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Joseph R, Hart NH, Bradford N, Crawford-Williams F, Wallen MP, Knowles R, Han CY, Milch V, Holland JJ, Chan RJ. Adopting a systems-thinking approach to optimise dietary and exercise referral practices for cancer survivors. Support Care Cancer 2024; 32:502. [PMID: 38985186 PMCID: PMC11236908 DOI: 10.1007/s00520-024-08692-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Service referrals are required for cancer survivors to access specialist dietary and exercise support. Many system-level factors influence referral practices within the healthcare system. Hence, the aim of this study was to identify system-level factors and their interconnectedness, as well as strategies for optimising dietary and exercise referral practices in Australia. METHODS A full-day workshop involving national multidisciplinary key stakeholders explored system-level factors impacting dietary and exercise referral practices. Facilitated group discussions using the nominal group technique identified barriers and facilitators to referral practices based on the six World Health Organisation (WHO) building blocks. The systems-thinking approach generated six cognitive maps, each representing a building block. A causal loop diagram was developed to visualise factors that influence referral practices. Additionally, each group identified their top five strategies by leveraging facilitators and addressing barriers relevant to their WHO building block. RESULTS Twenty-seven stakeholders participated in the workshop, including consumers (n = 2), cancer specialists (n = 4), nursing (n = 6) and allied health professionals (n = 10), and researchers, representatives of peak bodies, not-for-profit organisations, and government agencies (n = 5). Common system-level factors impacting on referral practices included funding, accessibility, knowledge and education, workforce capacity, and infrastructure. Fifteen system-level strategies were identified to improve referral practices. CONCLUSION This study identified system-level factors and strategies that can be applied to policy planning and practice in Australia.
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Affiliation(s)
- Ria Joseph
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Faculty of Health, Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Sydney, NSW, Australia
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, Australia
| | - Reegan Knowles
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Chad Y Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Vivienne Milch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer Australia, Sydney, NSW, Australia
- The University of Notre Dame, Sydney, NSW, Australia
| | - Justin J Holland
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
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2
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Patel I, Winer A. Assessing Frailty in Gastrointestinal Cancer: Two Diseases in One? Curr Oncol Rep 2024; 26:90-102. [PMID: 38180691 DOI: 10.1007/s11912-023-01483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
PURPOSEOF REVIEW This review examines the challenges of treating gastrointestinal cancer in the aging population, focusing on the importance of frailty assessment. Emphasized are the rise in gastrointestinal cancer incidence in older adults, advances in frailty assessments for patients with gastrointestinal cancer, the development of novel frailty markers, and a summary of recent trials. RECENT FINDINGS Increasing evidence suggests that the use of a Comprehensive Geriatric Assessment (CGA) to identify frail older adults and individualize cancer care leads to lower toxicity and improved quality of life outcomes. However, the adoption of a full CGA prior to chemotherapy initiation in older cancer patients remains low. Recently, new frailty screening tools have emerged, including assessments designed to specifically predict chemotherapy-related adverse events. Additionally, frailty biomarkers have been developed, such as blood tests like IL-6 and performance tracking through physical activity monitors. The relevance of nutrition and muscle mass is discussed. Highlights from recent trials suggest the feasibility of successfully identifying patients most at risk of serious adverse events. There have been promising developments in identifying novel frailty markers and methods to screen for frailty in the older adult population. Further prospective trials that focus on and address the needs of the geriatric population for early identification of frailty in cancer care, facilitating a more tailored treatment approach. Practicing oncologists should select a frailty assessment to implement into their routine practice and adjust treatment accordingly.
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Affiliation(s)
- Ishan Patel
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA.
| | - Arthur Winer
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA
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3
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Testa S, Furness K, Choi T, Haines T, Huggins CE. The roles of the dietitian in an 18-week telephone and mobile application nutrition intervention for upper gastrointestinal cancer: a qualitative analysis. Support Care Cancer 2023; 31:245. [PMID: 36977801 PMCID: PMC10049904 DOI: 10.1007/s00520-023-07684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/11/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE This study aimed to explore the patient-dietitian experience during an 18-week nutrition counselling intervention delivered using the telephone and a mobile application to people newly diagnosed with upper gastrointestinal (UGI) cancer to (1) elucidate the roles of the dietitian during intervention delivery and (2) explore unmet needs impacting nutritional intake. METHODS Qualitative case study methodology was followed, whereby the case was the 18-week nutrition counselling intervention. Dietary counselling conversations and post-intervention interviews were inductively coded from six case participants which included fifty-one telephone conversations (17 h), 244 written messages, and four interviews. Data were coded inductively, and themes constructed. The coding framework was subsequently applied to all post-study interviews (n = 20) to explore unmet needs. RESULTS Themes describing the roles of the dietitian were as follows: regular collaborative problem-solving to encourage empowerment, a reassuring care navigator including anticipatory guidance, and rapport building via psychosocial support. Psychosocial support included provision of empathy, reliable care provision, and delivery of positive perspective. Despite intensive counselling from the dietitian, nutrition impact symptom management was a core unmet need as it required intervention beyond the scope of practice for the dietitian. CONCLUSION Delivery of nutrition care via the telephone or an asynchronous mobile application to people with newly diagnosed UGI cancer required the dietitian to adopt a range of roles to influence nutritional intake: they empower people, act as care navigators, and provide psychosocial support. Limitations in dietitians' scope of practice identified unmet patient's needs in nutrition impact symptom management, which requires medication management. TRIAL REGISTRATION 27th January 2017 Australian and New Zealand Clinical Trial Registry (ACTRN12617000152325).
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Affiliation(s)
- Sharni Testa
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, VIC, Australia
| | - Kate Furness
- Nutrition and Dietetics, Monash Medical Centre, Monash Health, Clayton, VIC, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, 3199, Australia
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Tammie Choi
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, VIC, Australia
| | - Terry Haines
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, 3199, Australia
- School of Primary and Allied Health Care, National Centre for Healthy Ageing, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC, 3199, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, VIC, Australia.
