Skip to main content
SpringerLink
Log in

Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREE II instrument

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the quality of published clinical practice guidelines (CPGs) regarding the nutritional risk screening and assessment of cancer patients and to identify high-quality CPGs for clinical healthcare professionals.

Methods

Guidelines for the nutritional risk screening and assessment of cancer patients were comprehensively searched in eight electronic databases, including The Lancet, PubMed, Cochrane Library, Excerpta Medica dataBASE (EMBASE), Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), and Wan Fang Data, through August 2020. Six relevant guideline databases, including the National Comprehensive Cancer Network (NCCN), the National Guideline Clearinghouse (NGC), the Guideline International Network (GIN), the New Zealand Guidelines Group (NZGG), the China Guideline Clearinghouse (CGC), and Medlive, and relevant nutrition society websites, were also searched through August 2020. The methodological quality of the included CPGs was appraised independently by three assessors using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II) tool.

Results

Seven CPGs were located, and the domain with the highest percentage was “clarity of presentation” (85.44%), while the domain with the lowest percentage was “applicability” (40.26%). From the AGREE II results, two guidelines were rated as “strongly recommended,” three were assessed as “recommended with modifications,” and two were deemed as “not recommended.”

Conclusion

Considering that the two “strongly recommended” guidelines were developed within the American and European contexts, translation, validation, and cultural adaptation are recommended prior to implementing these guidelines in other countries or healthcare contexts to improve their effectiveness and sensitivity for local cancer patients.

Trial registration

PROSPERO registration of the study protocol: CRD42020177390 (July 5, 2020)

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Brouwers MC, Kho ME, Browman GP et al (2010) AGREE II: advancing guideline development, reporting and evaluation in health care. J Clin Epidemiol 63(12):1308–1311. https://doi.org/10.1016/j.spinee.2015.06.022

    Article  PubMed  Google Scholar 

  2. Coroneos CJ, Voineskos SH, Cornacchi SD, Goldsmith C, Ignacy T, Thoma A (2014) Users’ guide to the surgical literature: how to evaluate clinical practice guidelines. Can J Surg 57(4):280–286. https://doi.org/10.1503/cjs.029612

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sabharwal S, Patel V, Nijjer SS, Kirresh A, Darzi A, Chambers JC, Malik I, Kooner JS, Athanasiou T (2013) Guidelines in cardiac clinical practice: evaluation of their methodological quality using the AGREE II instrument. J R Soc Med 106(8):315–322. https://doi.org/10.1177/0141076813486261

    Article  PubMed  PubMed Central  Google Scholar 

  4. Don-Wauchope AC, Sievenpiper JL, Hill SA, Iorio A (2012) Applicability of the AGREE II Instrument in evaluating the development process and quality of current national academy of clinical biochemistry guidelines. Clin Chem 58(10):1426–1437. https://doi.org/10.1373/clinchem.2012.185850

    Article  CAS  PubMed  Google Scholar 

  5. Cluzeau F (2003) Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care 12(1):18–23. https://doi.org/10.1136/qhc.12.1.18

    Article  Google Scholar 

  6. Brouwers MC, Kerkvliet K, Spithoff K, AGREE Next Steps Consortium (2016) The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ 352:i1152. https://doi.org/10.1136/bmj.i1152

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jun C-C, Jian P-L, Wu W (2007) Appraisal of Guidelines Research & Evaluation: AGREE instrument. J Evid Based Med 7(5):291–294. https://doi.org/10.3969/j.issn.1671-5144.2007.05.010

    Article  Google Scholar 

  8. AGREE Next Steps Consortium. (2017). The AGREE II instrument [Electronic version]. Available at: http://www.agreetrust.org.

  9. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  10. Maia F, Silva TA, Generoso SV et al (2020) Malnutrition is associated with poor health-related quality of life in surgical patients with gastrointestinal cancer. Nutrition 75-76:110769. https://doi.org/10.1016/j.nut.2020.110769

    Article  PubMed  Google Scholar 

  11. Planas M, Alvarez-Hernandez J, Leon-Sanz M et al (2016) Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES(R) study. Support Care Cancer 24(1):429–435. https://doi.org/10.1007/s00520-015-2813-7

    Article  PubMed  Google Scholar 

  12. Capra S, Ferguson M, Ried K (2001) Cancer: impact of nutrition intervention outcome nutrition issues for patients. Nutrition 17(9):769–772. https://doi.org/10.1016/s0899-9007(01)00632-3

