Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

Among the 20 studies, cancer site was represented by a variety of solid and hematological malignancies, including nine colorectal, eight breast, five gastrointestinal, three head and neck, three hematological, three lung, two pancreatic; one central nervous system, one gynecological, one esophageal, one prostate, one ovarian, eight other cancer types, and one cancer type that was not specified.

“Among the 20 studies, cancer site was represented by a variety of solid and hematological malignancies, including nine colorectal, eight breast, five gastrointestinal, three head and neck, three hematological, three lung, two pancreatic; one central nervous system, one gynecological, one esophageal, one prostate, one ovarian, eight other cancer types (”

Probably not a substantial claim: may not pass S3 (load-bearing).

Males and females were represented almost equally (54.7% males).

“Males and females were represented almost equally (54.7% males).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The database search resulted in 11,551 records, of which 4445 were duplicates, leaving 7106 unique records.

“The database search resulted in 11,551 records, of which 4445 were duplicates, leaving 7106 unique records.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of the 738 full-text screened, 718 did not meet inclusion criteria and were excluded, leaving 20 records for inclusion.

“Of these, 718 did not meet the inclusion criteria and were excluded, leaving 20 records for inclusion in the review (Figure 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most studies evaluated the PG-SGA SF, MST, NRS-2002, and MUST.

“Most studies evaluated the PG-SGA SF, MST, NRS-2002, and MUST.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No included studies were conducted in the US.

“No studies were conducted in the US.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

After title and abstract screening, 6368 were excluded, leaving 738 for full-text screening.

“After title and abstract screening, 6368 were excluded, leaving 738 for full-text screening.”

May combine two claims.

The reference standard for most of the studies (n = 16) was the PG-SGA, followed by the SGA in three studies, and GLIM in one study.

“The reference standard for most of the studies (n = 16) was the PG-SGA, followed by the SGA in three studies, and GLIM in one study.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The BMI category distribution was 7.9% underweight (six studies), 43.2% normal weight (six studies), and 48.5% overweight/obese (eight studies).

“the BMI category distribution was 7.9% underweight (six studies), 43.2% normal weight (six studies), and 48.5% overweight/obese (eight studies).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Fifty percent of the studies included stage III/IV cancers.

“Fifty percent of the studies included stage III/IV cancers.”

May combine two claims.

Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening -2002 (NRS-2002; ...).

“Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5),Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening -2002 (NRS-2002;”

May combine two claims.

All included studies were observational (18 cross-sectional, one longitudinal, one retrospective) and included between 52 and 450 screened patients.

“All studies were observational (18 cross-sectional, one longitudinal, and one retrospective) and included between 52 and 450 screened patients.”

May combine two claims.

Malnutrition, according to the reference standard, was reported in 19 of the 20 studies and ranged from 6.9% to 98%.

“Malnutrition, according to the reference standard, was reported in 19 of the 20 studies and ranged from 6.9% to 98%.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the 18 studies that reported mean age, the average age of the population was 59.7 years.

“Of the 18 studies that reported mean age, the average age of the population was 59.7 years.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The average BMI across the studies was 24.3 kg/m2 (13 studies).

“The average body mass index (BMI) across the studies was 24.3 kg/m 2 (13 studies)”

May combine two claims.

Three of the evaluations using the MUST had good sensitivity and specificity, one had good sensitivity and fair specificity, and one had fair sensitivity and poor specificity.

“Three of the evaluations using the MUST had good sensitivity and specificity, one had good sensitivity and fair specificity, and one had fair sensitivity and poor specificity.”

May combine two claims.

Although one examination of NRS-2002 ≥ 3 had good sensitivity and specificity, when filtered to studies that used the PG-SGA boxes B and C (BC) or SGA BC reference standard, the results were either good sensitivity and poor specificity or good specificity and fair sensitivity.

