# Impact of COVID-19 on early identification of protein-energy malnutrition in the cancer care setting: a repeated cross-sectional survey of cancer care professionals

## TL;DR

This study examines how cancer care professionals' approaches to identifying malnutrition changed before and after the COVID-19 pandemic.

## Contribution

The study reveals regional shifts in malnutrition screening practices and barriers among cancer care professionals during and after the pandemic.

## Key findings

- Nutrition screening policies increased in North America post-pandemic.
- Barriers like limited awareness rose in North America but decreased in Oceania.
- Patient self-screening increased, but overall screening practices stagnated or declined in most regions.

## Abstract

What are the perceptions and practices regarding protein energy malnutrition (PEM) screening and assessment for patients with cancer among health professionals working in the cancer setting, and how have these perceptions and practices changed since the COVID-19 pandemic?

A repeated cross-sectional study was conducted in 2018 (pre-COVID-19) and 2024 (post-COVID-19) using a study-specific online 24-item questionnaire. Qualified health professionals working as clinicians in the cancer setting were eligible. The survey was disseminated via professional associations internationally. Data were analysed in Stata/MP 18.5.

Of N = 282 participants included (n = 197 pre-COVID-19, n = 85 post-COVID-19), most were dietitians (39%) from Oceania (29%). The reporting of workplace nutrition screening policies increased between pre- and post-COVID-19, especially in North America (56% to 100%, p = 0.013). Barriers to nutrition screening remained consistent pre- and post-COVID-19 except in North America where limited awareness increased (50% to 93%, p = 0.019) and in Oceania where there was a decrease in incorrect use of a screening tool (63% to 36%, p = 0.027). Nutrition screening and assessment implementation remained mostly unchanged, except for an increase in patient self-screening (15% to 28%; p = 0.029) and fewer non-admission assessments conducted in Oceania.

While some positive changes were observed between the pre- and post-COVID-19 period, nutrition screening and assessment continue to face many barriers. This has led to a lack of improvement or decline in nutrition screening and assessment practices in most regions and settings. PEM identification must evolve to ensure early detection for best patient care and in preparedness for future global health events.

The online version contains supplementary material available at 10.1007/s00520-026-10338-1.