Health care professionals’ experiences of dealing with cancer cachexia

Abstract

Background Cancer cachexia (CC) is a debilitating syndrome severely impacting patients’ quality of life and survivorship. We aimed to investigate the health care professionals’ (HCPs’) experiences of dealing with CC. Methods Survey questions entailed definitions and guidelines, importance of CC management, clinician confidence and involvement, screening and assessment, interventions, psychosocial and food aspects. The online survey was disseminated through Australian and New Zealand palliative care, oncology, allied health and nursing organisations. Frequencies were reported using descriptive statistics accounting for response rates. Associations were examined between variables using Fisher’s exact and Pearson’s chi-square tests. Results Over 90% of the respondents (n = 192) were medical doctors or nurses. Over 85% of the respondents were not aware of any guidelines, with 83% considering ≥ 10% weight loss from baseline indicative of CC. CC management was considered important by 77% of HCPs, and 55% indicated that it was part of their clinical role to assess and treat CC. In contrast, 56% of respondents were not confident about managing CC, and 93% believed formal training in CC would benefit their clinical practice. Although formal screening tools were generally not used (79%), 75% of respondents asked patients about specific symptoms. Antiemetics (80%) and nutritional counselling (86%) were most prescribed or recommended interventions, respectively. Conclusion This study underlines the deficiencies in knowledge and training of CC which has implications for patients’ function, well-being and survival. HCP training and a structured approach to CC management is advocated for optimal and continued patient care.

The barriers to interprofessional care for cancer cachexia among Japanese healthcare providers: A nationwide survey

“…16 Five major surveys evaluated cancer cachexia among global HCPs (Table S3). Four surveys focused on HCPs in medical oncology or palliative/supportive care, 9,10,18,19 while one targeted HCPs in general medicine. 11 In Australia and New Zealand, 36.3% of HCPs lacked confidence in managing cancer cachexia, 19 which aligns with our findings.…”

“…Four surveys focused on HCPs in medical oncology or palliative/supportive care, 9,10,18,19 while one targeted HCPs in general medicine. 11 In Australia and New Zealand, 36.3% of HCPs lacked confidence in managing cancer cachexia, 19 which aligns with our findings. Additionally, two studies 9,19 reported that 35-83% of HCPs misunderstood the weight loss cut-off.…”

“…Second, most surveys were conducted among HCPs in designated or specialized cancer treatment facilities. 9,10,[17][18][19] Few surveys have targeted HCPs managing patients with cancer in general medicine or home care facilities. 11,16 Similarly, most surveys included medical oncologists, dietitians and nurses specializing in oncology, [9][10][11][17][18][19] while a few have included other professionals involved in interprofessional cachexia care, including pharmacists, rehabilitation therapists, psychotherapists or social workers.…”

“…9,10,[17][18][19] Few surveys have targeted HCPs managing patients with cancer in general medicine or home care facilities. 11,16 Similarly, most surveys included medical oncologists, dietitians and nurses specializing in oncology, [9][10][11][17][18][19] while a few have included other professionals involved in interprofessional cachexia care, including pharmacists, rehabilitation therapists, psychotherapists or social workers. 11,16,17,19 Finally, most surveys were weighted towards domains in knowledge, awareness and personal practice, 9,11,17,18 with a few surveys simultaneously asking balanced questions about confidence, team practice and education.…”

“…11,16,17,19 Finally, most surveys were weighted towards domains in knowledge, awareness and personal practice, 9,11,17,18 with a few surveys simultaneously asking balanced questions about confidence, team practice and education. 10,17,19 These limited perspectives make it difficult to see the impact of cancer cachexia care on the overall healthcare system.…”