Psychosocial Support and Nutrition Counselling Among Patients with Cancer Receiving Chemotherapy: A Mixed-Methods Study

Purpose Cancer chemotherapy causes nutrition impact symptoms (NIS) that affect patient diet and nutrition. Such patients, therefore, require nutrition counselling. In this study, we aimed to 1) identify the psychosocial factors of patients who require nutrition counselling and 2) articulate the specific details of the issues for which patients desire advice. Methods We conducted anthropometric measurements, surveys using questionnaires, and interviews with patients receiving outpatient chemotherapy for head and neck, oesophageal, gastric, colorectal, and lung cancers. The questionnaire included items on NIS, patients’ experience of eating-related distress (ERD), and quality of life (QOL). Interviews were conducted with patients who required nutrition counselling regarding specific issues. We provided nutrition counselling in two sessions. Results Of the 151 patients, 42 required nutrition counselling. The psychosocial factors affecting the required nutrition counselling were the number of people in the household, employment status, QOL, and ERD. The contexts of the specific issues patients wanted to discuss included self-management, distress, understanding and sympathy, anxiety, and confusion. Conclusion Nutrition counselling for patients receiving cancer chemotherapy needs to involve multidisciplinary support that considers psychological (anxiety, confusion) and social (family structure, employment situation) aspects as additional means to address NIS.

Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.

[ID 54107] O NUTRITION IMPACT SYMPTOMS (NIS) PODE SER UTILIZADO COMO UM INSTRUMENTO DE TRIAGEM NUTRICIONAL EM PACIENTES COM DOENÇA RENAL CRÔNICA NA POPULAÇÃO BRASILEIRA?

Objetivo: Adaptar e validar o uso da ferramenta Nutritional Impact Symptoms (NIS) como instrumento de triagem nutricional em indivíduos com DRC na população brasileira. Metodologia: Estudo do tipo transversal desenvolvido em um Hospital Universitário, baseado nos procedimentos de validação sugeridos por Beaton et al. (2000), American Educational Research Association, American Psychological Association e National Council on Measurement in Education (2014) e revisados por Muñiz, Elosua e Hambleton (2013). Resultados: Para a validação do NIS, utilizando-se a Avaliação Subjetiva Global (ASG) como padrão, foram realizadas as análises sequenciais, obtendo-se um coeficiente da correlação de Spearman classificado como moderado (ρ=0,51; p<0,001); um erro típico da medida absoluto de 0,46 e relativo de 30%; coeficiente de variação de 15% e ausência de diferenças entre avaliações médias (p=0,497). Embora a classificação entre o NIS e a ASG original tenham apresentado uma moderada correlação, sem diferenças entre as médias e um erro sistemático baixo, a concordância entre as variáveis apresentou uma amplitude alta no erro aleatório. Conclusão: A NIS foi adaptada, mas não validada para o público com doença renal em âmbito hospitalar, necessiatndo de uma avaliação com um maior número de pacientes para poder ser utilizada como parte de protocolos de avaliação nutricional com objetivo de rastreio da presença de desnutrição e posterior avaliação aprofundada da mesma.

Chronic Nutrition Impact Symptoms Are Associated with Decreased Functional Status, Quality of Life, and Diet Quality in a Pilot Study of Long-Term Post-Radiation Head and Neck Cancer Survivors

Background: As a result of tumor location and treatment that is aggressive, head and neck cancer (HNC) survivors experience an array of symptoms impacting the ability and desire to eat termed nutrition impact symptoms (NISs). Despite increasing cancer survival time, the majority of research studies examining the impact of NISs have been based on clinical samples of HNC patients during the acute phase of treatment. NISs are often chronic and persist beyond the completion of treatment or may develop as late side effects. Therefore, our research team examined chronic NIS complications on HNC survivors’ functional status, quality of life, and diet quality. Methods: This was a cross-sectional study of 42 HNC survivors who were at least 6 months post-radiation. Self-reported data on demographics, NISs, quality of life, and usual diet over the past year were obtained. Objective measures of functional status included the short physical performance battery and InBody© 270 body composition testing. NISs were coded so a lower score indicated lower symptom burden, (range 4–17) and dichotomized as ≤10 vs. >10, the median in the dataset. Wilcoxon rank sum tests were performed between the dichotomized NIS summary score and continuous quality of life and functional status outcomes. Diet quality for HNC survivors was calculated using the Healthy Eating Index 2015 (HEI-2015). Wilcoxon rank sum tests examined the difference between the HNC HEI-2015 as compared to the National Health and Nutrition Examination Survey (NHANES) data calculated using the population ratio method. Results: A lower NIS score was statistically associated with higher posttreatment lean muscle mass (p = 0.002). A lower NIS score was associated with higher functional (p = 0.0006), physical (p = 0.0007), emotional (p = 0.007), and total (p < 0.0001) quality of life. Compared to NHANES controls, HNC survivors reported a significantly lower HEI-2015 diet quality score (p = 0.0001). Conclusions: Lower NIS burden was associated with higher lean muscle mass and functional, physical, emotional, and total quality of life in post-radiation HNC survivors. HNC survivors reported a significantly lower total HEI-2015 as compared to healthy NHANES controls, providing support for the hypothesis that chronic NIS burden impacts the desire and ability to eat. The effects of this pilot study were strong enough to be detected by straight forward statistical approaches and warrant a larger longitudinal study. For survivors most impacted by NIS burden, multidisciplinary post-radiation exercise and nutrition-based interventions to manage NISs and improve functional status, quality of life, and diet quality in this survivor population are needed.

Diet and Nutrition Advice After a Solid Tumor Diagnosis

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.