Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Improving adherence to evidence-based, pre-operative nutrition care in patients undergoing oral cavity reconstruction surgery for head and neck cancer: A feasibility study (126418)

Shane McAuliffe 1 2 , Sarah Davies 2 , Masako Dunn 2 , Kate White 3 4 5 , Jonathan Clark 1 2 6 , Merran Findlay 2 3 5 7
  1. Sydney Medical School, Faculty of Medicine and Health, University of Sydney , Research Affiliate, Sydney , NSW
  2. Chris O'Brien Lifehouse, Camperdown, NSW, Australia
  3. Cancer Care Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney , , Sydney, NSW
  4. Cancer Services, Sydney Local Health District , , Sydney, NSW
  5. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Australia , , Sydney, NSW
  6. Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia, , Sydney, NSW
  7. Maridulu Budyari Gumal (SPHERE) Cancer Clinical Academic Group, South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia , , Sydney, NSW

Background/rationale:

Malnutrition is prevalent in patients undergoing reconstruction surgery for head and neck cancer (HNC), negatively impacting outcomes. Despite the availability of evidence-based guidelines (EBGs), evidence-practice gaps persist. This study examined the feasibility of implementing a pre-operative nutrition evidence-based care pathway (EBCP). 

Methods:

This mixed-methods, pre-post study included a retrospective audit (Jan-Dec 2023) and prospective pilot implementation of a pre-operative, supportive care-led clinic (Oct 2024-Jan 2025). Nutrition care processes (referrals, malnutrition screening and nutrition assessment with validated tools) were benchmarked against Clinical Oncology Society of Australia (COSA) EBGs. Clinical outcomes (complications, length of stay (LOS) and readmissions) were explored. A survey of multidisciplinary team (MDT) members examined the perception of the importance of nutrition, clinician roles and responsibilities and barriers to screening and assessment using the Capability, Opportunity, Motivation-Behaviour (COM-B) model. Subsequent MDT engagement informed the EBCP, guided by the Action, Actor, Context, Target, Time (AACTT) Implementation Framework.

Impact on practice:

Pre- (n=115, 56% male, mean (SD) age 62 (15) years) and post-implementation (n=41, 64% male, 62 (14) years) cohorts were included. All pre-operative nutrition care processes improved following EBCP implementation, including referrals (64% vs. 95%, p<0.001) and malnutrition screening (91 vs. 98%, p=0.14). False negative screening reduced (22% vs. 10%, p=0.13) and median time from screening to surgery increased (0 vs. 5 days, <0.001). Nutrition assessment with a validated tool increased (13% vs. 80%, p<0.001). Survey responses pre- (n=11) and post- (n=8) implementation indicated improved perception of the service and fewer barriers to screening and assessment. All respondents agreed that the service met patient’s nutrition care needs following EBCP implementation.

Discussion:

Implementing a pre-operative nutrition EBCP is feasible, improves adherence to evidence-based nutrition care for patients with HNC and has potential to improve patient outcomes. This model may be transferrable to other areas of cancer care.

  1. Findlay, M., et al., Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes. J Cachexia Sarcopenia Muscle, 2021. 12(6): p. 2187-2198
  2. Findlay M, Bauer JD, Brown T, et al. Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Sydney: Cancer Council Australia. 2011 Updated 26/1/2024]; Available from: https://app.magicapp.org/#/guideline/Eez3Kj.
  3. Kiss N, Loeliger J, Findlay M, et al. Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia. Nutrition and Dietetics. 2020;77(4):416-425.
  4. Presseau, J., McCleary, N., Lorencatto, F., Patey, A. M., Grimshaw, J. M., & Francis, J. J. (2019). Action, actor, context, target, time (AACTT): a framework for specifying behaviour. Implementation science : IS, 14(1), 102. https://doi.org/10.1186/s13012-019-0951-x