Factors Associated With Practice of Multimodal Care for Cancer Cachexia Among Physicians and Nurses Engaging in Cancer Care

Abstract

PURPOSE Multimodal care for cancer cachexia is needed. This study examined factors associated with practicing multimodal cachexia care among physicians and nurses engaging in cancer care. METHODS This was a preplanned secondary analysis of a survey investigating clinicians' perspectives on cancer cachexia. Data of physicians and nurses were used. Data on knowledge, skills, and confidence in multimodal cachexia care were obtained. Nine items on practicing multimodal cachexia care were evaluated. Participants were divided into two groups as practicing multimodal cachexia care (above median value for the nine items) or not. Comparisons were made using the Mann-Whitney U test or chi-square test. Multiple regression analysis was performed to identify the factors of practicing the multimodal care. RESULTS Total of 233 physicians and 245 nurses were included. Significant differences were observed between the groups: female sex ( P = .025), palliative care versus oncology specialization ( P < .001), the number of clinical guidelines used ( P < .001), the number of symptoms used ( P = .005), training for cancer cachexia ( P = .008), knowledge on cancer cachexia ( P < .001), and confidence in cancer cachexia management ( P < .001). Palliative care specialization (partial regression coefficient [ B] = 0.85; P < .001), the number of clinical guidelines used ( B = 0.44; P < .001), knowledge on cancer cachexia ( B, 0.94; P < .001), and confidence in cancer cachexia management ( B = 1.59; P < .001) were statistically significant in multiple regression analysis. CONCLUSION Specialization in palliative care, specific knowledge, and confidence were associated with the practice of multimodal care for cancer cachexia.

Holistic multimodal care for patients with cancer cachexia and their family caregivers

“…Holistic multimodal care, which is defined as a comprehensive approach that addresses physical health through medical, pharmacological, nutritional, and rehabilitative interventions as well as psychological, emotional, and social well-being issues, is needed for patients with advanced cancer and family caregivers in management of cancer cachexia. 23 Concrete interventions previously proposed by us 7 , 8 are modified and summarized in Table 1 to further advance discussions on this research area. Management of physical symptoms and psychological symptoms of illness and provision of multimodal therapies according to evidence-based clinical practice guidelines are suggested for patients.…”

“…The nurse constantly screens and assesses the patient and family caregiver and, when necessary, performs a hub function to connect the patient and family caregiver with the appropriate professionals. 23 , 24 Oral mucositis, which is the most significant symptom impacting food intaking during radiotherapy and/or chemotherapy, can be directly intervened by the dentist and dental hygienist with the nurse. A speech therapist should be actively involved in the multimodal care for swallowing difficulty, which is commonly seen in advanced-stage patients with cancer, with the nurse.…”

“…However, recent surveys investigating clinicians’ perspectives on cancer cachexia conducted in multiple countries revealed the insufficiency of knowledge, skills, and confidence in management of cancer cachexia. 23 , 24 , 30 , 31 , 32 , 33 , 34 …”

“… 31 Furthermore, the secondary analysis of the survey also showed that specialization in palliative care, specific knowledge, and confidence were associated with the practice of multimodal care for cancer cachexia among 233 physicians and 245 nurses. 23 Another secondary analysis of the survey using data of 237 dietitians reported that specific knowledge on cancer cachexia and training for management of cancer cachexia, as well as abundant experience of nutritional care in cancer, were associated with the dietitians’ perception of playing an important role in management of cancer cachexia. 32 …”

“…Proposed contents of the cancer cachexia education for nurses are categorize into topics as follows: (1) knowledge about responsible mechanisms of cancer cachexia, (2) knowledge about common symptoms and distress associated with cancer cachexia among patients and family caregivers, (3) awareness of nurses’ roles in management of cancer cachexia, (4) utilization of existing evidence-based clinical practice guidelines for management of cancer cachexia, (5) collaboration within multiple health disciplines to perform holistic multimodal care for cancer cachexia. 23 , 33 This categorization can help nurse educators know what should be covered in a teaching session and course about management of cancer cachexia.…”