Defining barriers to implementation of nutritional advice in patients with cachexia

Abstract

Background Cancer cachexia is a multidimensional wasting syndrome and a reduced dietary intake is both common and strongly correlated with degree of weight loss. Many patients with cachexia do not achieve recommended dietary intake even after nutritional counselling. Prior reports suggest this is likely due to barrier symptoms, but other potential contributory factors have not been studied in detail. Methods Dietitian‐assigned barriers to successful nutritional intervention were recorded at each visit in all patients attending a multidisciplinary clinic for management of cancer cachexia. The barriers were grouped into 15 categories and classified as either symptom‐related or not symptom‐related. In addition, symptom scores, dietary intake, and weight change were recorded. Results Data on 94 new patients showed that 89% of patients had at least one major barrier. Four of the five most common barriers and 65% of all barriers identified were not symptom‐related. Over sequential visits the specific barrier(s) in any one patient changed approximately 50% of the time. However, the presence of barriers did not render patients refractory to nutritional intervention and with intervention from the CNR‐JGH team, mean dietary intake increased significantly. Conclusions In advanced cancer patients with cachexia, non‐symptom‐related barriers to nutritional intervention are more common than symptom‐related. Barriers are dynamic, and repeated careful evaluation over time is required to achieve optimal impact with nutritional intervention in cancer cachexia. Members of the multidisciplinary team need appropriate expertise to address the barriers identified and achieve optimal results with nutritional intervention.

Nutrition in the spotlight in cachexia, sarcopenia and muscle: avoiding the wildfire

“…We selected articles investigating nutrition interventions, macronutrient intake below recommended, and micronutrient deficiency. We found 26 articles: 10 clinical trials, 3,25–33 five cross‐sectional studies, 34–38 three experimental animal studies 39–41 (one of which also included a human cross‐sectional analysis 38 ), three narrative reviews, 6,42,43 two retrospective studies, 44,45 two systematic reviews or meta‐analyses, 46,47 and one questionnaire survey 48 . Within the 320 original and review articles published in 2018, 2019, and 2020 in JCSM , the 26 articles on nutrition that we found comprise approximately 8%.…”

“…Articles also explored the associations of protein intake, 46,47 iron deficiency, 37,42 micronutrients, 35 calorie restriction, 43 nitrate dietary intake, 36 retrospective evaluation of early dietary supplementation, 44 and overall dietary intake and patterns 34 with several clinical outcomes and/or biomarkers of sarcopenia or cachexia. Two studies evaluated the perceptions of oncology patients regarding disease‐related nutritional issues and barriers to effective nutritional interventions 45,48 . One narrative review discussed potential nutrition interventions to augment muscle mass 6 …”

Nurses’ Knowledge in Relation to the Anorexia–Cachexia Syndrome in Cancer Patients: A Cross-National Comparison in Two European Countries

“…This primarily can be cultivated by the healthcare professionals and in the event that is poorly addressed then this results to a corresponding behavior by cancer patients and their informal caregivers. Studies show that this can be an attributing factor to poor adherence to nutritional advice ( Nasrah et al, 2020 ).…”

Medical Nutrition Reimbursement in Singapore: Who Are the Patients Receiving MediFund Assistance? An Audit of Clinical Outcomes and Issues Pertaining to Reimbursement in a Public Hospital in Singapore

“…The identification, treatment, and regular reviews of malnourished patients and/or those at risk have been shown to confer benefits, such as improved nutrition status and quality of life, regardless of funding availability 16,17 . The additional financial support provided to patients will likely improve compliance to MNPs and nutrition advice provided, as financial constraint is a known social barrier to the implementation of nutrition intervention in patients 18 …”