Rationale
Malnutrition is a common side effect of Upper Gastrointestinal (UGI) cancer which can negatively impact treatment and survival outcomes. Furthermore, the evidence suggests that treating malnutrition may have a positive impact on a patient's quality of life. Current clinical guidelines recommend all UGI cancer patients be considered at high risk of malnutrition and referred to a dietitian at diagnosis. The Optimal Care Pathway (OCP) for Oesophagogastric cancer indicates supportive care assessments should be completed using validated screening tools (including the Malnutrition Screening Tool (MST)) within 2 weeks of diagnosis.
Methods
Utilising available Gippsland cancer data, a manual file audit (n=40) was completed for all patients undergoing treatment (radiotherapy and/or systemic therapy) for UGI cancer during 2023 at Latrobe Regional Health (LRH) to investigate timeliness of malnutrition screening and dietitian assessment.
Results
64% of patients had documented evidence of MST completion, ranging from 0 to 33 days from date of initial oncologist appointment (IOA). 10% of patients had evidence of an MST completed on the same date as the IOA, and only 41% within 2 weeks of the IOA. Of those who had an MST completed, 87% scored 2 or above, indicating an elevated risk of malnutrition. 89% of patients were referred to a dietitian, however time ranged for dietetic assessment from IOA from 0 to 49 days. Reduced oral intake, reduced appetite and unintentional weight loss were documented in the IOA in 57%, 46% and 60% of patients (respectively) compared to 89%, 86% and 86% (respectively) when assessed by a dietitian.
Discussion
This audit indicates inconsistent nutritional screening and dietitian referral practices. Embedding malnutrition screening into current supportive care screening tools at IOA may improve consistency of malnutrition screening. Furthermore, systemised streamlined referral pathways for dietitian assessment may optimise early nutrition interventions and address detrimental nutrition impact symptoms.