“Although one examination of NRS-2002 ≥ 3 had good sensitivity and specificity, when filtered to studies that used the PG-SGA boxes B and C (BC) or SGA BC reference standard, the results were either good sensitivity and poor specificity or good specificity and fair sensitivity.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Seven of 100 patients were at nutrition risk before chemotherapy and this increased to 24 after chemotherapy.

“Seven of 100 patients were at nutrition risk before chemotherapy and this increased to 24 after chemotherapy.”

• cites [30]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The PG-SGA revealed malnutrition in 30% of males and 47% of females.

“The PG-SGA revealed malnutrition in 30% of males and 47% of females.”

• cites [29]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One study using the NRS-2002 did not measure sensitivity and specificity and used a Spearman correlation analysis.

“One study using the NRS-2002 did not measure sensitivity and specificity and used a Spearman correlation analysis.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The remaining eight studies were categorized as high risk because of the insufficient description of the selected participants.

“The remaining eight studies were categorized as high risk because of the insufficient description of the selected participants.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Thirteen studies were deemed low risk because of the clear description of the time interval between the index and reference tests and the inclusion of all patients evaluated.

“Thirteen studies were deemed low risk because of the clear description of the time interval between the index and reference tests and the inclusion of all patients evaluated.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Most research was focused on common solid tumors.

“Most research was focused on common solid tumors.”

May combine two claims.

The high risk of bias was due to the lack of clarity as to whether the index test results were interpreted without knowledge of the reference test outcomes and an absence of prespecified thresholds for the index test.

“The high risk of bias was due to the lack of clarity as to whether the index test results were interpreted without knowledge of the reference test outcomes and an absence of prespecified thresholds for the index test.”

May combine two claims.

Two studies were high risk and four were moderate risk, primarily owing to the absence of clarity about whether the reference standard results were interpreted without prior knowledge of index test results.

“Two studies were high risk and four were moderate risk, primarily owing to the absence of clarity about whether the reference standard results were interpreted without prior knowledge of index test results.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The third domain examined the risk of bias attributable to the reference standard used, wherein most (n = 14) studies were deemed at low risk of bias.

“The third domain examined the risk of bias attributable to the reference standard used, wherein most (n = 14) studies were deemed at low risk of bias.”

May combine two claims.

Malnutrition was associated with tumor progression but not the type of treatment.

“Malnutrition was also associated with tumor progression but not the type of treatment.”

• cites [26]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Only one study conducted malnutrition screenings at three different time intervals.

“Only one study conducted malnutrition screenings at three different time intervals.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Significant variations influenced by the location and the type of treatment in nutrition status were observed.

“Significant variations influenced by the location and the type of treatment in nutrition status were observed.”

• cites [16]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Nutrition risk and moderate or severe malnutrition (by PG-SGA ≥ 4) rose significantly as treatment progressed.

“Nutrition risk and moderate or severe malnutrition (by PG-SGA ≥ 4) rose significantly as treatment progressed.”

• cites [30]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

On the NRS-2002, a notable positive correlation occurred between the PG-SGA and the scored PG-SGA.

“On the NRS-2002, a notable positive correlation occurred between the PG-SGA and the scored PG-SGA.”

• cites [29]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The prevalence of malnutrition in patients with head and neck cancer was between 32% and 46%, whereas it remained <10% among patients with brain tumors.

“The prevalence of malnutrition in patients with head and neck cancer was between 32% and 46%, whereas it remained <10% among patients with brain tumors.”

• cites [21]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Five of nine studies assessing the MST used the PG-SGA as the reference standard, except one that used GLIM as the reference standard and had good sensitivity and fair specificity.

“Five of nine studies assessing the MST used the PG-SGA as the reference standard, except one that used GLIM as the reference standard and had good sensitivity and fair specificity.”

May combine two claims.

Three studies were high risk and four were moderate risk, primarily owing to the lack of inclusion of all patients who completed the index test in the final analysis and the lack of clarity regarding the interval between the index and reference tests.

