1
|
Levonyak NS, Hodges MP, Haaf N, Brown TJ, Hardy S, Mhoon V, Kainthla R, Beg MS, Kazmi SM. Importance of addressing malnutrition in cancer and implementation of a quality improvement project in a gastrointestinal cancer clinic. Nutr Clin Pract 2021; 37:215-223. [PMID: 34339072 DOI: 10.1002/ncp.10753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Malnutrition is exceedingly common in cancer patients, with some of the highest rates seen in gastrointestinal (GI) malignancies. Malnutrition and cachexia in cancer patients is associated with worse quality of life, poor treatment tolerance, and increased morbidity and mortality. The importance of early recognition of malnutrition in cancer patients is key, and numerous screening tools have been validated to aid practitioners in this diagnosis. In this paper, we summarize the importance of identifying and managing malnutrition in GI cancer patients as well as its impact on clinical outcomes. We then focus on presenting our own novel quality improvement project that aims to expand access to dietitian services in a GI cancer clinic at a large safety-net hospital system. Utilizing evidence-based quality improvement methodologies including the Model for Improvement and Plan-Do-Study-Act cycles, we increased the proportion of GI oncology patients seen by a dietitian from 5% to 20% from October 2018 to July 2019. In particular, we outline the challenges faced in the implementation process of a malnutrition screening tool built into the electronic medical record in an outpatient oncology clinic. We focus on the tool's ability to capture a greater number of patients with malnutrition and its clinical impact.
Collapse
Affiliation(s)
- Nicholas S Levonyak
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary P Hodges
- Parkland Health and Hospital System, Dallas, Texas, USA
| | - Nicole Haaf
- Parkland Health and Hospital System, Dallas, Texas, USA
| | - Timothy J Brown
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelli Hardy
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, Division of Hematology and Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Verca Mhoon
- Parkland Health and Hospital System, Dallas, Texas, USA
| | - Radhika Kainthla
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Parkland Health and Hospital System, Dallas, Texas, USA
| | - Muhammad Shaalan Beg
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, Division of Hematology and Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Syed M Kazmi
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Parkland Health and Hospital System, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, Division of Hematology and Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
2
|
Hopkinson JB, Kazmi C, Elias J, Wheelwright S, Williams R, Russell A, Shaw C. Diet and weight management by people with nonmetastatic colorectal cancer during chemotherapy: mixed methods research. COLORECTAL CANCER 2020. [DOI: 10.2217/crc-2019-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Aim: To investigate self-management of dietary intake by colorectal cancer patients receiving chemotherapy. Methods: A questionnaire was administered to 92 patients with nonmetastatic colorectal cancer receiving chemotherapy treatment at a UK cancer center in 2018–19. A maximum variation sample of 20 patients who completed the questionnaire were interviewed. Results: More than three in five patients were at nutritional risk but fewer than one in five were concerned about dietary intake or weight. Self-management of diet and weight was inconsistent with achieving the nutritional intake recommended by clinical guidelines on nutrition in cancer. Conclusion: There is potential for psychoeducation to support change in self-management of nutritional risk, with implications for better treatment tolerance and outcomes including quality of life.
Collapse
Affiliation(s)
- Jane B Hopkinson
- Cardiff University, School of Healthcare Sciences, Cardiff, Wales CF24 OAB, UK
| | - Catherine Kazmi
- Cardiff University, School of Healthcare Sciences, Cardiff, Wales CF24 OAB, UK
| | - Jayne Elias
- Velindre University NHS Trust, Cardiff, Wales CF15 7QZ, UK
| | - Sally Wheelwright
- Macmillan Survivorship Research Group, University of Southampton, England SO17 1BJ, UK
| | | | - Ann Russell
- National Institute for Health Research (NIHR), Cancer & Nutrition Collaborative, Level E, Lab & Path Block (MP113), Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Clare Shaw
- National Institute for Health Research (NIHR), Biomedical Research center, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| |
Collapse
|
3
|
Hopkinson J. Psychosocial Support in Cancer Cachexia Syndrome: The Evidence for Supported Self-Management of Eating Problems during Radiotherapy or Chemotherapy Treatment. Asia Pac J Oncol Nurs 2018; 5:358-368. [PMID: 30271817 PMCID: PMC6103201 DOI: 10.4103/apjon.apjon_12_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
People receiving cancer treatment are at nutritional risk. Their eating problems can lead to malnutrition and weight loss. Involuntary weight loss is also a defining characteristic of tumor-induced cachexia. Weight loss is associated with poor tolerance of treatment, poor treatment outcomes, morbidity, and mortality. Support for self-management of nutritional risk may protect against malnutrition and be important in multimodal therapies to arrest the progression of cachexia. Nurses can help patients by supporting self-management of eating problems. This scoping review is about eating problems during cancer treatment. It considers patient experience and self-management of eating problems during cancer treatment for the proactive management of malnutrition and cachexia. It draws on a systematic search of Medline, CINAHL, PsycINFO, and the Cochrane Library for publications about people with cancer who have eating problems during treatment. Limits were English language; January 2000 to December 2017; adults. The search found studies about eating problems in patients treated with chemotherapy or radiotherapy for head-and-neck cancer, lung cancer, gastrointestinal cancer, breast cancer, testicular cancer, and ovarian cancer. Nutritional counseling can improve nutritional intake, quality of life, and weight. However, the patient perspective on self-management and how to motivate engagement in nutritional care is unexplored. There is a potential for reducing nutritional risk during cancer treatment using psychoeducation to support behavioral change, thus empower self-management of eating problems. Benefits are likely in subgroups of people receiving cancer treatment, such as those with head and neck, gastrointestinal, and lung cancers.
Collapse
Affiliation(s)
- Jane Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
5
|
Baldwin C, Spiro A, Andreyev HJN. Response to nutrition support, quality of life and clinical outcomes. J Hum Nutr Diet 2012. [DOI: 10.1111/j.1365-277x.2012.01294.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Baldwin
- King's College London; Diabetes and Nutritional Sciences Division; London; UK
| | - Ayelet Spiro
- King's College London; Diabetes and Nutritional Sciences Division; London; UK
| | | |
Collapse
|
6
|
Baldwin C, Weekes CE. Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials. J Hum Nutr Diet 2012; 25:411-26. [DOI: 10.1111/j.1365-277x.2012.01264.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|