# Feasibility and Acceptability of the Cancer-Specific PRONTO Protocol for Nutritional Risk Screening in Outpatient Oncology Cancer Care: A Pilot Study

## TL;DR

A new tool called PRONTO helps oncologists quickly identify patients at risk of malnutrition during their first cancer visit, showing promise for early detection and better care.

## Contribution

PRONTO is a novel, simple, and efficient tool for early nutritional risk screening in oncology settings.

## Key findings

- PRONTO identified 62% of patients at nutritional risk, with high sensitivity and specificity compared to standard methods.
- Oncologists rated PRONTO highly for usability and would recommend it to colleagues.
- The study highlights the high prevalence of nutritional risk among newly diagnosed cancer patients.

## Abstract

Malnutrition or its risk is common in people with cancer and can negatively affect their treatment and quality of life. However, it is often not detected early enough. This study tested a new screening tool called PRONTO (PROtocol for NuTritional risk in Oncology), designed to help oncologists quickly identify patients at risk of malnutrition during their first oncology visit. The tool is simple, fast, and easy to use, and it asks patients about recent weight loss, appetite, and strength. In this pilot study, the PRONTO successfully identified most patients who were later confirmed to have malnutrition using standard methods. Oncologists also found the tool highly usable and would recommend it to colleagues. These results suggest that the PRONTO could help improve early detection of nutritional problems in cancer care, allowing for timely support and better outcomes. Further research is needed to confirm its use in larger and more diverse patient groups and oncologist subspecialties.

Background: Malnutrition or its risk is common among patients with cancer (from 15% to 90%) and can negatively impact treatment outcomes and quality of life. Early detection and nutritional intervention are essential to improve clinical, health, and economic outcomes. This study evaluates the PRONTO (PROtocol for NuTritional risk in Oncology), a novel tool designed for the early identification of nutritional risk in patients with cancer. Objectives: To assess the feasibility of the PRONTO in detecting nutritional risk among newly diagnosed oncology patients. Methods: This cross-sectional, observational pilot study included 200 patients from two oncology centers in Madrid, Spain. The PRONTO was applied during the first oncology visit. Nutritional risk was assessed using PRONTO and nutritional status was evaluated with the Global Leadership Initiative on Malnutrition (GLIM) criteria. Tool acceptability was measured using the System Usability Scale (SUS) and Net Promoter Score (NPS) among participating oncologists. Results: The PRONTO identified 62.0% of patients at nutritional risk, while malnutrition was confirmed in 57.0% of patients using GLIM criteria. The PRONTO demonstrated high sensitivity (90.4%) and specificity (75.6%) compared to the GLIM. Oncologists rated the PRONTO highly, with a SUS score of 87.9 and an NPS of 9.1, indicating strong usability and recommendation potential. Conclusions: The PRONTO is a feasible and practical tool for early nutritional risk screening in oncology settings. Its simplicity and efficiency support its integration into routine clinical practice. The high prevalence of nutritional risk underscores the need for early screening to guide timely nutrition care. Further research with larger and diverse groups of patients and oncologists is needed to validate scalability and assess the impact of nutritional interventions on patient outcomes.