“Three studies were high risk and four were moderate risk, primarily owing to the lack of inclusion of all patients who completed the index test in the final analysis and the lack of clarity regarding the interval between the index and reference tests.”

May combine two claims.

The NRI, evaluated in three studies, performed poorly, as did CONUT, MS-score, and SNAQ, in which each were evaluated in only one study.

“The NRI, evaluated in three studies, performed poorly, as did CONUT, MS-score, and SNAQ, in which each were evaluated in only one study.”

May combine two claims.

All 16 evaluations using the PG-SGA SF showed fair to good performance; the best performance with PG-SGA SF was at the cut-points of ≥7 and ≥8.

“All 16 evaluations using the PG-SGA SF showed fair to good performance; the best performance with PG-SGA SF was at the cut-points of ≥7 and ≥8.”

Probably not a substantial claim: may not pass S3 (load-bearing).

By the end of radiotherapy, all participants were at nutrition risk.

“By the end of radiotherapy, all participants were at nutrition risk.”

• cites [30]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The impact of malnutrition screening on clinical outcomes was not reported by these studies and therefore cannot inform these recommendations.

“Furthermore, the impact of malnutrition screening on clinical outcomes was not reported by these studies and therefore cannot inform these recommendations.”

May combine two claims.

Using GLIM as a reference standard, the MUST had good sensitivity and specificity, and the sensitivity and specificity were good in one study using the MUST with a cut-point of ≥1.

“Using GLIM as a reference standard, the MUST had good sensitivity and specificity, and the sensitivity and specificity were good in one study using the MUST with a cut-point of ≥1.”

May combine two claims.

Although seven of nine studies evaluating the MST used a cut-point of ≥2, one did not specify the cut-point, and one used a cut-point of ≥3.

“Although seven of nine studies evaluating the MST used a cut-point of ≥2, one did not specify the cut-point, and one used a cut-point of ≥3.”

May combine two claims.

Three of five MUST studies used a cut-point of ≥2; the PG-SGA was used as the reference standard in three of the five studies.

“Three of five MUST studies used a cut-point of ≥2; the PG-SGA was used as the reference standard in three of the five studies.”

Classified as probably not a substantial claim.

The Academy of Nutrition and Dietetics (AND) and ASPEN recommend the use of a single set of diagnostic criteria, including validated malnutrition screening tools to rapidly identify patients at risk.

“The Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) recommend the use of a single set of diagnostic criteria, including validated malnutrition screening tools to rapidly identify patients at risk. 5”

• cites [5]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In a 2019 survey, approximately half (53%) of all cancer centers implemented screening, with only 35% of those using validated screening tools.

“In a 2019 survey, approximately half (53%) of all cancer centers implemented screening, with only 35% of those using validated screening tools.6”

• cites [6]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Malnutrition is present in 25% to 75% of patients with cancer.

“Malnutrition is present in 25% to 75% of patients with cancer, [1][2][3]”

• cites [1]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [2]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [3]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Malnutrition increases treatment interruptions and toxicities, hospital admissions and length of stay, and mortality in patients with cancer.

“increasing treatment interruptions and toxicities, hospital admissions and length of stay, and mortality.4”

• cites [4]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable).

Recommendations for malnutrition screening in outpatient cancer centers can better define malnutrition prevalence and impact on patients.

“Thus, recommendations for malnutrition screening in outpatient cancer centers can better define malnutrition prevalence and impact on patients.”

May combine two claims.

Although medical insurance providers are increasingly covering nutrition counseling by RDN practitioners, the Centers for Medicare and Medicaid Services do not reimburse nutrition services for oncology patients.

“Although medical insurance providers are increasingly covering nutrition counseling by RDN practitioners, the Centers for Medicare and Medicaid Services do not reimburse nutrition services for oncology patients.”

• cites [6]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

The updated evaluation of the literature supports prior reports recommending regular malnutrition screening for all patients with cancer.

“Our updated evaluation of the literature supports these prior reports.”

