PURPOSE Malnutrition (MN) in cancer is common but underdiagnosed. Dietitian referrals may not occur until MN is established. We investigated cancer patient characteristics (demographics, nutritional status, and nutrition barriers) on referral to oncology dietitians. We also examined referral practices and prevalence of missed referral opportunities. METHODS This was a naturalistic multi-site study of clinical practice. Data from consecutive referrals were collected in inpatient and outpatient settings. Demographics, nutritional status (weight, body mass index (BMI), weight loss in the preceding 3-6 months, oral intake, nutrition barriers), referral reasons, and use of screening were recorded. Missed opportunities for earlier referral were also noted. RESULTS Two hundred patients were included (60% male, 51% inpatients). Half had gastrointestinal and hepatobiliary cancers. The majority were on antitumor treatment. Two-thirds had lost ≥ 5% body weight. Forty percent were overweight or obese. Seventy percent had ≥ 2 nutritional barriers. Most common nutrition barriers were anorexia, nausea, and early satiety. Greater weight loss and lower food intake were associated with ≥ 2 barriers. Weight loss was the most common referral reason. Screening was used in 35%. Referrals should have occurred sooner in nearly half (45%, n = 89). CONCLUSIONS Cancer patients were referred late to a dietitian, with multiple nutritional barriers. Most referrals were for established weight loss (WL). WL may be masked by pre-existing obesity. Almost half had missed earlier referral opportunities; screening was infrequent. Over one-quarter should have been re-referred sooner. There is a clear need for clinician education. Future research should investigate the optimal timing of dietitian referral and the best nutrition screening tools for use in cancer.

中文翻译：

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营养不良的癌症患者晚期转诊至营养师：临床实践的前瞻性研究。

目的癌症中的营养不良（MN）很常见，但诊断不足。营养师转诊可能要等到MN建立后才能进行。我们调查了转介给肿瘤营养师的癌症患者特征（人口统计学，营养状况和营养障碍）。我们还检查了转诊实践和错过转诊机会的普遍性。方法这是对临床实践的自然主义多站点研究。连续转诊的数据是在住院和门诊患者中收集的。记录人口统计学，营养状况（体重，体重指数（BMI），前3-6个月的体重减轻，口服，营养障碍），转诊原因以及筛查的方法。还注意到错过了提前转诊的机会。结果共纳入200名患者（男性60％，住院患者51％）。一半患有胃肠道和肝胆癌。大多数接受抗肿瘤治疗。三分之二的体重减轻了5％以上。40％的人超重或肥胖。70％的营养障碍≥2。最常见的营养障碍是厌食，恶心和早饱。更大的体重减轻和更低的食物摄入量与≥2个障碍相关。减肥是最常见的转诊原因。筛查占35％。转诊应该早于近一半（45％，n = 89）。结论癌症患者被延迟到营养师那里接受营养治疗。大多数转诊是针对既定的体重减轻（WL）。WL可能被先前存在的肥胖所掩盖。几乎一半的人错过了更早的推荐机会；筛查很少。超过四分之一的内容应尽快重新引用。显然需要临床医生教育。未来的研究应该调查营养师转诊的最佳时机以及用于癌症的最佳营养筛查工具。