Q4. How should nutritional status be assessed?
The Evidence Based Practice Guidelines for Nutritional Management of Malnutrition in Adult Patients Across the Continuum of Care state that validated tools for your patient population should be used for assessment . The scored Patient-Generated Subjective Global Assessment (PG-SGA)  and Subjective Global Assessment (SGA)  have been validated for use in the cancer population and are recommended in the Evidence Based Practice Guidelines for Nutritional Management of Patients Receiving Radiation Therapy  and the Evidence Based Practice Guidelines for the Nutritional Management of Cancer Cachexia .
Three studies examined the use of PG-SGA in the head and neck cancer population. Isenring et al.  (level II, positive quality) found a statistically smaller deterioration in nutritional status (determined using the PG-SGA) of head and neck or gastrointestinal cancer patients receiving nutritional intervention compared with usual care. Kiss et al.  (level III-3, neutral quality) utilised the PG-SGA as the key component of the nutrition care pathway used to direct care in a dietitian-led clinic for head and neck cancer patients receiving (chemo)radiotherapy, with the positive outcomes of this intervention outlined further in question 5. Britton et al.  (level II, positive quality) used the PG-SGA to determine the presence of malnutrition and predictors thereof in head and neck cancer patients undergoing radiotherapy.
A level III-2 neutral quality study reported that serum leptin levels could be used to determine level of cachexia in patients with oral SCC, as leptin levels correlated with body fat mass, and were found to be lower in patients with oral SCC .
One level III-3, neutral quality study  validates hand grip strength as an indicator of nutritional status, however, these single parameter measurements do not provide an adequate overall assessment of nutritional status .
|Use a validated nutrition assessment tool (e.g. scored Patient Generated–Subjective Global Assessment or Subjective Global Assessment) to assess nutritional status.||B|
- 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. Nutrition & Dietetics 2009 Dec;66(Suppl 3):1-34. Abstract available at http://www.clinicalguidelines.gov.au/search.php?pageType=2&fldglrID=1617&.
- Ottery FD. Patient generated-subjective global assessment. In: McCallum PD, Polisena CG, editors. The clinical guide to oncology nutrition. Chicago: The American Dietetic Association 2000;11-23.
- Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987;11(1):8-13 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3820522.
- Isenring E. Evidence based practice guidelines for the nutritional management of patients receiving radiation therapy. Nutrition & Dietetics 2008;65:1-20. Abstract available at http://www.clinicalguidelines.gov.au/search.php?pageType=2&fldglrID=1256&.
- Bauer JD, Ash S, Davidson WL, et al. Evidence based practice guidelines for the nutritional management of cancer cachexia. Nutrition & Dietetics 2006;63:3-32. Abstract available at http://onlinelibrary.wiley.com/doi/10.1111/j.1747-0080.2006.00099.x/abstract.
- Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 2004 Aug 2;91(3):447-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15226773.
- Kiss NK, Krishnasamy M, Loeliger J, Granados A, Dutu G, Corry J. A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer. Support Care Cancer 2012 Sep;20(9):2111-20 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22086406.
- Britton B, Clover K, Bateman L, Odelli C, Wenham K, Zeman A, et al. Baseline depression predicts malnutrition in head and neck cancer patients undergoing radiotherapy. Support Care Cancer 2012 Feb;20(2):335-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21234608.
- Gharote HP, Mody RN. Estimation of serum leptin in oral squamous cell carcinoma. J Oral Pathol Med 2010 Jan;39(1):69-73 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19817969.
- Guo CB, Zhang W, Ma DQ, Zhang KH, Huang JQ. Hand grip strength: an indicator of nutritional state and the mix of postoperative complications in patients with oral and maxillofacial cancers. Br J Oral Maxillofac Surg 1996 Aug;34(4):325-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8866070.
- Gibson RS. Principles of Nutritional Assessment. 2nd Edition. New York: Oxford University Press 2005 Abstract available at http://www.oup.com/us/catalog/he/subject/Nutrition/?view=usa&ci=9780195058383.