- School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
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Keaver L, O'Callaghan N, LaVertu AE, Semple CJ, Hughes CM, Hanna JR, Ryan L. Experiences of cancer patients in receiving dietary advice from healthcare professionals and of healthcare professionals in providing this advice-a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01359-4. [PMID: 36964295 DOI: 10.1007/s11764-023-01359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE This systematic review investigated qualitative and quantitative studies exploring patients and healthcare professionals' (HCP) experience of nutrition care throughout the cancer journey. METHODS Five databases were systematically searched for studies reporting on patient and healthcare professionals' experience of nutrition advice. RESULTS Fifteen studies including 374 patients and 471 healthcare professionals were included. Findings indicate that patients desire more specific nutrition advice supported by members of the multidisciplinary team and delivered in appropriate and understandable language. Healthcare professionals have highlighted a lack of time, funding, dietetic roles, and knowledge as barriers to integrating nutrition as a standard part of cancer care. Five themes were identified (current provision of nutrition advice, optimal provision of nutrition advice, tension between patient values and nutritional or HCP priorities, providing evidence-based nutrition care, and practical barriers to nutrition advice provision). CONCLUSIONS Further work is essential to better understand and address identified barriers and improve the provision of nutrition advice to this population. IMPLICATIONS FOR CANCER SURVIVORS Findings from this review will guide the delivery of nutrition advice for cancer survivors.
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Affiliation(s)
- Laura Keaver
- Atlantic Technological University, Sligo, Ireland.
| | | | - Amy E LaVertu
- Hirsh Health Sciences Library, Tufts University, Boston, MA, USA
| | | | | | | | - Lisa Ryan
- Atlantic Technological University, Sligo, Ireland
- Atlantic Technological University, Galway, Ireland
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Erickson N, Sullivan ES, Kalliostra M, Laviano A, Wesseling J. Nutrition care is an integral part of patient-centred medical care: a European consensus. Med Oncol 2023; 40:112. [PMID: 36881207 PMCID: PMC9992033 DOI: 10.1007/s12032-023-01955-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe's Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath-primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.
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Affiliation(s)
- Nicole Erickson
- Comprehensive Cancer Center Munich, Ludwig Maximilian University of Munich Hospital, Munich, Germany.
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK.
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands.
| | - Erin Stella Sullivan
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Marianna Kalliostra
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands
- The European Nutrition for Health Alliance, London, UK
| | - Alessandro Laviano
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joost Wesseling
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
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Leis C, Arthur AE, Chen X, Greene MW, Frugé AD. Systematic Review of Nutrition Interventions to Improve Short Term Outcomes in Head and Neck Cancer Patients. Cancers (Basel) 2023; 15:822. [PMID: 36765780 PMCID: PMC9913111 DOI: 10.3390/cancers15030822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023] Open
Abstract
Head and neck cancer (HNC) is associated with high rates of malnutrition. We conducted a systematic review and descriptive analysis to determine the effects of nutrition interventions on the nutrition status, quality of life (QOL), and treatment tolerance of HNC patients. PubMed, Web of Science, and Embase were searched to include all potentially relevant studies published between 2006-2022. Meta-analysis was not conducted due to heterogeneity of study designs and outcomes reported. Studies were categorized as nutrition interventions: (1) with oral nutrition supplements (ONS) and medical nutrition therapy (MNT) delivered by an RD; (2) with enteral nutrition (EN) support and MNT delivered by an RD; (3) with motivational interviewing and no ONS or EN; and (4) with ONS and no RD. Seven articles met inclusion criteria. Studies measured outcomes from immediately following treatment to 12 months post-treatment. Interventions resulted in benefits to lean mass/weight maintenance (three studies), QOL (two studies), nutrient intake adequacy (one study) and treatment tolerance (two studies). Nutrition counseling by a registered dietitian leads to improved nutrition status and QOL. Further research is needed to determine best practices related to timing of initiation, duration of nutrition intervention, as well as frequency of dietitian follow-up.
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Affiliation(s)
- Claire Leis
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | - Anna E. Arthur
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Xin Chen
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Michael W. Greene
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | - Andrew D. Frugé
- College of Nursing, Auburn University, Auburn, AL 36849, USA
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7
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A large, multi-centre prospective study demonstrating high prevalence of malnutrition associated with reduced survival in ambulatory systemic anti-cancer therapy patients. Clin Nutr ESPEN 2022; 52:208-217. [PMID: 36513456 DOI: 10.1016/j.clnesp.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND & AIMS The nutritional status of cancer patients is highly variable, and known to impact on clinical outcomes. To date, no large study evaluating the nutritional status of Irish cancer patients has been reported. The aim of this study was to describe the nutritional status, using gold standard methods, of a large cohort of ambulatory oncology patients receiving Systemic Anti-Cancer Therapy and to assess the impact of abnormal body composition phenotypes on survival. METHODS A prospective study in adults undergoing Systemic Anti-Cancer Therapy for solid tumours enrolled patients between 2012 and 2016. Baseline details were collected incorporating demographics, cancer pathology, lifestyle, body composition (by computed tomography (CT), and inflammatory status. Skeletal muscle index (SMI) and mean muscle attenuation (MA) were obtained from CT images and categorised to low muscle mass and low MA using previously published sex specific cut points. Survival was monitored for a median of 25 months [IQR:10-46 months]. Survival analyses were conducted using multivariate Cox Proportional Hazards Models. RESULTS Of 1015 patients recruited, 940 patients with an evaluable CT were included in this analysis. Median age was 64 years [IQR 55-71] and 56% were male. Colorectal cancer (28%) and gastro-oesophageal (16%) were the most common diagnoses and 58% of patients had stage IV disease. Despite 56% being overweight or obese (BMI >25 kg/m2), 52% were weight losing and 17% had lost >10% body weight. Cancer Cachexia (CC) was present in 42%, 39% had low muscle mass (MM) (sarcopenia) and 45% had low MA. Overall, 73% of patients exhibited an abnormal body composition (BC) phenotype (≥1 of CC, low MM/MA). Overall survival was significantly lower in those with abnormal BC phenotype, independent of site, stage, sex, ECOG and mGPS (HR: 1.416 [95% CI: 1.069-1.875], p = 0.015). CONCLUSIONS Malnutrition and abnormal body composition phenotypes are common in cancer, but are often masked by adiposity. Appropriate screening and diagnostic tools should consider this co-presentation of overweight and obesity, alongside muscle depletion. Given that abnormal body composition phenotypes detectable only via CT are associated with reduced survival, these should be more widely employed to identify patients at risk of poor prognosis, and allow potentially more effective, early intervention.
