Perspectives of Health Care Professionals on Multimodal Interventions for Cancer Cachexia

Abstract

Background: Holistic multimodal interventions have not been established for cancer cachexia. The beliefs and perceptions of health care professionals (HCPs) based on their experiences influence the interventions. Objectives: HCPs' knowledge, perceptions, and practices in cancer cachexia management were evaluated. Design/Setting/Subjects/Measurements: A nationwide questionnaire survey was conducted that focused on the perspectives of HCPs on interventions in 451 designated cancer hospitals across Japan. Descriptive statistics were applied. Results: Among 2255 participants, 1320 responded (58.5%), and 1188 in 258 institutes were included in the analysis. The current international definition of cancer cachexia is not commonly known and recent clinical practice guidelines have not been widely adopted. More than 50% of participants considered ≥5% weight loss in six months and ECOG PS (Eastern Cooperative Oncology Group Performance Status) 2–4 to be cancer cachexia, whereas 50% answered that there was no relationship between life expectancy and cancer cachexia. Participants tended to consider it important to initiate nutritional and exercise interventions before cancer cachexia becomes apparent. The majority of participants recognized the importance of holistic multimodal interventions, particularly for the management of physical and psychological symptoms; however, only 20% reported that they educated patients and families. Furthermore, 33% of participants considered themselves to have provided patients and families with sufficient nutritional and exercise interventions and evidence-based information. Conclusion: The results reveal that HCPs are not regularly providing education and emotional support to patients and families suffering from cancer cachexia. The results also show the need for education for HCPs to enhance implementation of holistic multimodal interventions for cancer cachexia.

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

“…We previously reported the methods elsewhere. 11 In brief, a nationwide multicenter anonymized self-report questionnaire was administered in 451 designated cancer hospitals in Japan between February and March 2022. Eligibility criteria were (1) clinicians with at least 3 years of practicing experience and (2) clinicians engaging in cancer care as their major specialty.…”

“…A questionnaire for clinicians written in Japanese was developed by the authors in consideration of the findings of previous global surveys 9,10 and discussions among the authors. 11 Information on participant demographics, including age, sex, occupations, clinical experience, and the primary area of practice, was obtained. Data about the clinical utilization of the international definition of cancer cachexia in 2011 1 and three clinical practice guidelines (ie, the ASCO guidelines in 2020, 5 the European Society for Medical Oncology clinical practice guidelines in 2021, 6 and the European Society for Clinical Nutrition and Metabolism [ESPEN] practical guidelines in 2021 7 ) were also obtained.…”

“…4 Currently, information on the factors associated with the practices of clinicians involved in palliative care and oncology care is limited, with regard to cancer cachexia. [9][10][11] The previous study indicated that multimodal care needs to be comprehensively and cooperatively performed by a multimodal care team. 11 Furthermore, physicians and nurses have to comprehensively contribute to the interventions as not only specialists but also generalists, whereas other occupations, such as pharmacists and dietitians, need to play specific roles as specialists with a high level of expertise.…”

“…[9][10][11] The previous study indicated that multimodal care needs to be comprehensively and cooperatively performed by a multimodal care team. 11 Furthermore, physicians and nurses have to comprehensively contribute to the interventions as not only specialists but also generalists, whereas other occupations, such as pharmacists and dietitians, need to play specific roles as specialists with a high level of expertise. 11 Therefore, we conducted a preplanned secondary analysis of a nationwide survey investigating the perspectives of clinicians on the management of cancer cachexia.…”

Educational needs of self-care in cachectic cancer patients and caregivers

“…They also show that educated healthcare professionals are more likely to be aware of guidelines and to have the confidence to provide patients with nutritional advice [20]. However, education and training in cancer cachexia is reported to be inadequate [21,22 ▪ ,23] despite being recognized for its potential to improve practice [22 ▪ ,24].…”