Implementation and Impact of Nutritional Protocols in Oncology: A Multicenter Evaluation and HCPs' Perspectives on Screening, Intervention, and Monitoring Practices

BACKGROUND AND AIM: Malnutrition is a prevalent yet under-recognized complication in oncology that adversely affects treatment outcomes and quality of life. Although existing guidelines recommend early nutritional screening and intervention, their consistent implementation in routine oncology care remains limited. This study aimed to address this gap by: (1) developing and implementing a nutritional screening protocol across cancer day hospitals, (2) assessing health care professionals' (HCPs) perceptions about the protocol's effectiveness, and (3) building expert consensus on approaches to better integrate nutritional care into routine oncology practice.

METHODS: A standardized nutritional screening protocol for patients with cancer was implemented across 13 hospitals in Portugal. Subsequently, a mixed-methods approach was employed involving, in the first phase, a quantitative survey to assess HCPs' perceptions regarding the protocol's implementation and impact, and in the second phase of the study, an expert panel consensus. The survey's structured questionnaire evaluated implementation practices, perceived care improvements, and patient demographics. Surveys were distributed in two rounds (October 1 and October 21, 2024) and responses were collected over two months. Subsequently, the findings were presented to a multidisciplinary expert panel (May, 2025) to establish consensus on strategies for the integration of nutritional care into routine oncology practice. Descriptive statistics and qualitative synthesis were used for data analysis.

RESULTS: Sixty HCPs (oncologists: 21, nurses: 23, nutritionists: 16) participated in the survey. Nutritional risk screening was conducted for 1,023 patients over an average period of four months; 55% of them were at nutritional risk as per the HCP survey. Screening was primarily conducted by nurses during initial appointments, using validated tools such as Nutritional Risk Screening (NRS)-2002. Key criteria for identifying risk included: nutrition impact symptoms, weight loss, and reduced intake. The most commonly implemented interventions were referral to a clinical nutritionist and the use of oral nutritional supplements. Post-implementation, nutritional consultations increased by 20.2% (p = 0.033), and waiting times for high-risk patients decreased by 43.2% (p = 0.001), allowing for compliance with the national directives. HCPs reported improved multidisciplinary coordination and training. The main implementation challenges were time constraints and insufficient staff.

CONCLUSIONS: Implementation of nutritional screening protocols in routine oncology care is feasible and effective but requires systemic support for sustainability.