Relationship Between Risk, Nutritional Status and Functional Capacity and Clinical Outcomes in Cancer Patients: A Systematic Review

Abstract

Abstract Objectives To systematically review the published evidence on nutritional risk screening instruments, nutritional assessment and functional capacity used in hospitalized cancer patients and possible associations with unfavorable clinical outcomes. Methods A systematic search was performed in EMBASE, PubMed/MEDLINE, LiLACS and SciELO (publications from January 2010 to January 2021) databases by search terms related to “nutritional risk”, “nutritional assessment”, functional capacity” and “cancer”. Results 3753 articles were identified, and 321 duplicates were excluded. Of the 3432 articles analyzed by title/abstract, 109 were selected for full reading and 28 studies meeting the inclusion criteria. The agreement analysis between the researchers generated a Kappa of 0.813. The evaluated studies included comparison of tools: 1) nutritional screening, 2) nutritional screening based on laboratory parameters, 3) nutritional assessment, 4) nutritional diagnosis and, 5) functional capacity. The higher nutritional risk, worst nutritional status and low functional capacity assessed by the Nutritional Risk Screening 2002 (NRS- 2002), Patient-Generated Subjective Global Assessment (PG-SGA); Subjective Global Assessment (SGA) and lower handgrip strength, respectively, were associated with longer of hospital stay. The worst nutritional status, identified by the SGA scores, Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Index (NRI) were significant predictors of postoperative mortality. Conclusions The studies included in this systematic review showed that higher nutritional risk, worse nutritional status and low functional capacity are associated with unfavorable outcomes such as longer hospital stay and mortality. The combination of the tools can be recommended for a complete assessment of the nutritional status of hospitalized cancer patients. Funding Sources Fundo de Incentivo à Pesquisa (FIPE) do Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil. (number# 2019/0708).