Background: Colorectal cancer (CRC) is commonly treated with surgery and its success is frequently defined by cure rates. Impact on other aspects of health and wellbeing are less frequently considered in clinical practice. Patient-reported outcome measures (PROMs) provide a useful means of assessing such impacts. This study examines changes in healthrelated quality of life (HRQoL) after surgical resection using PROMs. Methods: A prospective, longitudinal study was undertaken in 49 adults receiving curative surgery for CRC. Participants completed the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) before surgery, and at 2 to 4 weeks, 3 and 6 months post-surgery. Linear mixed models were used to analyse FACT-C wellbeing and subscale scores. Results: Patients reported a clinically important deterioration in functional and physical wellbeing 2 to 4 weeks post-surgery (both P < 0.05); differences at 6 months after surgery were trivial. Conversely, patients reported clinically important improvement in emotional wellbeing at 2 to 4 weeks post-surgery; this improvement was sustained at 3 and 6 months post-surgery (all P < 0.05). For social wellbeing and colorectal cancer-specific concerns, changes from before surgery at follow-up assessments were not statistically significant (all P > 0.05). Conclusion: While physical aspects of HRQoL are affected in the short term by CRC surgery, clinically significant improvement in emotional wellbeing are reported early (2 to 4 weeks post-surgery). Future research may help identify patients who are at greater risk of surgical impacts on health and wellbeing.
Doctors' knowledge and perceptions of perioperative nutrition support; results from a large Australian tertiary referral Centre Nutritional optimisation in the perioperative period is essential in the prevention and treatment of malnutrition, a state of poor bodily function caused by a lack of nutritional intake, thereby altering body composition. 1 Although identification and treatment of malnutrition is well recognized as a key component of Enhanced Recovery After Surgery (ERAS) guidelines, it is still highly prevalent, and significantly associated with poor outcomes. Studies have shown that up to 50% of patients undergoing abdominal surgery are malnourished. [2][3][4][5] These patients are further at risk due to reduced recognition, combined with poor clinician understanding of treatment strategies due to their lack of knowledge and experience. [6][7][8][9][10] To identify how we can improve on surgical nutrition management within our surgical units, we performed a survey within a large tertiary referral hospital in Melbourne, Australia. The project was approved by the Western Health Office of Research (QA2020.13_61439). A purpose-built, 23-item anonymous online REDCap survey was distributed to all doctors (including interns, residents, registrars, fellows and consultants) working across all general surgical units at Western Health. As our recruitment strategy involved advertising the survey at the weekly surgical morbidity and mortality meeting and via email distribution, response rate calculation was not feasible. The survey, developed by a team of senior academic dietitians and surgeons, included Likert scale 'agree/disagree' questions as well as clinical multiplechoice questions to assess doctor's perceptions and knowledge of perioperative nutritional support within general surgery. Of the 50 respondents, the majority were junior doctors (11 [22%] interns and 17 [34%] residents), 11 were registrars (22%) and a further 11 were consultant surgeons (22%). Only 24% (12) of respondents reported any prior training on perioperative nutritional support. While all respondents agreed on the importance of perioperative nutrition training (100%) and 94% (47) agreed on the need for nutritional assessment both before and after abdominal surgery, only 46% (23) felt confident in being able to initiate enteral or parenteral support according to evidence based guidelines. This was reflected when only approximately half of respondents correctly identified the correct timing to commence enteral (62%; 31) and total parenteral nutrition (50%; 25).Early identification of patients with nutritional deficits is important to ensure appropriate and timely interventions, however only a small proportion (20%; 10) of doctors surveyed were confident in identifying malnutrition and only 34% (17) were able to identify
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