May combine two claims.

Implementing nutrition screenings in the electronic health record is feasible and can offer consistent long-term results.

“Implementing nutrition screenings in the EHR is feasible and can offer consistent long-term results.”

• cites [65]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Several systematic reviews and international panels recommend that all patients with cancer be screened for risk of malnutrition regularly with a valid malnutrition screening tool.

“Several systematic reviews and international panels recommend that all patients with cancer be screened for risk of malnutrition regularly with a valid malnutrition screening tool.”

• cites [55]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [56]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two reviewers independently screened each record at both stages; a different third reviewer resolved any disagreements.

“Two reviewers independently screened each record at both stages; a different third reviewer resolved any disagreements between the reviewers.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Considering that malnutrition affects 25% to 75% of patients with cancer, between 475,000 and 1.425 million individuals may be at risk for malnutrition.

“Considering that malnutrition affects 25% to 75% of patients with cancer, 1-3 between 475,000 and 1.425 million individuals may be at risk for malnutrition.”

• cites [1]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [2]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [3]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

An independent panel convened during a National Institutes of Health workshop supports malnutrition screening at the time of cancer diagnosis and at regular intervals throughout treatment and survivorship.

“An independent panel, convened during a National Institutes of Health workshop, also supports the recommendation of malnutrition screening at the time of cancer diagnosis and at regular intervals throughout the course of treatment and survivorship.”

• cites [63]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

A protocol for the systematic review was written a priori following the PRISMA-P checklist.

“A protocol for the systematic review on malnutrition screening tools used in oncology care was written a priori following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) checklist.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two reviewers assessed risk of bias for each included article independently using QUADAS-2; disagreements resolved by discussion.

“Two reviewers assessed the risk of bias for each included article independently using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.12 Disagreements between reviewers were resolved by discussion between the reviewers and an additional team member.”

• cites [12]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Before formal screening, all participating reviewers completed pilot training.

“Before commencing the formal screening process, all participating reviewers completed pilot training.”

May combine two claims.

Although achieving 100% screening might be challenging, screening rates of close to 75% are feasible.

“Although achieving 100% screening might be challenging, screening rates of close to 75% are feasible.”

May combine two claims.

Malnutrition is associated with increased complication rates, poor postoperative outcomes, longer hospitalization, and poor quality of life.

“and increased complication rates, poor postoperative outcomes, longer hospitalization, and a poor quality of life.”

• cites [1]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [50]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [51]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two reviewers independently extracted data from each included article; discrepancies were resolved by a different reviewer.

“Two reviewers independently extracted data from each included article using Microsoft Excel (Redmond, WA).Discrepancies were resolved by a different reviewer.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The PRISMA checklist was used for reporting this review.

“The PRISMA checklist was used for reporting this review.9,10”

• cites [9]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [10]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Even though healthcare professionals recognize the role of nutrition in patient recovery, nutrition care often happens in an isolated manner with team members working concurrently but not collaboratively.

“Even though healthcare professionals recognize the role of nutrition in patient recovery, nutrition care often happens in an isolated manner with team members working concurrently but not collaboratively.”

• cites [67]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

In the US, an estimated 1.9 million individuals were diagnosed with cancer in 2023.

“In the US, an estimated 1.9 million individuals were diagnosed with cancer in 2023.”

• cites [69]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

This is the first systematic review to examine malnutrition screening tools specifically designed and validated for use in ambulatory settings for adults and for those with cancer.

“This is the first systematic review to examine malnutrition screening tools specifically designed and validated for use in ambulatory settings for adults and for those with cancer.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Diagnosing malnutrition may involve simple assessments of appetite and unintentional weight loss, whereas more complex tools measure anthropometric data and laboratory parameters.

“Diagnosing malnutrition may involve simple assessments of appetite and unintentional weight loss, whereas more complex tools measure anthropometric data and laboratory parameters.5”

• cites [5]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

The European Society for Clinical Nutrition and Metabolism advises regular screening for malnutrition risk or presence in all patients with cancer.

