Performance of the NutriPal nutritional screening algorithm in advanced cancer palliative care: A multicenter study.

12062 Background: Malnutrition is highly prevalent in advanced cancer and is closely associated with functional decline, systemic inflammation, symptom burden, and impaired quality of life (QoL). Although several nutritional screening tools exist, none were specifically developed for patients with advanced cancer receiving palliative care. The NutriPal nutritional screening algorithm, which integrates the Patient-Generated Subjective Global Assessment short form and the Glasgow Prognostic Score, was recently developed for this population; however, evidence of its performance outside the development cohort remains limited. The objective was to evaluate the performance of the NutriPal nutritional screening algorithm in identifying nutritional risk among patients with advanced cancer receiving palliative care in a multicenter clinical setting and its association with functional status, inflammation, muscle strength, and QoL. Methods: This multicenter, cross-sectional study included adults with locally advanced or metastatic cancer receiving palliative care in four private oncology centers in Brazil from June 2024 to November 2025. Nutritional risk was classified using NutriPal in degrees 1 (lower) to 4 (greater nutritional risk). Karnofsky Performance Status (KPS), handgrip strength (HGS), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and QoL (EORTC QLQ-C15-PAL) were evaluated as independent variables. Associations with worsening nutritional risk were examined using ordinal logistic regression. Results: A total of 165 patients were included (60% women; 70% ≥60 years). NutriPal classified 54% as degree 1, 25% degree 2, 10% degree 3, and 11% degree 4 nutritional risk. Worse nutritional risk was independently associated with KPS < 60% (OR 2.67; 95% CI 1.17 - 6.07), low HGS in women ( < 22 kg; OR 2.69; 95% CI 1.19 - 6.12) and men ( < 32 kg; OR 2.06; 95% CI 1.02 - 5.44), NLR ≥2.78 (OR 2.02; 95% CI 1.18–3.15), and PLR ≥171.95 (OR 2.09; 95% CI 1.12 - 3.89). Poorer scores across all QoL domains (except insomnia) were significantly associated with higher nutritional risk (OR range 1.14 - 7.68), including global QoL (OR 4.08; 95% CI 2.14 - 7.61). Conclusions: NutriPal effectively discriminated nutritional risk severity and identified clinically relevant profiles characterized by functional impairment, systemic inflammation, and poorer QoL among patients with advanced cancer receiving palliative care in private oncology centers. These findings support its clinical utility as a targeted and pragmatic nutritional screening tool in real-world palliative oncology practice settings.