    Article  CAS  PubMed  Google Scholar 

  13. Ukovic B, Porter J (2020) Nutrition interventions to improve the appetite of adults undergoing cancer treatment: a systematic review. Support Care Cancer 28(10):4575–4583. https://doi.org/10.1007/s00520-020-05475-0

    Article  PubMed  Google Scholar 

  14. Huhmann MB, August DA (2020) Perioperative nutrition support in cancer patients. Nutr Clin Pract 27(5):586–592. https://doi.org/10.1177/0884533612455203

    Article  Google Scholar 

  15. Leuenberger M, Kurmann S, Stanga Z (2010) Nutritional screening tools in daily clinical practice: the focus on cancer. Support Care Cancer 18:17–27. https://doi.org/10.1007/s00520-009-0805-1

    Article  Google Scholar 

  16. Zhang Y, Jiang Z-M (2012) Nutrition screening, assessment, and intervention are key steps in the diagnosis and treatment of adult nutrition: the American Society for Parenteral & Enteral Nutrition (ASPEN) 2011 Clinical Guidelines. Chin J Clin Nutr 20(5):261–268. https://doi.org/10.3760/cma.j.issn.1674-635X.2012.05.001

    Article  Google Scholar 

  17. Thompson KL, Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T (2016) Oncology evidence-based nutrition practice guideline for adults. J Acad Nutr Diet 117(2):297–310. https://doi.org/10.1016/j.jand.2016.05.010

    Article  PubMed  Google Scholar 

  18. 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 (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36(1):11–48. https://doi.org/10.1016/j.clnu.2016.07.015

    Article  PubMed  Google Scholar 

  19. Mueller C, Compher C, Ellen DM (2011) A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. J Parenter Enter Nutr 35(1):16–24. https://doi.org/10.1177/0148607110389335

    Article  Google Scholar 

  20. Wu G-H, Tan S-J (2017) Guidelines on nutritional support in patients with tumor. Chin J Surg 55(11):801–829. https://doi.org/10.3760/cma.j.issn.0529-5815.2017.11.001

    Article  Google Scholar 

  21. Yao L, Chen Y, Wang X, Shi X, Wang Y, Guo T, Yang K (2017) Appraising the quality of clinical practice guidelines in traditional Chinese medicine using AGREE II instrument: a systematic review. Int J Clin Pract 71(5). https://doi.org/10.1111/ijcp.12931

  22. Ciapponi A, Tapia-Lopez E, Virgilio S et al (2020) The quality of clinical practice guidelines for preoperative care using the AGREE II instrument: a systematic review. Cochrane Database Syst Rev 9(1):159. https://doi.org/10.1186/s13643-020-01404-8

    Article  Google Scholar 

  23. Nygaard CC, Tsiapakidou S, Pape J, Falconi G, Betschart C, Pergialiotis V, Doumouchtsis SK (2020) Appraisal of clinical practice guidelines on the management of obstetric perineal lacerations and care using the AGREE II instrument. Eur J Obstet Gynecol Reprod Biol 247:66–72. https://doi.org/10.1016/j.ejogrb.2020.01.049

    Article  PubMed  Google Scholar 

  24. Jin F-W, Xu Y, Chen Y et al (2018) Quality appraisal of evidence-based guidelines on prevention and repair of perineal injury at vaginal delivery. Chin J Nurs 53(02):162–168. https://doi.org/10.3761/j.issn.0254-1769.2018.02.007

    Article  Google Scholar 

  25. Koo TK, Li Mae YL (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  26. Skipper A, Coltman A, Tomesko J, Charney P, Porcari J, Piemonte TA, Handu D, Cheng FW (2020) Position of the academy of nutrition and dietetics: malnutrition (undernutrition) screening tools for all adults. J Acad Nutr Diet 120(4):709–713. https://doi.org/10.1016/j.jand.2019.09.011

    Article  PubMed  Google Scholar 

  27. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN) (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22(4):415–421. https://doi.org/10.1016/s0261-5614(03)00098-0

    Article  CAS  PubMed  Google Scholar 

  28. Ruiz-Santana S, Arboleda SJ, Abiles J (2011) Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Nutritional assessment. Nutr Hosp 26(Suppl 2):12–15. https://doi.org/10.1590/S0212-16112011000800003

