Malnutrition in Spine Oncology: Where Are We and What Are We Measuring?

Study Design: Scoping review.

Objective: To identify which markers are used as surrogates for malnutrition in metastatic spine disease and which are the most studied outcomes associated with it.

Methods: A scoping review was performed by searching the PubMed/Medline, EMBASE, and Web of Science databases up to July 2022. We searched for articles exploring markers of malnutrition in spine oncology patients including but not limited to albumin, body weight, weight loss, and nutrition indices. A narrative synthesis was performed.

Results: A total of 61 articles reporting on 31,385 patients met inclusion criteria. There were 13 different surrogate markers of nutrition, with the most common being albumin in 67% of studies (n = 41), body weight/BMI in 34% (n = 21), and muscle mass in 28% (n = 17). The most common studied outcomes were survival in 82% (n = 50), complications in 28% (n = 17), and length of stay in 10% (n = 6) of studies. Quality of life and functional outcomes were assessed in 2% (n = 1) and 3% (n = 2) of studies, respectively. Out of 61 studies, 18% (n = 11) found no association between the examined markers and outcome.

Conclusion: Assessment of nutritional status in patients with spinal metastases is fundamental. However, there is lack of a comprehensive and consistent way of assessing malnutrition in oncologic spine patients and therefore inconsistency in its relationship with outcomes. A consensus agreement on the assessment and definition of malnutrition in spine tumor patients is needed.