Associations between outcome variables of nutritional screening methods and systemic treatment tolerance in patients with colorectal cancer: A systematic review

INTRODUCTION: Multiple screening methods for malnutrition are available, but a systematic review of evidence in patients with colorectal cancer (CRC) is lacking. The aim of this study is to systematically investigate which outcome variables of nutritional screening methods are associated with treatment tolerance in patients with CRC. MATERIAL AND METHODS: A systematic review was performed with respect to outcome variables of nutritional screening methods and their association with systemic treatment tolerance in patients with CRC. The Cochrane guidelines for systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Two authors independently assessed the risk of bias and quality of each included study. RESULTS: A total of sixteen studies were included. The following screening methods for malnutrition were assessed in the included studies: serum albumin, body mass index, C-reactive protein/albumin ratio, modified version of the Glasgow prognostic score, mini nutritional assessment, nutritional risk index, patient-generated subjective global assessment, sarcopenia and weight loss. DISCUSSION: Sarcopenia tended to be associated with treatment tolerance more often than other screening methods but the current review suggests that there are ample screening methods rendering meaningful outcomes regarding a patient's nutritional status and associated risk for treatment intolerance. This grants practitioners the flexibility to choose from a variety of different nutritional screening methods. Nutritional screening can thus be tailored to the individual patient. Importantly, nutritional screening may help identify those patients at risk for chemotoxicity thus allowing for the implementation of targeted prehabilitation programs in order to prevent (severe) chemotoxicity