    Article  PubMed  Google Scholar 

  29. Zhang B, Xing X-X, Li X-L (2018) Analysis of guidelines for the prevention of chemotherapy-induced nausea and vomiting and methodology evaluation. Pract Pharm Clin Rem 21(2):146–152. https://doi.org/10.14053/j.cnki.ppcr.201802006

    Article  Google Scholar 

  30. Hou Y, Yang Z, Lin J, Chen Y, Xing D, Wang B (2018) Systematic review of clinical practice guidelines on exercise therapy for knee osteoarthritis and critical appraisal using AGREE II instrument. Osteoarthr Cartil 26:S324–S325. https://doi.org/10.1016/j.joca.2018.02.646

    Article  Google Scholar 

  31. Ruszczynski M, Ambrozej D, Adamiec A et al (2020) Preschool wheezing and asthma in children: A systematic review of guidelines and quality appraisal with the AGREE II instrument. Pediatr Allergy Immunol 32:92–105. https://doi.org/10.1111/pai.13334

    Article  PubMed  Google Scholar 

  32. Xing Y-N, Chen J, Liu H et al (2019) Quality evaluation and content analysis of clinical practice guidelines on childhood asthma. Adv Nurse Pract 19(02):253–260. https://doi.org/10.3969/j.issn.1672-1756.2019.02.020

    Article  Google Scholar 

  33. Zhu C, Wang B, Gao Y, Ma X (2018) Prevalence and relationship of malnutrition and distress in patients with cancer using questionnaires. BMC Cancer 18(1):1272. https://doi.org/10.1186/s12885-018-5176-x

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zeng X, Zhang Y, Kwong JS et al (2015) The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med 8(1):2–10. https://doi.org/10.1111/jebm.12141

    Article  PubMed  Google Scholar 

  35. Shokri A, Sabour S (2020) Validity and reliability of a nutrition screening tool in identifying malnutrition among hospitalized adult patients: methodological issue. Nutr Clin Pract 35(2):363–364. https://doi.org/10.1002/ncp.10460

    Article  PubMed  Google Scholar 

  36. Armstrong MJ, Gronseth GS, Gagliardi AR, Mullins CD (2020) Participation and consultation engagement strategies have complementary roles: a case study of patient and public involvement in clinical practice guideline development. Health Expect 23(2):423–432. https://doi.org/10.1111/hex.13018

    Article  PubMed  Google Scholar 

  37. Moayyedi P, Marsiglio M, Andrews CN, Graff LA, Korownyk C, Kvern B, Lazarescu A, Liu L, MacQueen G, Paterson WG, Sidani S, Vanner SJ, Sinclair P, Marshall L, Fernandes A (2019) Patient engagement and multidisciplinary involvement has an impact on clinical guideline development and decisions: a comparison of two irritable bowel syndrome guidelines using the same data. J Can Assoc Gastroenterol 2(1):30–36. https://doi.org/10.1093/jcag/gwy072

    Article  PubMed  PubMed Central  Google Scholar 

  38. Boivin A, Currie K, Fervers B, Gracia J, James M, Marshall C, Sakala C, Sanger S, Strid J, Thomas V, van der Weijden T, Grol R, Burgers J, on behalf of G-I-N PUBLIC (2010) Patient and public involvement in clinical guidelines: international experiences and future perspectives. Qual Saf Health Care 19(5):e22. https://doi.org/10.1136/qshc.2009.034835

    Article  PubMed  Google Scholar 

  39. Zhou F (2020) Research progress on the construction of clinical practice guidelines for patient and public participation and their methods. J Nurs (China) 27(05):14–17. https://doi.org/10.16460/j.issn1008-9969.2020.05.014

    Article  Google Scholar 

  40. Colapinto CK, Ellis A, Faloon-Drew K, Lowell H (2016) Developing an evidence review cycle model for Canadian dietary guidance. J Nutr Educ Behav 48(1):77–83. https://doi.org/10.1016/j.jneb.2015.08.018

    Article  PubMed  Google Scholar 

  41. Liu JP (2009) Clinical research methodology of evidence-based Chinese medicine. Beijing, China

    Google Scholar 

  42. Nissen T, Wayant C, Wahlstrom A, Sinnett P, Fugate C, Herrington J, Vassar M (2017) Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity. Clin Obes 7(1):34–45. https://doi.org/10.1111/cob.12174

