International Nutrition Audit in Foregut Tumours (INFORM): An Exploration of Nutrition Care Processes in Cancer Care Settings
Nutrition, Food Science and Packaging
American Society of Enteral and Parenteral Nutrition
Purpose: Providing nutrition care for patients with head and neck (HN) and esophageal (E) cancers is complex and system level nutrition processes in cancer care centres can highly influence the delivery of nutrition care in these high-risk patients. The purpose of this paper is to describe current nutrition care processes in place for HN and E cancer patients across several international cancer care settings and the patient characteristics, type and amount of nutrition received at baseline.
Methods: In a multicenter prospective audit, consenting adult patients with curative HN or E cancer were enrolled from 11 cancer care centres from Canada, the Netherlands, Italy, Australia and the United States. Data on the demographics of each participating site, the allied health teams involved and existing processes related to nutrition screening, assessment, intervention and follow up were collected for each cancer care centre before the start of the audit. Baseline data on patient characteristics, nutrition practice (nutrition type, route, and adequacy defined as calories and protein received as a % prescribed) on the patients that were in the dataset as of March 16 2018 is presented. Descriptive analyses using means, standard deviation and percentages were used and data is shown on the combined sample of HN and E cancer patients.
Results: A total of 11 cancer care centers participated in the audit (6 from Canada, 1 each from the Netherlands, Italy, the US and 2 from Australia) and site characteristics are shown in table 1. Existing ASPEN 2019 Nutrition Science & Practice Conference 197 processes at the centers related to nutrition screening, assessment, intervention and follow up are also presented in table 1. Nutrition assessment is most commonly done using height, weight or BMI (39% centers) followed by Subjective Global Assessment (SGA) (27%), Patient Generated-SGA (15%), body composition (4%), hand grip strength (4%) or other methods not specified (11%). Calorie and protein needs are most commonly being determined by weight based formulas followed by predictive equations while indirect calorimetry is used less frequently. A total of 145 patients were enrolled (95 HN, 50 E cancer) between 2016 and 2018 from the 11 centers. Of these, at least 118 have complete data on nutrition practices at baseline. Characteristics and nutrition practices of these patients at baseline are described in table 2.
Conclusions: Although current nutrition care processes across international cancer care settings seem to suggest there is support in place for adequate nutrition screening and assessment in HN and E cancer patients, there is a need to examine if these processes will translate into improved delivery of nutrition in these patients. Efforts are underway within the context of the INFORM audit (ClinicalTrials.gov ID NCT02829489), to collect data on patient level outcomes and study their association to these reported nutrition processes.
Leah Gramlich, Rupinder Dhaliwal, Marian d. Schueren, Alessandro Laviano, Merran Findlay, Judy Bauer, Merrilyn Banks, and Adrianne M. Widaman. "International Nutrition Audit in Foregut Tumours (INFORM): An Exploration of Nutrition Care Processes in Cancer Care Settings" American Society of Enteral and Parenteral Nutrition (2019). https://doi.org/10.1002/jpen.1511