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Aktas A, Lorton CM, Griffin O, Higgins K, Roulston F, Stewart G, Corkery N, Barnes E, Walsh D. Application of the 2011 international consensus cancer cachexia classification in routine oncology dietetic practice: An observational study. Nutr Clin Pract 2022. [DOI: 10.1002/ncp.10915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Aynur Aktas
- Department of Supportive Oncology Levine Cancer Institute, Atrium Health Charlotte North Carolina USA
| | - Cliona M. Lorton
- Academic Department of Palliative Medicine Our Lady's Hospice and Care Services Dublin Ireland
- School of Medicine Trinity College Dublin Dublin Ireland
| | - Oonagh Griffin
- School of Medicine Trinity College Dublin Dublin Ireland
- Department of Nutrition and Dietetics St Vincent's University Hospital Dublin Ireland
| | - Keira Higgins
- Department of Clinical Nutrition and Dietetics Tallaght University Hospital Dublin Ireland
| | - Fiona Roulston
- Department of Clinical Nutrition and Dietetics St Luke's Radiation Oncology Network Dublin Ireland
| | - Gillian Stewart
- Department of Nutrition and Dietetics St Vincent's Private Hospital Dublin Ireland
| | - Niamh Corkery
- Department of Nutrition and Dietetics Mater Private Mid‐Western Radiation Oncology Centre Limerick Ireland
| | - Elizabeth Barnes
- Department of Nutrition and Dietetics St Vincent's University Hospital Dublin Ireland
| | - Declan Walsh
- Department of Supportive Oncology Levine Cancer Institute, Atrium Health Charlotte North Carolina USA
- Hemby Family Endowed Chair in Department of Supportive Oncology, Levine Cancer Institute, Atrium Health Charlotte North Carolina USA
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Dunne RF, Roeland EJ. The Interplay Among Pancreatic Cancer, Cachexia, Body Composition, and Diabetes. Hematol Oncol Clin North Am 2022; 36:897-910. [PMID: 36154783 DOI: 10.1016/j.hoc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is associated with complex changes in body composition. Visceral obesity and type 2 diabetes mellitus are established risk factors for developing PDAC; however, clinical and metabolic features of PDAC commonly lead to cancer cachexia, a hypermetabolic syndrome characterized by weight loss secondary to muscle and adipose tissue wasting. Reduction in muscle mass in patients with PDAC is associated with poorer survival in patients undergoing surgical resection and increased chemotherapy toxicity. Although no standardized treatment exists, a multidisciplinary, tailored, symptom-based approach is recommended to improve outcomes and quality of life for patients with PDAC and cachexia.
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Affiliation(s)
- Richard F Dunne
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
| | - Eric J Roeland
- Division of Hematology/Oncology, Oregon Health and Science University, Knight Cancer Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Huggins CE, Hanna L, Furness K, Silvers MA, Savva J, Frawley H, Croagh D, Cashin P, Low L, Bauer J, Truby H, Haines TP. Effect of Early and Intensive Telephone or Electronic Nutrition Counselling Delivered to People with Upper Gastrointestinal Cancer on Quality of Life: A Three-Arm Randomised Controlled Trial. Nutrients 2022; 14:nu14153234. [PMID: 35956410 PMCID: PMC9370208 DOI: 10.3390/nu14153234] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Delay in dietetic service provision for upper gastrointestinal cancer exacerbates disease-related malnutrition and consequently increases morbidity and mortality. Dietetic services are usually referral-based and provided face-to-face in inpatient or outpatient settings, which can delay the commencement of nutrition care. The aim of this study was to provide intensive dietetic intervention close to the time of diagnosis for upper gastrointestinal cancer and assess the effect on quality-adjusted life years. METHODS A three-arm randomised controlled trial of adults newly diagnosed with upper gastrointestinal cancer was performed. A behavioural-based, individually tailored, symptom-directed nutrition intervention was provided in addition to usual care, delivered by a dietitian using a telephone (synchronously) or a mobile application (asynchronously) for 18 weeks, compared with a usual care control group. Data were collected at baseline, three, six, and twelve months post-randomisation. The primary outcome was quality-adjusted life years (EQ-5D-5L quality of life assessment tool). Data were analysed using linear mixed models. RESULTS One hundred and eleven participants were randomised. Quality-adjusted life years were not different in the intervention groups compared with control (telephone: mean (95% CI) 0.04 (0.43, 2.3), p = 0.998; App: -0.08 (-0.18, 0.02), p = 0.135) after adjustment for baseline, nutrition risk status, age, and gender. Survival was similar between groups over 12 months. The asynchronous mobile app group had a greater number of withdrawals compared with the telephone group. CONCLUSION Early and intensive nutrition counselling, delivered at home, during anticancer treatment did not change quality-adjusted life years or survival over 12 months compared with usual care. Behavioural counselling alone was unable to achieve nutritional adequacy. Dietetic services delivered asynchronously using a mobile app had low acceptance for patients undergoing anticancer treatment. TRIAL REGISTRATION 27 January 2017 Australian and New Zealand Clinical Trial Registry, ACTRN12617000152325.
