A qualitative exploration of nutrition screening, assessment and oral support used in patients undergoing cancer surgery in low-and middle-income countries

Anne Marie Sowerbutts, Stephen R. Knight, Marie Carmela M. Lapitan, Ahmad U. Qureshi, Mayaba Maimbo, Edwin Mwintiereh Ta Ang Yenli, Stephen Tabiri, Dhruva Ghosh, Pamela Alice Kingsley, Sudha Sundar, Catherine A. Shaw, Apple Valparaiso, Cristina Almira Alviz, Aneel Bhangu, Evropi Theodoratou, Thomas G. Weiser, Ewen M. Harrison, Sorrel T. Burden*

*Corresponding author for this work

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Preoperative undernutrition is a prognostic indicator for postoperative mortality and morbidity. Evidence suggests that treating undernutrition can improve surgical outcomes. This study explored the provision of nutritional screening, assessment and support on surgical cancer wards in low-and middle-income countries (LMICs). This was a qualitative study and participants took part in one focus group or one individual interview. Data were analysed thematically. There were 34 participants from Ghana, India, the Philippines and Zambia: 24 healthcare professionals (HCPs) and 10 patients. Results showed that knowledge levels and enthusiasm were high in HCPs. Barriers to adequate nutritional support were a lack of provision of ward and kitchen equipment, food and sustainable nutritional supplements. There was variation across countries towards nutritional screening and assessment which seemed to be driven by resources. Many hospitals where resources were scarce focused on the care of individual patients in favour of an integrated systems approach to identify and manage undernutrition. In conclusion, there is scope to improve the efficiency of nutritional management of surgical cancer patients in LMICs through the integration of nutrition assessment and support into routine hospital policies and procedures, moving from case management undertaken by interested personnel to a system-based approach including the whole multidisciplinary team.

Original languageEnglish
Article number863
Issue number4
Publication statusPublished - 18 Feb 2022

Bibliographical note

Funding Information:
Funding: This research was funded by Medical Research Council, grant number MR/S014527/1, and the National Institute for Health Research (NIHR; NIHR 16.136.79), using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK Government. ET is funded by a Cancer Research UK Career Development Fellowship (C31250/A22804).

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Cancer
  • Low-and middle-income countries
  • Oncology
  • Perioperative
  • Surgery
  • Undernutrition

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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