RESUMO
Background: The current systematic review aimed to evaluate the Malnutrition Universal Screening Tool (MUST) for its effectiveness in determining patient outcomes (length of hospital stay, postoperative complications, infection rates, and survival) for colorectal cancer. Methods: Utilizing a comprehensive search strategy, this review mined literature up to December 2023 from the PubMed, Scopus, and Embase databases. The focus was on identifying studies that scrutinize the prognostic value of MUST in relation to hospital outcomes in colorectal cancer contexts. Adherence to PRISMA guidelines ensured a systematic approach, encompassing various study designs and outcome measures. Results: Among the seven studies incorporating 1950 patients, a significant correlation emerged between MUST scores and key hospital outcomes. Specifically, patients categorized as high MUST risk faced longer hospital stays, with a mean length of stay for high-risk patients extending up to 26.6 days compared to 14 days for those at lower risk. The prevalence of postoperative complications was substantially higher in the high-risk group, with up to 41.4% of high MUST risk patients experiencing severe complications (Clavien-Dindo 3-5) compared to 8.5% in the low-risk category. Notably, the review found that high MUST scores were strongly predictive of increased postoperative complications and a prolonged hospital stay, underscoring the tool's critical predictive utility for quality of life and use in clinical settings. Conclusions: Therefore, MUST's capability to predict longer hospital stays and a higher incidence of postoperative complications among high-risk patients highlights its essential function in preoperative evaluations and supports the integration of MUST into routine clinical assessments.
RESUMO
BACKGROUND: Evidence-based antiemetic guidelines offer predominantly consistent recommendations for chemotherapy-induced nausea and vomiting (CINV) prophylaxis. However, studies suggest that adherence to these recommendations is suboptimal. We explored inconsistencies between clinical practice and guideline-recommended treatment with a registry evaluating the effect of guideline-consistent CINV prophylaxis (GCCP) on patient outcomes. PATIENTS AND METHODS: This was a prospective, non-interventional, multicentre study. The primary objective was to assess the overall (Days 1-5) complete response (CR: no emesis/no rescue use) rates in patients who received GCCP or guideline-inconsistent CINV prophylaxis (GICP) using diaries for 5 days following chemotherapy. Cycle 1 results are presented in patients who received either (1) anthracycline/cyclophosphamide (AC) highly emetogenic chemotherapy (HEC), non-AC HEC or carboplatin, with GCCP for all these groups consisting of prophylaxis with an NK1 receptor antagonist (RA), 5-HT3RA and dexamethasone prior to chemotherapy or (2) moderately emetogenic chemotherapy (MEC), with GCCP consisting of a 5-HT3RA and dexamethasone prior to chemotherapy as per MASCC/ESMO 2016 guidelines, in place at the time of the study. RESULTS: 1,089 patients were part of the cycle 1 efficacy evaluation. Overall GCCP was 23%. CR rates were significantly higher (P < 0.05) in patients receiving GCCP (62.2%) versus GICP (52.6%) in the overall population, as well as in the subsets of patients receiving AC/non-AC HEC (60.2% versus 47.8%), MEC (73.8% versus 57.8%) and in those non-naïve to the chemotherapy received (65.9% versus 53.8%). No impact on daily living due to CINV (FLIE assessment) was observed in 43.4% patients receiving GCCP versus 28.5% GICP (P < 0.001). CONCLUSION: Consistent with prior studies, GCCP was very low; a significant benefit of almost 10% improved prevention of CINV was observed with GCCP. As per MASCC/ESMO guidelines, such an absolute difference should be practice changing. Comprehensive multifaceted strategies are needed to achieve better adherence to antiemetic guidelines.