The knowledge, attitude, and practice score on oral nutrition supplementation is inversely associated with malnutrition risk of tumor patients during the peri-radiotherapy period: a multicenter cross-sectional study

Background: Oral nutritional supplements (ONS) plays a key role in improving outcomes in cancer patients undergoing radiotherapy. However, the relationship between patients' knowledge, attitude, and practice (KAP) toward ONS and malnutrition risk remains unclear. Methods: This multicenter cross-sectional study included 1737 cancer patients from 25 hospitals in Shandong, China. KAP toward ONS was assessed using a structured questionnaire. Logistic regression analyses were performed to evaluate the association between KAP scores and malnutrition risk. Results: The prevalence of malnutrition risk was 70.1%. Higher KAP scores were independently associated with lower malnutrition risk. Patients in the highest KAP quartile had a significantly reduced risk compared with the lowest quartile (adjusted OR = 0.48, 95% CI: 0.35-0.66). Education level was positively associated with KAP scores. Conclusion: Higher KAP toward ONS is significantly associated with reduced malnutrition risk in cancer patients during the peri-radiotherapy period. Improving patient education and standardized nutritional management may represent effective strategies for reducing malnutrition risk in clinical practice. Limitation: Due to the cross-sectional design, causal relationships cannot be established. Clinical trial registration: Identifier ChiCTR1800019983.