Effectiveness of the nutrition referral system in a multidisciplinary pancreatic cancer clinic

Wong, Sydnee C.; Reddy, Abhinav V.; Hacker-Prietz, Amy; Kress, Laura; Pathak, Priya; Hill, Colin; Lin, Timothy A.; Herman, Joseph M.; He, Jin; Li, Zheng; Brown, Mary-Eve; Narang, Amol

doi:10.1007/s00520-023-07795-3

Cited by 2 publications

(2 citation statements)

References 26 publications

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“…Previous studies have demonstrated the effectiveness of a one-day MDC in standardization of treatment decisions, reduced patient visits, and improved patient satisfaction ( 2 , 12 , 14 ). In addition, previous study by our group has demonstrated the feasibility of using tools such as a malnutrition assessment early in the disease course through the PMDC ( 18 ). Despite the recognition of the benefits of MDCs, its value in provision of institution based guideline-concordant care as compared to individual specialty specific oncology clinics had been previously unknown.…”

Section: Discussionmentioning

confidence: 99%

Variation in outcomes and practice patterns among patients with localized pancreatic cancer: the impact of the pancreatic cancer multidisciplinary clinic

Pathak,

Hacker-Prietz,

Herman

et al. 2024

Front. Oncol.

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IntroductionPatients with localized pancreatic adenocarcinoma (PDAC) benefit from multi-modality therapy. Whether care patterns and oncologic outcomes vary if a patient was seen through a pancreatic multi-disciplinary clinic (PMDC) versus only individual specialty clinics is unclear.MethodsUsing institutional Pancreatic Cancer Registry, we identified patients with localized PDAC from 2019- 2022 who eventually underwent resection. It was our standard practice for borderline resectable (BRPC) patients to undergo ≤4 months of neoadjuvant chemotherapy, ± radiation, followed by exploration, while locally advanced (LAPC) patients were treated with 4-6 months of chemotherapy, followed by radiation and potential exploration. Descriptive and multivariable analyses (MVA) were performed to examine the association between clinic type (PMDC vs individual specialty clinics i.e. surgical oncology, medical oncology, or radiation oncology) and study outcomes.ResultsA total of 416 patients met inclusion criteria. Of these, 267 (64.2%) had PMDC visits. PMDC group received radiation therapy more commonly (53.9% versus 27.5%, p=0.001), as compared to individual specialty clinic group. Completion of neoadjuvant treatment (NAT) was far more frequent in patients seen through PMDC compared to patients seen through individual specialty clinics (69.3% vs 48.9%). On MVA, PMDC group was significantly associated with receipt of NAT per institutional standards (adjusted OR 2.23, 95% CI 1.46-7.07, p=0.006). Moreover, the average treatment effect of PMDC on progression-free survival (PFS) was 4.45 (95CI: 0.87-8.03) months. No significant association between overall survival (OS) and clinic type was observed.DiscussionProvision of care through PMDC was associated with significantly higher odds of completing NAT per institutional standards as compared to individual specialty clinics, which possibly translated into improved PFS. The development of multidisciplinary clinics for management of pancreatic cancer should be incentivized, and any barriers to such development should be addressed.

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Section: Discussionmentioning

confidence: 99%

Variation in outcomes and practice patterns among patients with localized pancreatic cancer: the impact of the pancreatic cancer multidisciplinary clinic

Pathak,

Hacker-Prietz,

Herman

et al. 2024

Front. Oncol.

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“…Cancers such as esophago-gastric and head and neck tumors usually have a more marked and dramatic nutritional impact on patients at the time of presentation due to symptoms such as dysphagia, which coupled with a tendency towards a later staging at diagnosis, can seriously hinder attempts to achieve a curative outcome [ 4 ]. In these cancer types in particular, but also in others such as pancreatic cancer or patients undergoing neoadjuvant treatment [ 5 , 6 ], both nutritional screening, subsequent assessment of at-risk patients, then intervention, is key to being able to improve morbidity, mortality and psychological outcomes in patients undergoing oncological resections [ 7 ]. In support of this, evidence from Gillis and colleagues used pooled data from five prehabilitation studies to demonstrate that in patients with colorectal cancer, those with malnutrition suffer poor physical and mental health before elective resection [ 8 ].…”

Section: Nutritional Support As Independent Prehabilitation For Cance...mentioning

confidence: 99%

Nutritional interventions in prehabilitation for cancer surgery

Wall,

Paul,

Phillips

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review Nutrition remains a key focus in the preoptimization of patients undergoing cancer surgery. Given the catabolic nature of cancer, coupled with the physiological insult of surgery, malnutrition (when assessed) is prevalent in a significant proportion of patients. Therefore, robust research on interventions to attenuate the detrimental impact of this is crucial. Recent findings As a unimodal prehabilitation intervention, assessment for malnutrition is the first step, as universal supplementation has not been shown to have a significant impact on outcomes. However, targeted nutritional therapy, whether that is enteral or parenteral, has been shown to improve the nutritional state of patients’ presurgery, potentially reducing the rate of postoperative complications such as nosocomial infections. As part of multimodal prehabilitation, the situation is more nuanced given the difficulty in attribution of effects to the differing components, and vast heterogeneity in intervention and patient profiles. Summary Multimodal prehabilitation is proven to improve length of hospital stay and postoperative outcomes, with nutrition forming a significant part of the therapy given. Further work is required to look at not only the interplay between the optimization of nutritional status and other prehabilitation interventions, but also how to best select which patients will achieve significant benefit.

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Effectiveness of the nutrition referral system in a multidisciplinary pancreatic cancer clinic

Cited by 2 publications

References 26 publications

Variation in outcomes and practice patterns among patients with localized pancreatic cancer: the impact of the pancreatic cancer multidisciplinary clinic

Variation in outcomes and practice patterns among patients with localized pancreatic cancer: the impact of the pancreatic cancer multidisciplinary clinic

Nutritional interventions in prehabilitation for cancer surgery

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