Nutritional Outcomes of patients Undergoing Resection for upper gastroIntestinal cancer in AuStralian Hospitals (NOURISH): protocol for a multicentre point prevalence study

Abstract

IntroductionNutritional intervention and prevention of malnutrition is significantly important for patients with upper gastrointestinal oesophageal, pancreatic and gastric cancer. However, there is limited information regarding nutritional status, and perioperative nutritional interventions that patients receive when undergoing curative surgery.Methods and analysisPatients diagnosed with upper gastrointestinal cancer, planned for curative intent resection across 27 Australian hospitals will be eligible to participate in this point prevalence study. The primary aim is to determine the prevalence of malnutrition in patients with upper gastrointestinal cancer at the time of surgery using subjective global assessment. Secondary aims are to determine the type and frequency of perioperative nutritional intervention received, the prevalence of clinically important weight loss and low muscle strength, and to investigate associations between the use of an evidence-based nutrition care pathway or protocol for the nutritional management of upper gastrointestinal surgical oncology patients and malnutrition prevalence. Data collection will be completed using a purpose-built data collection tool.Ethics and disseminationEthical approval was granted in May 2019 (LNR/51107/PMCC-2019). The design and reporting of this study comply with the Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting of observational cohort studies. Findings will be published in peer-reviewed scholarly journals and presented at relevant conferences. Results will assist in defining priority areas for research to improve patient outcomes.

Preoperative Nutrition Intervention in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

“…Ethics approval was obtained from The Peter MacCallum Cancer Centre Ethics Committee prior to commencement (LNR/51107/PMCC-2019). Further details of study design, participating sites, and methods are reported in the previously published study protocol [ 12 ]. Verbal consent was provided by participants and all patients received the standard dietetics care of the participating health service.…”

“…Percentage weight loss was also calculated at the 3-month, 1-month, and 2-week preoperative timeframes. Clinical data were obtained from participant’s medical records, including age, sex, postcode of residence to determine metropolitan or regional/rural locality, surgery type (gastric, oesophageal, or pancreatic), tumour type, pathological tumour stage from intraoperative histopathology [ 15 ], receipt of neoadjuvant chemo/radiotherapy, surgical LOS, and surgical complications (converted into a binary variable of ‘no complications’ or ‘one or more complication’) ( Supplementary File 1 ) [ 12 ].…”

“…A nutritional assessment was completed within seven days of surgery by site investigator dietitians using the SGA [13], and patients were classified as well-nourished (SGA A) or malnourished (SGA B or C). Further data were collected using a purpose-built data collection tool, including assessment of preoperative weight loss (per patient reported history/medical record entries) and information pertaining to receipt of preoperative dietetics (type, location, number of appointments, timing of last appointment) or nutritional intervention (type, timing, any other nutritional advice provided) (Supplementary File 1) [12]. Clinically significant weight loss was deemed to be ≥5% in 6 months prior to surgery [14].…”

“…The multi-centre Nutritional Outcomes of Patients Undergoing Resection for Upper Gastrointestinal Cancer in Australian Hospitals study (The NOURISH Point Prevalence Study) was therefore initiated to investigate the nutritional status and perioperative nutritional interventions received by patients undergoing curative intent surgery for UGI cancer [ 12 ]. Outcomes of the NOURISH study, including detailed analysis of nutritional status, site-specific nutritional practices, and perioperative nutritional intervention will be reported in a series of sub-studies.…”

Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

“…The Nutritional Outcomes of patients Undergoing Resection for upper gastroIntestinal cancer in AuStralian Hospitals study (The NOURISH Point Prevalence Study) was conducted to investigate nutritional status and nutritional interventions received by patients undergoing UGI cancer surgery and associations with clinical outcomes, as well as health-service-level practices [ 17 ]. NOURISH is the largest study internationally to assess nutritional status in UGI cancer patients at the time of surgery using a validated assessment method [ 17 ]. The aims of this study were to determine the prevalence of malnutrition, clinically important weight loss, low muscle strength and nutrition impact symptoms.…”