Who should be screened
Evidence-based nutrition guidelines recommend all individuals with cancer be screened for malnutrition risk using a validated tool at diagnosis, and during and after cancer treatment, including surgery1-5. For this reason, all individuals referred into the prehabilitation service should be screened for malnutrition.
Why nutrition screening is important
As malnutrition is directly linked to increased risk of post-operative complications, the aim of nutrition screening is to identify if an individual is at risk of malnutrition. If deemed at risk, the patient should be referred to the dietitian for a comprehensive nutrition assessment and diagnosis of malnutrition3,5,6.
Which screening tool(s) to use
Whilst there is no universally recommended malnutrition screening tool for prehabilitation in individuals planned for cancer surgery, the following can be considered.
This quick, easy, two question tool investigates recent unintentional weight loss and recent poor intake due to poor appetite. It creates a score between 0-5, with a score of 2-5 indicating a risk of malnutrition which requires a referral to a dietitian for assessment of nutritional status and nutrition intervention. It is validated in cancer patients, reliable, and as height and weight is not required, no equipment is needed7,10. It is the most commonly used nutrition screening tool in Australia.
| Number of items | Time to complete | Cut offs for risk stratification | Can be completed by any clinician? | Can be completed by patient? | Can be completed remotely? | Freely available^? |
| 2 | 2 mins | 2-5 is risk of malnutrition | Yes | Yes | Yes | Yes |
This three question tool incorporates current weight and height (to calculate body mass index), the percentage of recent unintentional weight loss, and an acute disease state score (determined by the presence of acute illness, and/or if the individual is having/likely to have no nutritional intake for >5 days). This creates a score of 0-6, with 2-6 considered at risk of malnutrition, requiring a referral to a dietitian for assessment of nutritional status and nutrition intervention. The MUST is validated in acute and community adults, not specifically in cancer patients8,10.
| Number of items | Time to complete | Cut offs for risk stratification | Can be completed by any clinician? | Can be completed by patient? | Can be completed remotely? | Freely available^? |
| 3 | 3 mins | 2-6 is risk of malnutrition | Yes | Yes | Yes | Yes |
This is a component of the full Patient-Generated Subjective Global Assessment (PG-SGA) tool, which is used for assessing malnutrition status. The PG-SGA SF (also known as the abridged PG-SGA) consists of the first page of the 2 page PG-SGA, and is designed for the patient to complete. It consists of four boxes: box 1- body weight (scored 0–5); box 2- food intake (scored 0–4); box 3- symptoms affecting oral food intake (scored 0–23); and box 4- activities and function (scored 0-3). Upon completion, the scores of boxes 1-4 are totalled by a clinician. A score of >5 is considered at risk of malnutrition, requiring a referral to a dietitian for assessment of nutritional status and nutrition intervention9.
| Number of items | Time to complete | Cut offs for risk stratification | Can be completed by any clinician? | Can be completed by patient? | Can be completed remotely? | Freely available^? |
| 4 | 5 mins | >5 is risk of malnutrition | Yes | Yes | Yes | Yes |
^Correct at time of publication
- Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48.
- Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S, Laviano A, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40:4745-4761.
- Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Muhlebach S, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser J, Bischoff S. ESPEN practical guideline: Clinical nutrition in cancer. Clin Nutr. 2021;40:2898-2913.
- Macmillan Cancer Support (2025) Prehabilitation for people with cancer: clinical and implementation guidelines.
- Prado C, Laviano A, Gillis C, Sung A, Gardner M, Yalcin S, Dixon S, Newman S, Bastasch M, Sauer A, Hegazi R, Chasen M. Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care. Support Care Cancer. 2022;30:3073-3083.
- Gillis C, Hasil L, Kasvis P, Bibby N, Davies SJ, Prado C, West MA, Shaw C. Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology. Front Nutr. 2021;24(8):644706.
- Ferguson, Capra S, Bauer J, Banks M. Development of a valid and reliable Malnutrition Screening tool for adult acute hospital patients. Nutr. 1999;15(6):458-64.
- Elia M. THE ‘MUST’ REPORT. Nutritional screening of adults: a multidisciplinary responsibility Development and use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. Malnutrition Advisory Group. BAPEN. 2003 (pdf).
- De Groot LM, Lee G, Ackerie A, van der Meij BS, et al. Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria. Nutrients. 2020;12(8):2287.
- Reeves, J., Karunaratne, S., Alexander, K. et al. Expert Consensus on Self-Reported Physical, Nutritional, and Psychological Screening Tools for Prehabilitation in Gastrointestinal Cancer Surgery: An International Delphi Study. Ann Surg Oncol 33, 5751–5761 (2026)