Will the use of proactive nutrition screening for cancer patients in Comprehensive Oncology Center increase their awareness on their nutritional status?
By CHOW Min Yan, Jessica, BSc Nutrition & Dietetics, MSc Gastroenterology
The purposes of this project were to provide nutritional screening to out-patients cancer patients with the use of Patient Generated Subjective Global Assessment (PG-SGA) and to find out if the patients would take the PG-SGA score for reference and consult dietitians when advised.
The prevalence of malnutrition is high in cancer patients and it is associated with poorer prognosis and decreased quality of life. The American Society of Parenteral and Enteral Nutrition endorsed malnutrition screening for adult oncology population that was undergoing cancer treatment.
Studies from randomized controlled trials showed that nutrition counseling with or without oral nutrition supplement was associated with much more consistent and significant improvements in nutrition status outcomes. The Patient Generated Subjective Global Assessment (PG-SGA) is one of the best validated screening tools for use in cancer patients. The advantages of using PG-SGA include it facilitates screening, assessment, triaging for and monitoring of interventions, in turn allowing for a continuous variable assessment.
All cancer patients attending the Comprehensive Oncology Center from 26th Sept to 6th Oct 2017 were invited by the center nurses to fill out the PG-SGA form and questionnaires. If the PG-SGA score reached 6 and above, the patient would be informed he/she was at risk for malnutrition and a dietitian consultation would be suggested. A dietary consultation would be conducted if the patient accepted the referral. If the patient refused, the nurse would ask why and the patient would be reminded he/she can attend the dietary talk delivered by dietitians every month in the center.
Besides the PG-SGA screening, a Healthy Diet booklet would also be given to each patients, so they could take reference to what kind and how much from each food group constitutes to a healthy diet (See Table 1).
The pre-implementation data showed that nine cancer patients were seen by dietitians in the out-patients clinic from June to August 2017. Five patients were self-referred and the rest were by oncologists. Seven of them were seen for nutrition support. Five of them had significant weight loss (Average 8.7%) and six of them had inadequate food intake.
The post-implementation data showed that 40% of out-patients in the Comprehensive Oncology center were at risk for malnutrition (See Table 2). 91% of patients found PG-SGA easy to fill out, 93% of patients reported they will change their diet according to PG-SGA scores and 86% of patients reported they will see a dietitian if PG-SGA indicated there was a risk for malnutrition.
All patients agreed that adequate nutrition was important during cancer treatment. 98% of patients agreed that weight loss may increase the incidence and severity of cancer treatment side effects, only 2% of patients had no comments on the association of weight loss and the incidence and severity of cancer treatment side effects. The reasons for not seeing dietitians when a referral was indicated include I will use my own way to increase food intake, I will see dietitian if my doctor instructed me to, etc. (See Table 3).
We have found that 40% of our out-patients attending the comprehensive Oncology center were at risk for malnutrition. More than 90% of patients reported they would change their diet according to screening result and more than 85% of patients would see a dietitian if screening score indicated there was a risk of malnutrition. But only 2 patients at the end were referred to see dietitians. For further studies, we suggest we could explore why there was such a low dietitian referral rate despite having a high PG-SGA score and the changing behaviors of patients to seeing dietitians for cancer diet so that connection to the expert makes “NO DELAY”.