Association between malnutrition risk and healthcare utilization in a culturally diverse sample of ambulatory patients with cancer.

254 Background: Malnutrition is prevalent among cancer patients placing them at an increased risk for treatment-related complications and poor clinical outcomes. This study investigated the relationship between malnutrition risk and healthcare utilization in a diverse sample of adult ambulatory cancer patients from the Sylvester Comprehensive Cancer Center. Methods: A retrospective analysis was conducted with data collected through the My Wellness Check (MWC), an electronic health record (EHR)-based assessment. Malnutrition was assessed through the NUTRISCORE, an integrated and validated nutritional screening tool within MWC that evaluates self-reported weight loss, appetite, cancer type, and treatment modality to assess risk of malnutrition. A NUTRISCORE greater or equal to 5 is considered malnutrition risk. Time to an emergency room (ER) visit and hospitalization were calculated in days from the first MWC questionnaire assignment and the first event, respectively. All ER visits and hospitalizations in the University of Miami Health System, self-reported patient demographics, and clinical characteristics were captured from the EHR. Uni- and multi-variate logistic regression models were used to examine factors associated with malnutrition risk. For survival analyses, the Kaplan-Meier method was used to calculate the cumulative incidence function of events and the cox proportional hazards regression models adjusting for patient demographics and clinical characteristics. Results: A total of5,984 ambulatory patients completed the MWC assessment between October 2019, and August 2023, with 31.2% (n=1,868) identified at malnutrition risk (NUTRISCORE ≥5). Patients were predominately White (n=5,092, 85.2%), and Hispanic (n=2,341, 39.1%). Hematologic cancer was the most common diagnosis (n=1284, 21.5%) followed by malignancies in digestive system (n=903, 15.1%) and male genitourinary (n=892, 14.9%). After adjusting for covariates, patients at malnutrition risk were at significantly higher risk for both ER visits (HR 1.57, 95% CI; 1.29 - 1.91, p<0.0001) and hospitalizations (17.4% vs. 7.4% at 100 days, p<0.0001) compared to those with low malnutrition risk. Factors associated with malnutrition risk included Hispanic ethnicity (aOR 1.17, 95% CI; 1.01-1.35), fatigue (aOR 1.62, 95%CI; 1.07-2.45), declined physical function (aOR 1.75, 95% CI;1.37 - 2.24), physical inactivity (aOR 1.20, 95%CI;1.04 - 1.38) and low HRQOL (aOR 2.48, 95%CI; 1.93-3.19). Conclusions: Malnutrition was associated with higher healthcare utilization in a diverse sample of ambulatory cancer patients. Hispanic ethnicity and worse PROs are factors associated with higher risk for malnutrition. Results from this work underscore the need of early nutritional interventions to prevent malnutrition and improve clinical outcomes.