“The European Society for Clinical Nutrition and Metabolism advises regular screening for malnutrition risk or presence in all patients with cancer.”

• cites [55]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [62]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Malnutrition is associated with a lower tolerance to anticancer treatments because of increased toxicity, lower compliance, and reduced response to treatments.

“Malnutrition is associated with a lower tolerance to anticancer treatments because of increased toxicity, lower compliance, and reduced response to treatments”

• cites [49]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In the US, there is an average of 1.7 full-time equivalent RDNs employed in outpatient oncology centers and one RDN for every 2308 patients.

“In the US, there is an average of 1.7 full-time equivalent RDNs employed in outpatient oncology centers and one RDN for every 2308 patients.”

• cites [6]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Implementing malnutrition screening can be challenging, with barriers including nonstandardized patient referral protocols, limited administrative support, competing staff time constraints, limited RDN services, lack of screening tools and implementation consensus, and limited frontline or nursing support.

“Implementing malnutrition screening can be challenging, with barriers including nonstandardized patient referral protocols, limited administrative support, competing staff time constraints, limited RDN services, lack of screening tools and implementation consensus, and limited frontline or nursing support.”

• cites [6]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Many centers do not bill for nutrition services.

“Many centers do not bill for nutrition services.”

Classified as probably not a substantial claim. May combine two claims.

Malnutrition screening is crucial for the early identification of patients requiring nutrition intervention and across various cancer types, stages, and treatments.

“Malnutrition screening is crucial for the early identification of patients requiring nutrition intervention and across various cancer types, stages, and treatments.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Implementation of malnutrition screening is inexpensive, requires minimal time, and can be efficient.

“Implementation is inexpensive, requires minimal time, and can be efficient.”

May combine two claims.

Many patients in adult oncology ambulatory care are malnourished and require timely medical nutrition therapy.

“Many patients in adult oncology ambulatory care are malnourished and require timely medical nutrition therapy.”

Probably not a substantial claim: may not pass S3 (load-bearing).

As GLIM is a relatively recent screening and assessment tool, its use as a reference standard was less frequent.

“As GLIM is a relatively recent screening and assessment tool, its use as a reference standard was less frequent.”

May combine two claims.

These high costs are primarily due to increased rates of hospital admissions, readmissions, more frequent consultations with primary care providers, and increased use of medications.

“These high costs are primarily due to increased rates of hospital admissions, readmissions, more frequent consultations with primary care providers, and increased use of medications.”

• cites [71]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [72]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [73]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Roughly 5% of patients with cancer undergoing medical treatment were at risk, whereas approximately 12% of patients undergoing radiation treatment were at risk.

“Roughly 5% of patients with cancer undergoing medical treatment were at risk, whereas approximately 12% of patients undergoing radiation treatment were at risk.”

• cites [65]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The studies were conducted outside the US, limiting their applicability in the US healthcare system.

“The studies were conducted outside the US, limiting their applicability in the US healthcare system.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Consequently, the financial burden of failing to address malnutrition is substantial.

“Consequently, the financial burden of failing to address malnutrition is substantial.”

The quote only partly states this claim.

Based on previous findings that oncology RDNs evaluate or counsel an average of 7.4 patients in an 8-h workday, 1.2 RDN full-time equivalents would be required to provide proactive nutrition counseling to patients identified at risk for malnutrition.

“Based on previous findings that oncology RDNs evaluate or counsel an average of 7.4 patients in an 8-h workday, 6 1.2 RDN fulltime equivalents would be required to provide proactive nutrition counseling to patients identified at risk for malnutrition.”

• cites [6]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [65]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Widespread standardization and implementation of malnutrition screening would reduce the massive underdiagnosis of malnutrition in oncology patients.

“Widespread standardization and implementation of malnutrition screening would serve to reduce the massive underdiagnosis of this common and debilitating issue.”