Importance of addressing malnutrition in cancer and implementation of a quality improvement project in a gastrointestinal cancer clinic

Abstract

Malnutrition is exceedingly common in cancer patients, with some of the highest rates seen in gastrointestinal (GI) malignancies. Malnutrition and cachexia in cancer patients is associated with worse quality of life, poor treatment tolerance, and increased morbidity and mortality. The importance of early recognition of malnutrition in cancer patients is key, and numerous screening tools have been validated to aid practitioners in this diagnosis. In this paper, we summarize the importance of identifying and managing malnutrition in GI cancer patients as well as its impact on clinical outcomes. We then focus on presenting our own novel quality improvement project that aims to expand access to dietitian services in a GI cancer clinic at a large safety‐net hospital system. Utilizing evidence‐based quality improvement methodologies including the Model for Improvement and Plan‐Do‐Study‐Act cycles, we increased the proportion of GI oncology patients seen by a dietitian from 5% to 20% from October 2018 to July 2019. In particular, we outline the challenges faced in the implementation process of a malnutrition screening tool built into the electronic medical record in an outpatient oncology clinic. We focus on the tool's ability to capture a greater number of patients with malnutrition and its clinical impact.

Phase Angle Research Study in NeoplastIc Patients Treated with Standard Chemotherapy (PARSNIP)

“…Overall, evidence of the literature reasonably supports the view that widespread malnutrition can be found in patients with GI malignancies, though it remains an underdiagnosed problem in cancer patients [37][38].…”

Contribution of non‐socioeconomic factors to healthy quality of life in socioeconomically deprived patients with advanced gastrointestinal cancer: Measuring attributable fraction

“…Also, although the nutritional deterioration in cancer was the highly complex end result of multiple interactions, our results also suggested that when patients with advanced gastrointestinal cancer with socioeconomic deprivation were well nourished, they could contribute 23.11% to their healthy quality of life (95%CI: 9.67 to 36.56). This re‐emphasizes that early identification of malnutrition in cancer patients and effective nutritional support strategies may be an important predictor of increased quality of life (Levonyak et al, 2022; Vitaloni et al, 2022).…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…Medical professionals and cancer patients alike believe toxicities are inevitable and general amelioration techniques are often overlooked. Difficulty eating and malnutrition during cancer therapy are common problems that can be assessed with many tools [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The challenge is to have an acceptable quality and quantity of nutrient intake with minimal toxicity without compromising effective cancer treatment.…”

“…Malnutrition in cancer patients is a common problem. There are many indices and tools to define malnutrition, cachexia, and sarcopenia [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]62,[69][70][71][72][73][74][75][76][77]. Although weight loss from the time of diagnosis is one measure, the quantity and quality of food in the diet and information from the patient generated subjective global assessment (PG-SGA) tool can provide more specific information [35,36,45,51,62,66,[69][70][71][72][73][78][79][80].…”