Identification and management of cancer cachexia in patients: Assessment of healthcare providers' knowledge and practice gaps

Abstract

Background Cancer cachexia negatively impacts patient outcomes, quality of life and survival. Identification and management of cancer cachexia remains challenging to healthcare professionals (HCPs). The aim of this assessment was to identify current gaps in HCPs' knowledge and practice for identifying and managing adults with cancer‐related cachexia. Results may guide development of new educational programmes to close identified gaps and improve outcomes of cancer patients. Methods An international assessment was conducted using a mixed‐methods approach including focus group interviews with subject matter experts and an electronic survey of practising HCP. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in‐country collaborating organizations. Results A quantitative survey of 58 multiple‐choice questions was completed by physicians, nurses dietitians and other oncology HCP (N = 2375). Of all respondents, 23.7% lacked confidence in their ability to provide care for patients with cancer cachexia. Patients with gastrointestinal, head and neck, pulmonary cancers and leukaemia/lymphoma were reported as those at highest risk for cachexia. Only 29.1% of respondents recognized a key criterion of cancer cachexia as >5% weight loss from baseline, but many (14.4%) did not utilize a standardized definition of cancer cachexia. Despite this, most clinicians (>84%) were able to identify causes of weight loss—reduced oral intake, progressive disease, side effects of therapy and disease‐related inflammation. Of all respondents, 52.7% indicated newly diagnosed patients with cancer should be screened for weight loss. In practice, 61.9% reported that patient weight was systematically tracked over time, but only 1125 (47.4%) reported they weigh their cancer patients at each visit. Treatment of cachexia focused on increasing the patient's nutritional intake by oral nutritional supplements (64.2%), energy and protein fortified foods (60.3%) and counselling by a dietitian (57.1%). Whereas many respondents (37.3%) considered cachexia inevitable, most (79.2%) believed that an interprofessional team approach could improve care and that use of standardized tools is critical. Conclusions Findings from this international assessment highlight the challenges associated with the care of patients with cancer cachexia, opportunities for interventions to improve patient outcomes and areas of variance in care that would benefit from further analysis.

Educational needs of self-care in cachectic cancer patients and caregivers

“…They also show that educated healthcare professionals are more likely to be aware of guidelines and to have the confidence to provide patients with nutritional advice [20]. However, education and training in cancer cachexia is reported to be inadequate [21,22 ▪ ,23] despite being recognized for its potential to improve practice [22 ▪ ,24].…”

Anamorelin in Japanese patients with cancer cachexia: an update

“…In fact, in a questionnaire survey of Japanese healthcare professionals, only 17.4% of those assessed cachexia on their own 18 . Recent international quantitative survey showed that only 29.1% of respondents recognized a key criterion of cancer cachexia as >5% weight loss from baseline 19▪▪ . Many respondents (37.3%) believed that cachexia was inevitable.…”

ASPEN's international collaborative effort to explore knowledge and practice gaps for treating patients with cancer cachexia

“…The results of this multinational survey of interprofessional oncologic providers were recently published and offer a clinician point of view for the challenges of caring for patients with CC. 8 The results of the survey were sobering, as they revealed the belief by nearly 40% of respondents that cachexia is an inevitable reality for patients with cancer. Nearly 50% of respondents were very or somewhat confident in their ability to provide care for patients with CC despite many respondents reporting no use of a standardized definition of CC at their practice site and that the terms malnutrition and cachexia were often used interchangeably to describe cancer-related weight loss.…”

“…7 The need for further awareness of CC has been identified for patients and their caregivers, but a recent international mixed-method needs assessment was conducted to focus on the gaps in practices and understanding of CC among healthcare practitioners. 8 The mixed-method approach to this project included the creation of two levels of advisory boards from members of in-country collaborating organizations. The American Society for Parenteral and Enteral Nutrition (ASPEN) was represented by members of the ASPEN Oncology Section and was one of four collaborative organizations who participated in the global project led by the Society on Cachexia and Wasting Disorders (SCWD).…”

“…Members of the ASPEN Oncology Section represented just less than half of the North American Regional Advisory Board. 8 Survey participants were truly interdisciplinary. Those responding most frequently included physicians, dietitians/nutritionists, nurses/ advanced practice nurses, pharmacists, and physical therapists, as well as a smaller number of other healthcare professionals.…”