Q2. When should patients be screened and referred to the dietitian?
The Evidence Based Practice Guidelines for Nutritional Management of Malnutrition in Adult Patients Across the Continuum of Care recommends routine malnutrition screening in the acute care setting . The Evidence Based Practice Guidelines for Nutritional Management of Patients Receiving Radiation Therapy and the Updated Evidence-Based Practice Guidelines for the Nutritional Management of Patients Receiving Radiation Therapy and/or Chemotherapy recommend all patients receiving radiation therapy to the head and neck area should be referred to the dietitian for nutrition support . Three level II positive quality studies  support all head and neck patients receiving radiotherapy are at high nutritional risk and should be referred to the dietitian. A level III-3 neutral quality study suggests all patients receiving chemoradiotherapy should be referred prior to commencement of treatment .
There is limited evidence on when screening should be undertaken at other points in the continuum of care. A high prevalence of malnutrition or unintentional weight loss at baseline has been reported prior to commencing treatment, with one level III-2 neutral quality study and one level IV neutral quality study both reporting rates of 57% , and a further level IV neutral quality study reporting rates of 18-25% . Therefore, screening should take place at diagnosis, as well as at frequent intervals across the treatment continuum, to account for various stages of treatment taking place at different centres. A number of studies have highlighted certain clinical and treatment factors which may also elevate a patient’s risk of malnutrition during and post treatment. These groups of patients would also benefit from early referral and intervention, and this is explained in more detail in Q15 and Q25.
|All patients receiving radiation therapy to the head and neck area should be referred to the dietitian for nutrition support.||A|
|Patients who are not malnourished at baseline, but are identified as having future high nutritional risk, should be referred to the dietitian prior to the commencement of treatment for assessment and consideration of appropriate nutrition support.||C|
|Malnutrition screening should be undertaken on all patients at diagnosis to identify those at nutritional risk and then repeated at intervals through each stage of treatment (e.g. surgery, radiotherapy/chemotherapy, and post treatment). If identified at high risk refer to the dietitian for early intervention.||B|
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