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Affiliation(s)
- Catherine E. Huggins
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC 3168, Australia
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Correspondence:
| | - Lauren Hanna
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC 3168, Australia
- Department of Nutrition and Dietetics, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Kate Furness
- Department of Nutrition and Dietetics, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
- Department of Physiotherapy, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC 3199, Australia
| | - Mary Anne Silvers
- Department of Nutrition and Dietetics, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - June Savva
- Department of Nutrition and Dietetics, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Helena Frawley
- Department of Physiotherapy, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC 3199, Australia
| | - Daniel Croagh
- Upper Gastrointestinal and Hepatobiliary Surgery Unit, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 5 Block E, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Paul Cashin
- Upper Gastrointestinal and Hepatobiliary Surgery Unit, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 5 Block E, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Liang Low
- Upper Gastrointestinal and Hepatobiliary Surgery Unit, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, The University of Queensland, Level 2 Connell Building, St. Lucia, QLD 4072, Australia
| | - Helen Truby
- Department of Physiotherapy, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC 3199, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Level 2 Connell Building, St. Lucia, QLD 4072, Australia
| | - Terry P. Haines
- Department of Physiotherapy, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, School of Primary and Allied Health Care, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC 3199, Australia
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11
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Vitaloni M, Caccialanza R, Ravasco P, Carrato A, Kapala A, de van der Schueren M, Constantinides D, Backman E, Chuter D, Santangelo C, Maravic Z. The impact of nutrition on the lives of patients with digestive cancers: a position paper. Support Care Cancer 2022; 30:7991-7996. [PMID: 35761102 PMCID: PMC9512936 DOI: 10.1007/s00520-022-07241-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
Nutritional intervention is an essential part of cancer treatments. Research and clinical evidence in cancer have shown that nutritional support can reduce length of hospitalisation, diminish treatment-related toxicity, and improve nutrient intake, quality of life, and physical function. Nutritional intervention can improve outcomes and help patients in the successful completion of oncological treatments by preventing malnutrition. Malnutrition is a very common hallmark in patients with cancers. Almost one-fourth of cancer patients are at risk of dying because of the consequences of malnutrition, rather than cancer itself. Patients with digestive cancers are at higher risk of suffering malnutrition due to the gastrointestinal impairment caused by their disease. They are at high nutritional risk by definition, yet the majority of them have insufficient or null access to nutritional intervention.Inadequate resources are dedicated to implementing nutritional services in Europe. Universal access to nutritional support for digestive cancer patients is not a reality in many European countries. To change this situation, health systems should invest in qualified staff to reinforce or create nutritional teams’ experts in digestive cancer treatments. We aim to share the patient community’s perspective on the status and the importance of nutritional intervention. This is an advocacy manuscript presenting data on the topic and analysing the current situations and the challenges for nutrition in digestive cancers. It highlights the importance of integrative nutrition in the treatment of digestive cancers and advocates for equitable and universal access to nutritional intervention for all patients.
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Affiliation(s)
| | - Riccardo Caccialanza
- UOC Dietetics and Clinical Nutrition, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Paula Ravasco
- Medicine and Scientific Research, Catolica Medical School & Centre for Interdisciplinary Research in Health - Universidade Católica Portuguesa (UCP); Centre for Interdiscipinary Research Egas Moniz, (CiiEM), Egas Moniz Cooperativa de Ensino Superior, CRL, Lisbon, Portugal
| | - Alfredo Carrato
- Pancreatic Cancer Europe, Brussels, Belgium.,Alcalá University, Madrid, Spain
| | - Aleksandra Kapala
- Clinic of Oncological Diagnostics, Cardio-Oncology and Palliative Medicine, National Oncology Institute Maria Skłodowska-Curie, State Research Institute, Warsaw, Poland
| | | | - Dora Constantinides
- PASYKAF, the Cyprus Association of Cancer Patients and Friends, Nicosia, Cyprus
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12
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Joseph R, Hart NH, Bradford N, Agbejule OA, Koczwara B, Chan A, Wallen MP, Chan RJ. Diet and exercise advice and referrals for cancer survivors: an integrative review of medical and nursing perspectives. Support Care Cancer 2022; 30:8429-8439. [PMID: 35616734 PMCID: PMC9512858 DOI: 10.1007/s00520-022-07152-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022]
Abstract
Purpose To examine the perspectives of medical and nursing health professionals concerning their roles and responsibilities in providing dietary and exercise advice to cancer survivors, and referrals to allied health professionals. Methods An integrative review. PubMed, CINAHL, PsycINFO, Embase, Web of Science databases, and bibliographies of relevant studies were searched from December 2011 to June 2021. All studies were eligible for inclusion. The Mixed-Methods Appraisal Tool (MMAT) was used to critically appraise included studies. Data were extracted and synthesised regarding the perspectives of medical and nursing health professionals on their roles, responsibilities, barriers, and facilitators. Results Twenty-one studies involving 3401 medical and nursing health professionals and 264 cancer survivors of diverse cancer types were included. Ten quantitative, nine qualitative, and two mixed-methods studies were eligible. All included studies met at least 80% of the quality criteria in the MMAT. Major findings include the following: (1) medical and nursing health professionals were unclear on their roles in providing dietary and exercise advice to cancer survivors but agreed they play a key role in referrals to dietitians and exercise professionals; (2) most cancer survivors valued the involvement of their general practitioner when receiving dietary and exercise advice. Conclusion Although medical and nursing health professionals understand that referrals to allied health professionals form part of their role, there is a lack of clarity regarding their roles to provide dietary and exercise advice to cancer survivors. Future studies should address barriers and facilitators of dietary and exercise advice and referral by medical and nursing health professionals. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07152-w.
