NICE guidance for screening for malnutrition: implications for lung cancer services

The National Institute for Health and Clinical Excellence (NICE) guidelines on nutrition support in adults recommends screening all outpatients at their first clinic appointment to identify those who have malnutrition or are at risk of malnutrition.¹ A recent study of inpatients with cancer also suggests outpatient screening to improve the early identification of patients who may benefit from nutritional support.² In response to this, we have examined the potential impact of introducing routine screening for malnutrition into the two Combined Lung Oncology Clinics held weekly at the Nottingham University Hospitals NHS Trust. Neither clinic routinely screens for malnutrition, and referrals to a dietician are made—relatively infrequently—on an ad hoc basis. The malnutrition universal screening tool (MUST)³ was completed in 50 consecutive patients with lung cancer at their first or second outpatient attendance following their histological diagnosis. Using either the NICE or MUST guideline recommendations, about one third of patients had or were at high risk of malnutrition (table 1).¹,³

Table 1 Screening for malnutrition in 50 outpatients with lung cancer.

Mean (SD) age (years)	69 (10)
M:F	28:22
NSCLC:SCLC	39:11
Performance status (East Coast Oncology Group)
0–1	37
⩾2	7
Unknown	6
Mean (SD) BMI (kg/m2)	24 (5)
NICE recommends nutritional support is considered for any of the following:
BMI <18.5 kg/m2; weight loss >10% or
BMI <20 kg/m2 and weight loss >5%
Total meeting one of the above criteria	15 (30%)
MUST score, n (%)
0 (routine clinical care)	20 (40%)
1 (medium risk, observe)	12 (24%)
⩾2 (high risk, needs nutritional treatment)	18 (36%)

NSCLC, non‐small cell lung cancer; SCLC, small cell lung cancer; BMI, body mass index.

The introduction of routine screening for malnutrition into lung cancer clinics is therefore likely to identify a large number of patients at the time of their diagnosis who should be considered for nutrition support. The challenge locally is to identify how screening can be implemented routinely and how the dietetic input required can be funded, at a time when financial constraints are limiting service development. The generally nihilistic view of nutritional support will also need to be addressed. Progress cannot be made unless such patients are identified, receive high quality support and have the opportunity to take part in trials that aim to improve outcomes.