, et al. Reduced infections with perioperative immunonutrition in head and neck cancer: exploratory results of a multicenter, prospective, randomized, double – blind study. Clin Nutr. 2014;33:776–84. https://doi.org/10.1016/j.clnu.2013.10.006.

    Article  Google Scholar 

  10. Felekis D, Eleftheriadou A, Papadakos G, Bosinakou I, Ferekidou E, Kandiloros D, et al. Effect of perioperative immuno-enhanced enteral nutrition on inflammatory response, nutritional status and outcomes in head and neck cancer patients undergoing major surgery. Nutr Cancer. 2010;62(8):1105–12. https://doi.org/10.1080/01635581.2010.494336.

    Article  CAS  PubMed  Google Scholar 

  11. Goyal N, Yarlagadda BB, Deschler DG, Emerick KS, Lin DT, Rich DL, et al. Surgical site infections in major head and neck surgeries involving pedicled flap reconstruction. Ann Otol Rhinol Laryngol. 2017;126(1):20–8. https://doi.org/10.1177/0003489416672871.

    Article  PubMed  Google Scholar 

  12. Hatcher JL, Sterba KR, Tooze JA, Day TA, Carpenter MJ, Alberg AJ, et al. Tobacco use and surgical outcomes in head and neck cancer patients. Head Neck. 2016;38(5):700–6. https://doi.org/10.1002/hed.23944.

    Article  PubMed  Google Scholar 

  13. Kim JM, Sung MK. The efficacy of oral nutritional intervention in malnourished cancer patients: a systematic review. Clin Nutr Res. 2016;5(4):219–36. https://doi.org/10.7762/cnr.2016.5.4.219.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Koretz RL. Immunonutrition. Curr Opin Gastroenterol. 2002;4:332–7.

    Article  Google Scholar 

  15. Langius JAE, van Dijk AM, Doornaert P, Kruizenga HM, Langendijk JA, Leemans CR, et al. More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutr Cancer. 2013;65(1):76–83.

    Article  Google Scholar 

  16. Lassig AAD, Bechtold JE, Lindgren BR, Pisansky A, Itabiyi A, Yuen B, et al. Tobacco exposure and wound healing in head and neck surgical wounds. Laryngscope. 2018;128(30):618–25. https://doi.org/10.1002/lary.26813.

    Article  CAS  Google Scholar 

  17. Leistra E, Eerenstein S, van Aken L, Jansen F, de van der Schueren M, Twisk J, et al. Effect of early individualized dietary counselling on weight loss, complications, and length of hospital stay in patients with head and neck cancer: A comparative study. Nutr Cancer. 2015;67(7):1093–103. https://doi.org/10.1016/s0261-5614(14)50405-0.

    Article  CAS  PubMed  Google Scholar 

  18. Loh KW, Vriens MR, Gerritsen A, Borel Rinkers IHM, Hillegersberg RV, Schippers C, et al. Unintentional weight loss is the most important indicator of malnutrition among surgical cancer patients. Neth J Med. 2012;70(8):365–9.

    CAS  PubMed  Google Scholar 

  19. Luis DD, Aller R, Izaola O, Cuellar L, Terroba M. Post-surgery enteral nutrition in head and neck cancer patients. Eur J Clin Nutr. 2002;56(11):1126–9. https://doi.org/10.1038/sj.ejcn.1601458.

    Article  PubMed  Google Scholar 

  20. Machiels JP, Lambrecht M, Hanin FX, Duprez T, Gregoire V, Schmitz S, et al. Advanced in the management of squamous cell carcinoma of the head and neck. F1000Prime Rep. 2014;6(44):1–10.

    CAS  Google Scholar 

  21. McCowen KC, Bristriam BB. Immunonutrition: problematic or problem- solving? Am J Clin Nutr. 2003;77:764–70.

    Article  CAS  Google Scholar 

  22. Mehanna H, Paleri V, West CM, Nutting C. Head and neck cancer--Part 1: Epidemiology, presentation, and prevention. BMJ. 2010;341:c4684. https://doi.org/10.1136/bmj.c4684.

