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Monitoring your nutritional health in cancer

While your doctors and specialist nurses can give you the treatments to fight the cancer, eating well and keeping an eye on your nutritional health is your responsibility. Many people welcome this as a key area in which they can have some power, after feeling very much disempowered by the illness and treatment.

Your specialist team will routinely weigh you and monitor any weight loss or gain. However, it is also up to you to speak up if you feel you have a poor appetite or are losing weight, or you notice that your clothes are feeling loose, or if you have specific difficulties eating. Alternatively, if you feel you are gaining weight, you should also draw it to your team’s attention. It is also important to speak up if you have noticed any side effects which are affecting your appetite or your ability to eat normally.

Don’t be misled by your current weight, even if or especially if you are secretly relieved to have lost a few pounds. For example, you may feel that you are overweight – yet still be at risk for malnutrition, as I explain below. When tracking weight, it’s more important to look out for fluctuations, rather than necessarily going by your current weight. That is, it is more important to record any trends in weight changes, instead of what you actually weigh now.

Overweight but malnourished

Recording weight fluctuations is especially important if you were overweight when you started your treatment. Although you may feel or look as if you are currently at a healthier weight, it is still possible for your nutritional health to be compromised. This applies even if you are still at a weight that may normally be considered overweight for your height.

Quite often, people who have started treatment at a weight that would be normally considered higher than ideal are equally as at risk of nutrition or malnutrition problems. What needs to be monitored is how much weight has been lost overall, or the total percentage body weight lost over the past one to three months. People who are overweight may still look healthy or at a normal weigh. However, as their weight may have changed significantly during their treatment, below the surface they may have lost significant amounts of lean muscle weight and the body may be struggling with the consequences of depleted nutrient stores.

In fact, poor nutritional health issues are often overlooked in someone who appears overweight. Remember to look at weight changes in the recent weeks and months, not what weight you are at present.

Screening your nutrition health risks when you have cancer.

Here is a simple questionnaire referred to as the Malnutrition Screening Tool (MST). It can be used as a tool to help identify whether you might be at risk of nutritional problems during your treatment. Remember it is just a tool and if you are at all concerned you should talk to your doctor or the specialist nurse team.

The following questions are used by many Australian cancer centres to a help identify individuals who may be at risk of nutritional problems. While a higher score doesn’t automatically mean you have nutritional problems, it does flag up those at risk, and those who are in need of a more thorough nutritional assessment by their doctor or the dietitian.

These simple screening questions should be reviewed on a regular basis, especially if you have a cancer which puts you at risk of nutritional problems, or you notice weight or shape changes.

Simply answer the questions below and then add up your scores. It is important to use the questions as a guide and if you are concerned by your results you should discuss this with your doctor or specialist nurse teams. If you are having problems you should ask to be referred to a cancer specialist dietitian.

Over the past 6 months have you lost weight recently without trying?

No
Unsure
Yes

score 0
score 2
answer question below

If yes, how much weight have you lost (kg)?

1-5
6 -10
>15
Unsure

score 1
score 2
score 3
score 2

Have you been eating poorly because of a decreased appetite?

No
Yes

score 0
score 1

Total weight loss and appetite score _______________________

Results

Score 0-1 – Assumes you are eating well and have not noticed any recent weight loss. Ongoing and regular reviews with your team or using this questionnaire are recommended.

Score 2-3 – Assumes you are having difficulties with your eating and not managing your normal approaches. It also assumes you have lost between 1-5kg. It is important you inform your team of the difficulties you may be having and request a referral to the cancer specialist dietitian soon as this possible. It is important to remember that small weekly losses can quickly add up to larger losses, poor nutrition and treatment impacts. Overweight individuals can also become protein depleted and malnourished too.

Score 4-5 This score suggests you have been having a lot of difficulty eating and have lost a large amount of weight > 6kg. It is important to contact your doctor and specialist team for immediate guidance and support.

If it is difficult to weigh yourself, or you aren’t quite sure how much weight you have lost, or exactly when, then you can look for other clues such as:

  • changes in where you buckle your belt
  • whether your rings are becoming loose
  • whether you can observe changes in your face
  • if people have noticed that you may have lost weight
  • if you notice your eyes look a little more sunken than usual

If you note any significant changes here, you should record this as a score 3 or 4.

 

At times, the scale weight can be misleading, especially if you are experiencing fluid buildup around the belly or in the legs or hand areas. Some people stand on the scales and think they have gained weight. However, as fluid weighs the same as tissue weight, this type of weight gain is not an indication of excess nutrition. In fact, quite often behind the fluid weight gain many individuals have lost fat and muscle weight, putting them at risk of nutritional health problems. If you are retaining fluid (also referred to as oedema or ascites) you may be at a higher risk of nutritional problems and again you should discuss this with your doctor or the specialist team.

If you are a health professional, you may wish to download this pdf which provides further guidance on this Malnutrition Screening Tool.

 

Reference 1. Ferguson M, Capra S, Bauer J, Banks M: Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.
Nutrition 1999;15(6):458–464.