Low referral uptake, not patient adherence, limits implementation of early nutritional screening in head and neck and upper gastrointestinal cancers.

BACKGROUND: Malnutrition is highly prevalent in patients with head and neck and upper gastrointestinal cancers and is associated with poorer clinical outcomes. Despite guideline recommendations, early nutritional screening remains inconsistently implemented in routine oncology care. METHODS: This single-center prospective feasibility study evaluated the implementation of an early nutritional screening and intervention pathway in newly diagnosed oncology patients with head and neck and upper gatrointestinal cancers. Eligible patients were enrolled within 7 days of their first oncology consultation and entered a structured nutritional pathway including baseline (T0), one-month (T1), and two-month (T2) assessments. Nutritional evaluation included MUST screening, anthropometric measures, bioelectrical impedance analysis, handgrip strength, biochemical parameters, and patient-reported outcomes (ESAS and FACT-G). Feasibility endpoints included referral, enrolment, and adherence rates. RESULTS: Among 550 eligible patients, 77 were enrolled (14%). Once enrolled, adherence to the pathway was high (91%). At baseline, 47% of patients were classified as at high nutritional risk. Serum biochemical markers, available in a subset of patients, were consistent with mild nutritional alterations. During follow-up, body weight, handgrip strenght, biochemical and bioelectrical impedance parameters, and overall quality of life remained stable. Significant improvements were observed in selected symptoms, including fatigue, nausea, and well-being/malaise. CONCLUSION: Early nutritional screening is feasible and highly acceptable once implemented. However, implementation at the population level is limited by low and non-systematic referral rates, highlighting a critical gap in routine oncology care.