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Affiliation(s)
- Ria Joseph
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Nicolas H Hart
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.,Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia.,Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, USA
| | - Matthew P Wallen
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, Australia
| | - Raymond J Chan
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
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13
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Deftereos I, Yeung JM, Arslan J, Carter VM, Isenring E, Kiss N. Health service nutrition practices and associations with clinical outcomes in patients undergoing resection for upper gastrointestinal cancer: results from the multi-centre NOURISH point prevalence study. J Hum Nutr Diet 2022; 36:468-478. [PMID: 35320596 DOI: 10.1111/jhn.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal (UGI) cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, and the use of evidence-based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes. METHODS Principal investigator dietitians for the sites (n=27) participating in the NOURISH point prevalence study participated in a purpose-built site-specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day one post surgery, length of stay and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol. RESULTS The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty-five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, and higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions and ESPEN guideline compliant care day one post surgery. CONCLUSIONS The results of this study demonstrate varied perioperative outpatient nutrition services in this high-risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia.,Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia
| | - Justin Mc Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia.,Department of Colorectal Surgery, Western Health, Footscray, VIC 3011, Australia.,Western Health Chronic Disease Alliance, Western Health, Footscray, VIC 3011, Australia
| | - Janan Arslan
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia
| | - Vanessa M Carter
- Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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14
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Sulo S, Brunton C, Drawert S, Watson G, Hegazi R, Bastasch M. Increased Emergency Department Utilization and Costs for Medicare Cancer Patients with Malnutrition Diagnoses. J Nutr Health Aging 2022; 26:786-791. [PMID: 35934823 DOI: 10.1007/s12603-022-1826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Malnutrition or its risk affects up to 70% of cancer patients. Compared to adequately nourished oncology patients, those with malnutrition experience more complications and have poorer prognoses, thus higher needs for healthcare. We compared utilization of emergency department (ED) services and costs for Medicare-covered cancer patients with or without a malnutrition diagnosis. METHODS We used the Centers for Medicare and Medicaid Services (CMS) Standard Analytic File to identify fee-for-service beneficiaries who had a cancer diagnosis, and had one or more outpatient claims in 2018. We totaled individual claims and costs for ED visits per beneficiary, then calculated mean per-person claims and costs for malnourished vs non-malnourished patients. RESULTS Using data from over 2.8 million claims of patients with cancer diagnoses, the prevalence of diagnosed malnutrition was 2.5%. The most common cancer types were genitourinary, hematologic/blood, and breast. Cancer patients with a malnutrition diagnosis, compared to those without, had a significantly higher annual total number of outpatient claims (21.4 vs. 11.5, P<.0001), including a 2.5-fold higher rate of ED visits (1.43 vs. 0.56, p<.0001). As result, such patients incurred more than 2-fold higher mean ED claim costs than did their adequately nourished counterparts ($10,724 vs. $4,935, P<.0001). CONCLUSIONS Our results suggest that malnutrition in cancer patients imposes a high outpatient burden on resource utilization and costs of care in terms of ED use. We propose that nutritional interventions can be used to improve health outcomes for people with cancer and to improve economic outcomes for patients and providers.
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Affiliation(s)
- S Sulo
- Suela Sulo, PhD, MSc, Abbott Nutrition, 100 Abbott Park Rd, Abbott Park, IL 60064, Office: 224-668-1377, Fax: 224-668-8355, E-mail:
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15
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Ting G, Nursing MI, Hui-Lin C, Yee Mimi TM. A Systematic Review of Nurse-led Dietary Interventions for Cancer Patients and Survivors. Asia Pac J Oncol Nurs 2021; 9:81-87. [PMID: 35529414 PMCID: PMC9072171 DOI: 10.1016/j.apjon.2021.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 11/02/2022] Open
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16
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Maunsell R, Sodergren S, Hopkinson J, Shaw C, Foster C, Wheelwright S. Nutritional care in colorectal cancer-what is the state of play? Colorectal Dis 2021; 23:3227-3233. [PMID: 34605160 DOI: 10.1111/codi.15933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
AIM Nutrition is associated with aetiology and impacts outcomes in colorectal cancer (CRC). This study aimed to explore nutritional symptoms and concerns of patients with CRC and CRC dietetic resource across the UK. METHODS Study 1 is a descriptive analysis of nutrition-related measures in the ColoRectal Wellbeing (CREW) study, a prospective 5-year longitudinal cohort study of a representative sample of 872 adults with non-metastatic CRC. Study 2 is a descriptive analysis of data collected using a freedom of information request to all UK trusts/boards on dietetic resources for CRC. RESULTS Study 1 found that 31% of CREW participants wanted more diet and lifestyle advice. At 3 months post-surgery, 10% reported poor appetite. A fifth experienced weight loss and 16% had concerns regarding weight loss 9 months post-surgery. In study 2 just 3% of hospitals providing CRC services had a dedicated CRC dietitian (hepato-pancreato-biliary, 11.1%; head and neck cancer, 14.3%). There was no dietetic outpatient follow-up of CRC patients in 72% of hospitals. CONCLUSIONS Dietetic resource for patients with CRC is scarce even though weight loss, poor appetite and unmet needs are common and persist over time. Work is needed to embed nutritional care into the management of patients with CRC.
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Affiliation(s)
| | | | - Jane Hopkinson
- Interdisciplinary Cancer Care, School of Healthcare Sciences, Cardiff University, UK
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17
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Kadakia KC, Symanowski JT, Aktas A, Szafranski ML, Salo JC, Meadors PL, Walsh D. Malnutrition risk at solid tumor diagnosis: the malnutrition screening tool in a large US cancer institute. Support Care Cancer 2021; 30:2237-2244. [PMID: 34709459 PMCID: PMC8551662 DOI: 10.1007/s00520-021-06612-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/30/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND In cancer, malnutrition is common and negatively impacts tolerance and outcomes of anti-tumor therapies. The aim of this study was to evaluate the prevalence of malnutrition risk and compare the clinicodemographic features between those with high malnutrition screening tool (MST) scores (i.e., ≥ 2 of 5 = high risk for malnutrition, H-MST) to low scores (L-MST). METHODS A cohort of 3585 patients (May 2017 through December 2018), who completed the MST at least once at the time of diagnosis of any stage solid tumor, were analyzed. Logistic regression tested for associations between clinicodemographic factors, symptom scores, and H-MST prevalence. RESULTS The median age was 64 years (25-75 IQR, 55-72), with 62% females and 81% White. Most common tumor primary sites were breast (28%), gastrointestinal (GI) (21%), and thoracic (13%). Most had non-metastatic disease (80%). H-MST was found in 28%-most commonly in upper (58%) and lower GI (42%), and thoracic (42%) tumors. L-MST was most common in breast (90%). Multivariable regression confirmed that Black race (OR 1.9, 95% CI 1.5-2.4, p = < 0.001), cancer primary site (OR 1.6-5.7, p = < 0.001), stage IV disease (OR 1.8, 95% CI 1.4-2.2, p = < 0.001), low BMI (OR 4.2, 95% CI 2.5-6.9 p = < 0.001), and higher symptom scores were all independently associated with H-MST. CONCLUSIONS Twenty-eight percent of solid tumor oncology patients at diagnosis were at high risk of malnutrition. Patients with breast cancer rarely had malnutrition risk at diagnosis. Significant variation was found in malnutrition risk by cancer site, stage, race, and presence of depression, distress, fatigue, and trouble eating/swallowing.
