Late referral of cancer patients with malnutrition to dietitians: a prospective study of clinical practice
| Autor: | G. Stewart, K. Higgins, Aynur Aktas, Cliona Lorton, F. Roulston, E. Barnes, T. D. Walsh, O. Griffin, N. Gough |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Referral Nausea Nutritional Status Overweight Body Mass Index 03 medical and health sciences 0302 clinical medicine Weight loss Neoplasms Outpatients Weight Loss medicine Prevalence Humans Mass Screening 030212 general & internal medicine Nutritionists Obesity Prospective Studies Practice Patterns Physicians' Prospective cohort study Referral and Consultation business.industry Malnutrition Middle Aged medicine.disease Oncology 030220 oncology & carcinogenesis Female medicine.symptom business Body mass index |
| Zdroj: | Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 28(5) |
| ISSN: | 1433-7339 |
| Popis: | Malnutrition (MN) in cancer is common but underdiagnosed. Dietitian referrals may not occur until MN is established. We investigated cancer patient characteristics (demographics, nutritional status, and nutrition barriers) on referral to oncology dietitians. We also examined referral practices and prevalence of missed referral opportunities. This was a naturalistic multi-site study of clinical practice. Data from consecutive referrals were collected in inpatient and outpatient settings. Demographics, nutritional status (weight, body mass index (BMI), weight loss in the preceding 3–6 months, oral intake, nutrition barriers), referral reasons, and use of screening were recorded. Missed opportunities for earlier referral were also noted. Two hundred patients were included (60% male, 51% inpatients). Half had gastrointestinal and hepatobiliary cancers. The majority were on antitumor treatment. Two-thirds had lost ≥ 5% body weight. Forty percent were overweight or obese. Seventy percent had ≥ 2 nutritional barriers. Most common nutrition barriers were anorexia, nausea, and early satiety. Greater weight loss and lower food intake were associated with ≥ 2 barriers. Weight loss was the most common referral reason. Screening was used in 35%. Referrals should have occurred sooner in nearly half (45%, n = 89). Cancer patients were referred late to a dietitian, with multiple nutritional barriers. Most referrals were for established weight loss (WL). WL may be masked by pre-existing obesity. Almost half had missed earlier referral opportunities; screening was infrequent. Over one-quarter should have been re-referred sooner. There is a clear need for clinician education. Future research should investigate the optimal timing of dietitian referral and the best nutrition screening tools for use in cancer. |
| Databáze: | OpenAIRE |
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