Health service nutrition practices and associations with clinical outcomes in patients undergoing resection for upper gastrointestinal cancer: Results from the multi‐centre NOURISH point prevalence study

Abstract

Background The present study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, as well as the use of evidence‐based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes. Methods Principal investigator dietitians for the sites (n = 27) participating in the NOURISH point prevalence study participated in a purpose‐built site‐specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day 1 post surgery, length of stay, and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol. Results The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty‐five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, as well as higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions, and European Society of Clinical Nutrition and Metabolism (ESPEN) guideline compliant care day 1 post surgery. Conclusions The results of the present study demonstrate varied perioperative outpatient nutrition services in this high‐risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes.

Prehab to rehab: Living with and beyond cancer

“…Varying practices occur both nationally and internationally and there is much to be learnt from studies that focus on implementation of guidelines, nutrition pathways and service delivery, particularly because their use is associated with lower rates of malnutrition. Despite published nutrition guidelines, Deftereos et al 11 highlight that there is huge variability in service delivery, even in patients at high nutritional risk such as those with upper gastrointestinal cancer. The value of nutrition care pathways and their impact on access to dietetic care is an important consideration for service providers, particularly in high‐risk patients 12 .…”