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Affiliation(s)
- Kunal C Kadakia
- Department of Solid Tumor Oncology and Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA. .,Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
| | - James T Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC, USA
| | - Aynur Aktas
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Michele L Szafranski
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Jonathan C Salo
- Department of Surgery, Division of Surgical Oncology, Levine Cancer Institute, Charlotte, NC, USA
| | - Patrick L Meadors
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Declan Walsh
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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18
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Boyle DA. Contemporary Insights into Cancer Cachexia for Oncology Nurses. Asia Pac J Oncol Nurs 2021; 8:462-470. [PMID: 34527776 PMCID: PMC8420918 DOI: 10.4103/apjon.apjon-2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/21/2021] [Indexed: 12/02/2022] Open
Abstract
Cachexia is a complex, multiorgan phenomenon targeting skeletal muscle resulting from systemic metabolic imbalances. Multifocal in nature, It's ultimate outcome is significant muscle degradation and loss of adipose tissue exhibited as the "wasting syndrome" which is associated with significant functional decline. Currently, there are no approved biomarkers for screening nor therapeutic options to manage cancer cachexia. Furthermore, multiple psychosocial sequelae characterize the patient and family coping paradigm. Heightened education about the pathophysiology of cancer cachexia and awareness of intra-familial emotional distress can enhance oncology nurses' advocacy about, and attentiveness to, this common manifestation of advanced cancer.
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19
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Keum J, Chung MJ, Kim Y, Ko H, Sung MJ, Jo JH, Park JY, Bang S, Park SW, Song SY, Lee HS. Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e21088. [PMID: 34463630 PMCID: PMC8441607 DOI: 10.2196/21088] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/20/2020] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
Background Approximately 80% of pancreatic ductal adenocarcinoma (PDAC) patients suffer from anorexia, weight loss, and asthenia. Most PDAC patients receive chemotherapy, which often worsens their nutritional status owing to the adverse effects of chemotherapy. Malnutrition of PDAC patients is known to be associated with poor prognosis; therefore, nutritional management during chemotherapy is a key factor influencing the outcome of the treatment. Mobile apps have the potential to provide readily accessible nutritional support for patients with PDAC. Objective We aimed to evaluate the efficacy of a mobile app–based program, Noom, in patients receiving chemotherapy for PDAC. Methods We prospectively enrolled 40 patients who were newly diagnosed with unresectable PDAC from a single university-affiliated hospital in South Korea, and randomly assigned them into a Noom user group (n=20) and a non-Noom user group (n=20). The 12-week in-app interventions included meal and physical activity logging as well as nutritional education feedback from dietitians. The non-Noom user group did not receive any nutrition intervention. The primary outcomes were the changes in the nutritional status and quality of life (QoL) from the baseline to 12 weeks. The secondary outcomes included the changes in the skeletal muscle index (SMI) from the baseline to 12 weeks. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Patient-Generated Subjective Global Assessment (PG-SGA) were used as paper questionnaires to assess the QoL and nutritional status of the patients. Intention-to-treat and per-protocol analyses were conducted. Regarding the study data collection time points, we assessed the nutritional status and QoL at the baseline (T0), and at 4 (T1), 8 (T2), and 12 (T3) weeks. Abdominal computed tomography (CT) imaging was conducted at the baseline and after 8 weeks for tumor response and SMI evaluation. The skeletal muscle area (cm2) was calculated using routine CT images. The cross-sectional areas (cm2) of the L3 skeletal muscles were analyzed. Results Between February 2017 and January 2018, 48 patients were assessed for eligibility. Totally 40 patients with pancreatic cancer were included by random allocation. Only 17 participants in the Noom user group and 16 in the non-Noom user group completed all follow-ups. All the study participants showed a significant improvement in the nutritional status according to the PG-SGA score regardless of Noom app usage. Noom users showed statistically significant improvements on the global health status (GHS) and QoL scales compared to non-Noom users, based on the EORTC QLQ (P=.004). The SMI decreased in both groups during chemotherapy (Noom users, 49.08±12.27 cm2/m2 to 46.08±10.55 cm2/m2; non-Noom users, 50.60±9.05 cm2/m2 to 42.97±8.12 cm2/m2). The decrement was higher in the non-Noom user group than in the Noom user group, but it was not statistically significant (-13.96% vs. -3.27%; P=.11). Conclusions This pilot study demonstrates that a mobile app–based approach is beneficial for nutritional and psychological support for PDAC patients receiving chemotherapy. Trial Registration ClinicalTrials.gov NCT04109495; https://clinicaltrials.gov/ct2/show/NCT04109495.
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Affiliation(s)
- Jiyoung Keum
- Division of Gastroenterology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea.,Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youngin Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.,Noom Korea, Inc, Seoul, Republic of Korea
| | | | - Min Je Sung
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jung Hyun Jo
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Youp Park
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Si Young Song
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
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20
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Mullee A, O'Donoghue A, Dhuibhir PU, O'Donoghue N, Burke D, McSharry V, Stewart G, Casey L, Donnelly Y, Gallagher J, Higgins K, Roulston F, Barrett M, Corish CA, Walsh D. Diet and Nutrition Advice After a Solid Tumor Diagnosis. JCO Oncol Pract 2021; 17:e982-e991. [PMID: 33596097 DOI: 10.1200/op.20.00685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Credible evidence-based diet and nutrition advice is essential for patients with cancer. This study aimed to explore what advice patients with cancer obtained before a formal dietetic visit. METHODS A multicenter, observational study was conducted in seven hospital-based oncology services. Consecutive patients were recruited at first dietetic assessment. In addition to routine dietetic assessment, participants completed a four-item questionnaire describing diet and nutrition advice obtained since diagnosis. RESULTS Seventy-seven patients participated. More than 80% had multiple nutrition-impact symptoms. In total, 53 (69%) obtained advice from professional and nonprofessional sources before dietetic visit. Family and friends were the most common sources of advice. More than one third got advice from (nondietetic) healthcare professionals. Most advice related to "foods to include" (61%) and "foods to avoid" (54%) in the diet. Many of the "foods to avoid" were important sources of micro- and macronutrients. Advice about dietary supplements (31%) and specific diets (28%) was common, rarely evidence-based, and frequently contradictory. Participants found it difficult to discern what advice was trustworthy and reliable. Despite this, most followed the advice. CONCLUSION The majority of patients received diet and nutrition advice before first dietetic visit. Most of this came from nonprofessional sources. Any advice from nondietetic healthcare professionals was inconsistent or vague. This was mainly related to the avoidance and/or inclusion of particular foods and was often contradictory. Nevertheless, patients usually followed such advice fully. To help manage their frequent nutrition-impact symptoms and resolve the contradictory advice they had received, many expressed the need for earlier professional dietetic consultation.
