Aims: Effective, timely and evidence-based nutrition management of upper GI (UGI) cancer patients receiving chemo-radiation therapy is important to prevent the negative consequences of developing malnutrition and poor treatment outcomes in this high risk population group. This study evaluates nutrition outcomes and clinician compliance pre and post implementation of an evidence based nutrition care pathway (CP) for UGI patients in a tertiary cancer centre.
Methods: A comprehensive literature review was completed to identify relevant articles and evidence-based guidelines to inform the development and review of the CP. Evidence from the literature was assessed and used to modify the existing CP in collaboration with the multidisciplinary team. Clinician compliance and nutrition outcomes were evaluated through a retrospective audit of 16 patients that underwent definitive chemo-radiation between October 2011 - March 2012 prior to CP implementation, and compared to 27 patients between February 2016 - September 2017 post CP implementation.
Results: Post implementation 100% of patients were referred as per CP. Compliance with CP during treatment was high with 85% patients seen in week 1 treatment, 85% receiving weekly dietitian reviews and 100% seen during final week of treatment. Malnutrition screening by nurse coordinator has improved (44% pre vs. 76% post CP implementation). Compliance with PG-SGA assessment has increased at all specified time points, with the most significant increase seen at initial dietitian contact (25% pre vs. 67% post-implementation). Overall percentage weight loss from week 1 to final week of treatment was less post-implementation (-3.4%) compared to pre-implementation (-6.6%).
Conclusions: The CP continues to reflect the most current literature and evidence based practice guidelines, and overall nutrition outcomes were found to improve following implementation of the CP. This evaluation provides valuable information to inform future recommendations for the CP and assist with improving the overall nutrition management of UGI patients undergoing chemo-radiation.