    Article  CAS  PubMed  Google Scholar 

  43. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gordon G, Andrew DO, Elie A et al (2011) GRADE guidelines: 1. Introduction to GRADE evidence profiles and summary of findings tables. Chin J Evid Based Med 11(4):437–445. https://doi.org/10.1016/j.jclinepi.2010.04.026

    Article  Google Scholar 

  45. Shekelle PG, Ortiz E, Rhodes S, Morton SC, Eccles MP, Grimshaw JM, Woolf SH (2001) Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA 286(12):1461–1467. https://doi.org/10.1001/jama.286.12.1461

    Article  CAS  PubMed  Google Scholar 

  46. Lawson CS, Campbell KL, Dimakopoulos I, Dockrell MEC (2012) Assessing the validity and reliability of the MUST and MST nutrition screening tools in renal inpatients. J Ren Nutr 22(5):499–506. https://doi.org/10.1053/j.jrn.2011.08.005

    Article  PubMed  Google Scholar 

  47. Hartz L, Stroup BM, Bibelnieks TA et al (2019) ThedaCare Nutrition Risk Screen improves the identification of non-intensive care unit patients at risk for malnutrition compared with the Nutrition Risk Screen 2002. J Parenter Enter Nutr 43(1):70–80. https://doi.org/10.1002/jpen.1315

    Article  Google Scholar 

  48. Wei L-L, Li H-R, Wang Z-J et al (2020) Clinical practice guidelines of rehabilitation: methodological quality. Chin J Rehabil Theory Pract 26(02):144–149. https://doi.org/10.3969/j.issn.1006-9771.2020.02.003

    Article  Google Scholar 

  49. Husovich ME, Zadro R, Zoller-Neuner LL, Vangheel G, Anyangwe O, Ryan DP, Rygiel-Zbikowska B (2019) Process management framework: guidance to successful implementation of processes in clinical development. Ther Innov Regul Sci 53(1):25–35. https://doi.org/10.1177/2168479018817751

    Article  PubMed  Google Scholar 

  50. Zhang M, Zhou Y, Zhong J, Wang K, Ding Y, Li L, Pan X (2019) Quality appraisal of gestational diabetes mellitus guidelines with AGREE II: a systematic review. BMC Pregnancy Childbirth 19(1):478. https://doi.org/10.1186/s12884-019-2597-8

    Article  PubMed  PubMed Central  Google Scholar 

  51. Traversa G, Venegoni M (2018) Conflict of interest and public health body: the bias and the rule. Epidemiol Prev 42(2):105. https://doi.org/10.19191/EP18.2.P105.032

    Article  PubMed  Google Scholar 

Download references

Availability of data and materials

All authors agreed that the data can be made public and used.

Code availability

Not applicable.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Fujian University of Traditional Chinese Medicine, 1 Qiu Yang Road, Fuzhou, Fujian, China

    Hong-Juan Zhou, Li-Jin Deng, Jin-Xiu Chen, Liu Yang, Fang Liu, Mei-Hua Weng & Jing-Wen Hu

  2. College of Nursing and Midwifery Brisbane Center, Charles Darwin University, Brisbane, QLD, 4000, Australia

    Tao Wang & Jing-Yu Tan

  3. Rehabilitation Hospital affiliated with Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China

    Su-Zhen Jiang

Authors
  1. Hong-Juan Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li-Jin Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin-Xiu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Su-Zhen Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mei-Hua Weng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jing-Wen Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jing-Yu Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HJZ and LJD contributed equally to this work. HJZ and LJD led the study conception and design. HJZ, MHW, and JWH contributed to the data collection, review of the guidelines, and interpretation of the data. TW and SZJ examined the data. HJZ and LJD drafted and revised the manuscript. JYT and TW contributed to the study conception and design, and supported the data analysis and manuscript revision. JXC, LY, and FL supported the guideline review andrevised the manuscript.

Corresponding author

Correspondence to Jing-Yu Tan.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

All authors agree that the data can be made public.

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhou, HJ., Deng, LJ., Wang, T. et al. Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREE II instrument. Support Care Cancer 29, 2885–2893 (2021). https://doi.org/10.1007/s00520-021-06094-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-021-06094-z

Keywords

Search

Navigation