    Article  CAS  PubMed  Google Scholar 

  23. Poulia KA, Yannakoulia M, Karageorgou D, Gamaletsou M, Panagiotakos DB, Sipsas NV, et al. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr. 2012;31:378–85. https://doi.org/10.1016/j.clnu.2011.11.017.

    Article  PubMed  Google Scholar 

  24. Rahman A, Wu T, Bricknell R, Muqtadir Z, Armstrong D. Malnutrition matters in Canadian hospitalized patients: Malnutrition risk in hospitalized patients in a tertiary care center using the malnutritional universal screening tool. Nutr Clin Pract. 2015;30(5):709–13. https://doi.org/10.1177/0884533615598954.

    Article  PubMed  Google Scholar 

  25. Railundalia MD, Fang CH, Spinazzi EF, Vazquez A, Park RC, et al. Impact of diabetes mellitus on head and neck cancer patients undergoing surgery. Am Acad Otolaryngol Head Neck Surg. 2015;154(2):294–9.

    Article  Google Scholar 

  26. Rowan N, Johnson J, Fratangelo C, Smith B, Kemerer P, Ferris R. Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients. Oral Oncol. 2016;54:42–6. https://doi.org/10.1016/j.oraloncology.2016.01.006.

    Article  PubMed  Google Scholar 

  27. Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, et al. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg. 1999;134:1309–16. https://doi.org/10.1001/archsurg.134.12.1309.

    Article  CAS  PubMed  Google Scholar 

  28. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients prevalence, concurrent validity and ease of use of the ‘malnutritional universal screening tool’ (MUST) for adults. Br J Nutr. 2004;92:799–808. https://doi.org/10.1079/bjn20041258.

    Article  CAS  PubMed  Google Scholar 

  29. Tabachinick BG, Fidell LS. Using multivariate statistics. 5th ed. New York: Allyn and Bacon; 2007.

    Google Scholar 

  30. Van Bokhorst-de van der Schueren M, Guaitoli P, Jansma E, De Vet H. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr. 2014;33(1):39–58. https://doi.org/10.1016/j.clnu.2013.04.008.

    Article  Google Scholar 

  31. Velasco C, García E, Rodríguez V, Frias L, Garriga R, Álvarez J, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicenter study. Eur J Clin Nutr. 2010;65(2):269–74. https://doi.org/10.1038/ejcn.2010.243.

    Article  PubMed  Google Scholar 

  32. Watterson C, Fraser A, Banks M, Isenring E, Miller M, Silvester C, et al. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Diet. 2009;66:S1–S34. https://doi.org/10.1111/j.1747-0080.2009.01383.x.

    Article  Google Scholar 

  33. Zhong JX, Kang K, Shu XL. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pac J Clin Nurs. 2015;24(3):367–78.

    CAS  Google Scholar 

Download references

Acknowledgement

The authors would like to thank Dr. Julia Thompson for her guidance in this study.

Author information

Authors and Affiliations

  1. Division of Nursing, National Cancer Centre Singapore, SG, Singapore

    A. Chua

  2. Duke University School of Nursing, Durham, NC, USA

    B. S. Turner

  3. Division of Surgical Oncology, National Cancer Centre Singapore, SG, Singapore

    N. G. Iyer

  4. Division of Nursing, Singapore General Hospital, SG, Singapore

    S. F. Lim

Authors
  1. A. Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. S. Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. G. Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. F. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Chua.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was conducted after approval from both the Duke University Institutional Review Board (DIRB) and the Quality Department Management (QDM) of the tertiary cancer center.

Informed Consent

Verbal consent was obtained from all participants.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Surgery

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chua, A., Turner, B.S., Iyer, N.G. et al. Effectiveness of a Screening Tool for Early Identification of Malnutrition in Patients with Head and Neck Cancer. SN Compr. Clin. Med. 2, 203–208 (2020). https://doi.org/10.1007/s42399-019-00174-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42399-019-00174-2

Keywords

Search

Navigation