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Affiliation(s)
- Amy Mullee
- Department of Health and Nutritional Sciences, IT Sligo, Sligo, Ireland
| | - Aidan O'Donoghue
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland.,School of Medicine, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Pauline Uí Dhuibhir
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland.,School of Nursing, Midwifery and Health Science, University College Dublin, Dublin, Ireland
| | - Niamh O'Donoghue
- School of Medicine, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Burke
- Dietetics Department, St Vincent's University Hospital, Dublin, Ireland
| | - Veronica McSharry
- Department of Clinical Nutrition and Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gillian Stewart
- Dietetics Department, St Vincent's Private Hospital, Dublin, Ireland
| | - Louise Casey
- Dietetics Department, University Hospital Limerick, Limerick, Ireland
| | - Yvonne Donnelly
- Dietetics Department, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Julie Gallagher
- Dietetics Department, Tallaght University Hospital, Dublin, Ireland
| | - Kiera Higgins
- Dietetics Department, Tallaght University Hospital, Dublin, Ireland
| | - Fiona Roulston
- Dietetics Department, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Michelle Barrett
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Clare A Corish
- Department of Health and Nutritional Sciences, IT Sligo, Sligo, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Declan Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland.,School of Medicine, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Department of Supportive Oncology, Levine Cancer Institute, Charlotte, NC
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21
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Roeland EJ, Dunne RF. The Impact of Early Referrals to Dietitians for Patients With Esophagogastric Cancer. J Natl Compr Canc Netw 2021; 19:235-238. [PMID: 33545687 DOI: 10.6004/jnccn.2021.7006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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22
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Shaw C, Starling N, Reich A, Wilkes E, White R, Shepelev J, Narduzzi S. Modification of systemic anti-cancer therapies and weight loss, a population-level real-world evidence study. Ther Adv Med Oncol 2020; 12:1758835920982805. [PMID: 33488780 PMCID: PMC7768329 DOI: 10.1177/1758835920982805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Involuntary weight loss may occur during systemic anti-cancer therapy (SACT), causing treatment disruption and poorer prognoses. There remain gaps in clinical awareness as to which patients may benefit from nutritional interventions that aim to prevent unintended weight loss during SACT. We utilised England’s population-level cancer registry data, conducting a pan-cancer assessment of patient weight loss during SACT. We aimed to identify cancers with weight loss-associated treatment modifications, potential beneficiaries of nutritional intervention. Methods: This cross-sectional study used England’s Cancer Analysis System database, including SACT-treated adults with one tumour and ⩾2 weight recordings between 2014 and 2018. Binary weight loss (threshold: 2.5%) was derived from patients’ most negative weight change from first SACT weight recording. The Martin et al. body mass index-adjusted weight loss grading system (BMI-WLG) was assigned. We describe binary weight loss, BMI-WLG and treatment modification status by cancer. Multivariate logistic regression models of weight loss (binary and BMI-WLG) and a composite outcome of patient treatment-modification status by cancer were produced. Results: Our study population contained 200,536 patients across 18 cancers; 28% experienced binary weight loss during SACT. Weight loss patients were more likely to have multiple types of treatment modifications recorded across all cancers. Regression analyses included 86,991 patients. Binary weight loss was associated (p < 0.05) with higher likelihood of treatment modification in; colon [Odds Ratio (OR) = 1.72, 95% confidence interval (CI): 1.42, 2.07]; gynaecologic (excl. ovarian) (OR = 1.48, 95% CI: 1.08, 2.01); stomach (OR = 1.6, 95% CI: 1.04, 2.06); lung (OR = 1.38, 95% CI: 1.21, 1.58); leukaemia (OR = 1.30, 95% CI: 1.09, 1.55); head and neck (OR = 1.30, 95% CI: 1.02, 1.65) and oesophageal (OR = 1.29, 95% CI: 1.01, 1.64) cancers. In lung, colon, and grouped gastro-intestinal cancers, association between BMI-WLG and treatment modification increased by WLG. Discussion: Our study is a wide assessment of weight loss during SACT using England’s cancer registry data. Across different cancers we found patients have weight loss-associated treatment modifications during SACT, a precursor to poorer prognoses. Our findings highlight cancers that may benefit from improved nutritional intervention during SACT.
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Affiliation(s)
- Clare Shaw
- Biomedical Research Centre at The Royal Marsden and Institute of Cancer Research, London, UK
| | - Naureen Starling
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Emily Wilkes
- IQVIA, 210 Pentonville Road IQVIA, London, N1 9JY, UK
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Trujillo EB, Shapiro AC, Stephens N, Johnson SJ, Mills JB, Zimmerman AR, Spees CK. Monitoring Rates of Malnutrition Risk in Outpatient Cancer Centers Utilizing the Malnutrition Screening Tool Embedded into the Electronic Health Record. J Acad Nutr Diet 2020; 121:925-930. [PMID: 33309592 DOI: 10.1016/j.jand.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/12/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The risk of malnutrition in patients with cancer is well documented. However, screening to identify patients at risk in ambulatory cancer centers is not standardized nor uniform. The 2-question Malnutrition Screening Tool (MST) is validated in the ambulatory oncology setting and endorsed by the Academy of Nutrition and Dietetics. OBJECTIVE To test the feasibility of operationalizing and standardizing malnutrition risk assessment across 2 large ambulatory cancer centers by embedding the MST into the electronic health record (EHR) with the goal of identifying and quantifying the prevalence of malnutrition risk in outpatient settings. DESIGN A Quality Assurance Performance Improvement project was conducted to evaluate malnutrition screening practices by leveraging the EHR. Work standards were developed, implemented, and evaluated to assess the feasibility of utilizing de-identified MST data, entered as discrete variables in an EHR flowsheet, to track monthly MST completion rates and to identify and quantify patients being treated for cancer scoring at risk for impaired nutritional status. PARTICIPANTS/SETTING Data from 2 large adult ambulatory community cancer centers in the upper Midwest were collected between April 2017 and December 2018. RESULTS Over a 20-month period, the average monthly MST completion rate was 74%. Of those with completed MST screens, the average percentage of patients identified at nutritional risk (MST score ≥2) was 5% in medical oncology and 12% in radiation oncology. CONCLUSION It is feasible to (1) integrate and standardize data collection of the MST into existing EHR flowsheets and (2) identify and quantify patients at risk for malnutrition on a consistent basis.
