A Qualitative Exploration of Nutrition Screening, Assessment and Oral Support Used in Patients Undergoing Cancer Surgery in Low- and Middle-Income Countries

Abstract

Preoperative undernutrition is a prognostic indicator for postoperative mortality and morbidity. Evidence suggests that treating undernutrition can improve surgical outcomes. This study explored the provision of nutritional screening, assessment and support on surgical cancer wards in low- and middle-income countries (LMICs). This was a qualitative study and participants took part in one focus group or one individual interview. Data were analysed thematically. There were 34 participants from Ghana, India, the Philippines and Zambia: 24 healthcare professionals (HCPs) and 10 patients. Results showed that knowledge levels and enthusiasm were high in HCPs. Barriers to adequate nutritional support were a lack of provision of ward and kitchen equipment, food and sustainable nutritional supplements. There was variation across countries towards nutritional screening and assessment which seemed to be driven by resources. Many hospitals where resources were scarce focused on the care of individual patients in favour of an integrated systems approach to identify and manage undernutrition. In conclusion, there is scope to improve the efficiency of nutritional management of surgical cancer patients in LMICs through the integration of nutrition assessment and support into routine hospital policies and procedures, moving from case management undertaken by interested personnel to a system-based approach including the whole multidisciplinary team.

Current Oncology Nutrition Care Practice in Southeast Asia: A Scoping Review

“…Characteristics of the 18 studies are summarized in Table 2 [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Studies were published between 2012-2022 from five of 11 countries (45%) listed in Southeast Asia: Malaysia (n = 10, 56%) [32,[37][38][39][40][41]44,[47][48][49], Vietnam (n = 4, 22%) [33,35,36,42], Philippines (n = 2, 11%) [45,46], Singapore [34] and Thailand [43] (both n = 1, 6%). Half of the studies [32,[38][39][40]42,[45][46][47][48] were published in 2020 or later, while the remaining studies were published from 2012-2019 [33][34][35]…”

“…Studies were published between 2012-2022 from five of 11 countries (45%) listed in Southeast Asia: Malaysia (n = 10, 56%) [32,[37][38][39][40][41]44,[47][48][49], Vietnam (n = 4, 22%) [33,35,36,42], Philippines (n = 2, 11%) [45,46], Singapore [34] and Thailand [43] (both n = 1, 6%). Half of the studies [32,[38][39][40]42,[45][46][47][48] were published in 2020 or later, while the remaining studies were published from 2012-2019 [33][34][35][36][37]41,43,44,49]. Nine studies used observational study design, with most (n = 7) undertaken as a prospective observational study [35,36,38,41,43,44,46], retrospective [33] or prospective cohort [40].…”

“…Nine studies used observational study design, with most (n = 7) undertaken as a prospective observational study [35,36,38,41,43,44,46], retrospective [33] or prospective cohort [40]. The remaining studies were audits [34,37], study protocols [32,47], randomized controlled trials (RCT) [48,49], qualitative studies [39,45], and a quasi-experimental study [42].…”

“…In 16 studies (89%) [32][33][34][35][36][38][39][40][41][42][43][44][46][47][48][49], participants were patients with cancer, while in two studies (11%), participants were a mix of patients and health professionals; the health professionals were nurses and medical professionals in one study [37], and nurses, nutritionists and dietitians, oncologists, study coordinators, and surgeons in the other study [45].…”

Postoperative mortality in Africa: are there any improvements in the last decade?

“…Most Africans are unable to afford postoperative treatment because of economic challenges and lack cash. Patients’ nutritional status, for example, cannot be evaluated in LMICs following surgery due to the high cost of indicators 15 . Other challenges include late presentation of patients, abysmal reports of complex surgery, dilapidated modes of transport leading to untimely admissions of surgical patients, and poor compliance with prescribed treatment on the part of the patient 12 .…”