Malnutrition is common in oncology patients undergoing chemotherapy, which can compromise quality of life (QoL) and other clinical outcomes. This project aimed to pilot and evaluate the feasibility and acceptability of a proactive model of care encompassing targeted malnutrition screening and assessment, effective workforce planning through the use of a nutrition assistant and provision of a fortified food model to ambulatory patients attending the Chemotherapy Day Unit (CDU) and provide recommendations regarding its potential efficacy in usual care.
Data was collected pre-implementation (baseline, n=95) and post-implementation (pilot, n=99) of a new model of nutritional care. Nutritional risk (Malnutrition Screening Tool), nutritional status (Patient Generated-Subjective Global Assessment) and QoL(European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, EORTC-QLQ C30) were evaluated in week 1 and 6 of chemotherapy. Unplanned hospital admissions and chemotherapy treatment outcomes were evaluated 12 weeks post chemotherapy commencement.
The new model of care demonstrated improved nutrition screening rates (0% vs 95%), food provision, patient and staff satisfaction and reduced occurrence of chemotherapy dose delays (18.9% vs 8.1%), dose reductions (20% vs 2%) and length of stay of unplanned admissions (7 days vs 4 days). The new model did not show statistically significant improvements in QoL, nutritional risk, nutritional status, or unplanned admission rates however positive trends were found.
This project demonstrated that positive outcomes can be achieved through the use of an evidence based, structured and workforce efficient nutrition support program. This program was able to contribute to improvements for patients and at an organisational level and has now been implemented into usual care with no additional resource requirements. Further research is required to determine the optimal type and frequency of nutrition interventions and whether nutritional and clinical outcomes can be improved over a greater time period of intervention.