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Eglseer D, Bauer S. Predictors of Dietitian Referrals in Hospitals. Nutrients 2020; 12:nu12092863. [PMID: 32962105 PMCID: PMC7551325 DOI: 10.3390/nu12092863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 01/04/2023] Open
Abstract
Dietitian involvement has considerable benefits for hospitalized patients, resulting in better health outcomes and improved quality of life. However, dietitian referral routines are often inappropriate in hospitals. The aim of this study was to identify predictors for dietitian referrals in hospitalized patients. This study was performed on data collected in an annually conducted cross-sectional study (in the years 2017, 2018, 2019). A standardized questionnaire was used to collect data, and logistic regression and a generalized estimating equation (GEE) model were used to calculate the associations between the patient characteristics and dietitian referrals. In the final GEE model, the following predictors for dietitian referrals remained significant: diabetes diagnosis (OR 1.80), cancer diagnosis (OR 1.76), digestive disease diagnosis (OR 2.03), presence of a pressure injury (OR 1.58), risk of malnutrition based on body mass index (BMI) and weight loss (OR 1.72), risk of malnutrition based on the malnutrition universal screening tool (MUST) (2.55), and the application of any malnutrition screening at admission to hospital (2.20). Total dietitian referral rate was 16.8%. The highest rate of dietitian referrals was found in patients with a risk of malnutrition (37%). This study included a large sample of hospitalized adult patients and revealed a low dietitian referral rate among these patients. These results indicate that dietitian involvement in hospitalized patients with nutrition-related conditions urgently needs to be improved.
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Péluchon R. [Not Available]. REVUE DE L'INFIRMIERE 2020; 69:8. [PMID: 32993916 DOI: 10.1016/s1293-8505(20)30214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Schneider CK, Bressler T. Malnutrition Screening: An Interprofessional Approach in Outpatient Oncology. Clin J Oncol Nurs 2020; 24:E28-E33. [PMID: 32441690 DOI: 10.1188/20.cjon.e28-e33] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Malnutrition is highly prevalent in the oncology population and is associated with poor treatment outcomes. OBJECTIVES This study aimed to implement a malnutrition screening process using a validated tool in three outpatient cancer centers. METHODS Nursing and nutrition department leaders collaborated to establish malnutrition screening. The Malnutrition Screening Tool (MST) was embedded in the electronic health record. Based on the MST, a score of 2 or greater is considered at risk for malnutrition. Nurses were educated on screening all patients completing their first cycle of infusion chemotherapy. Data were collected for six months. FINDINGS Interprofessional collaboration established a process to implement malnutrition screening. Twenty-eight percent of patients with cancer were at risk for malnutrition. Fifty-three percent were at risk for malnutrition based on MST scores of 2. Compliance with the MST at first infusion visit was 30%-81% across the three cancer centers.
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Abstract
Nutrition and gastrointestinal cancer are inextricably linked. The metabolic effects of cancer along with changes in dietary intake, the development of cancer cachexia and the presence of sarcopenia can influence changes in body composition. These have a negative impact on quality of life and tolerance to cancer treatment. Treatment for cancer presents some significant nutritional challenges as nutrition impact symptoms may develop, be exacerbated by treatment and may contribute to a worsening in nutritional status. Nutrition screening and assessment should be an integral part of holistic patient care. The provision of appropriate, evidence-based dietary advice should occur before, during and after cancer treatment. Appropriate and timely methods of nutritional support across the spectrum of gastrointestinal cancer are needed to ensure that people are adequately supported during courses of treatment that can span weeks and months. These can range from standard approaches of supplementing oral intake to complex interventions such as managing high output intestinal stomas. The gastrointestinal tract is particularly susceptible to impact from systemic anti-cancer treatments and radiotherapy. Gastrointestinal late effects of cancer treatment are now recognised to present particular challenges in terms of both medical and nutritional management. These late effects have a significant impact on the individual and their quality of life in addition to implications for the health service. Dietary intake following cancer treatment has an impact on quality of life and future research may demonstrate its influence on the risk of recurrence of gastrointestinal cancer.
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Nutritional considerations for the management of the older person with hepato-pancreatico-biliary malignancy. Eur J Surg Oncol 2020; 47:533-538. [PMID: 32362465 DOI: 10.1016/j.ejso.2020.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/04/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023] Open
Abstract
Malnutrition and cancer cachexia are prevalent in older people with hepato-pancreatico-biliary (HPB) malignancy, with the resultant loss of muscle mass and function accelerating normal age-associated losses. Unintentional weight loss may be missed in patients with pre-illness obesity, delaying diagnosis and limiting treatment potential and access. Sarcopenia and/or sarcopenic obesity increase the risk of dose-limiting chemotherapy toxicity, post-operative mortality and overall survival. The aetiology of malnutrition and weight loss is multi-factorial in patients with HPB malignancy, necessitating systematic evaluation of endocrine and exocrine function, and multi-modal therapeutic strategies. Prehabilitation aims to reduce the complications and side effects associated with treatment, aid recovery and improve quality of life, with the greatest benefits potentially being seen in high risk groups, such as people who are older and frail. Post-operatively, individualised nutritional support therapies targeting the preservation of weight and muscle indices are required to improve post-operative morbidity, and avoid delay or early cessation of any necessary adjuvant therapy.
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