Rationale
Malnutrition is a common side effect of Upper Gastrointestinal (UGI) cancer which can negatively impact treatment and survival outcomes. Furthermore, the evidence suggests that treating malnutrition may have a positive impact on a patient's quality of life. Current clinical guidelines recommend all UGI cancer patients be considered at high risk of malnutrition and referred to a dietitian at diagnosis. The Optimal Care Pathway (OCP) for Oesophagogastric cancer indicates supportive care assessments should be completed using validated screening tools (including the Malnutrition Screening Tool (MST)) within 2 weeks of diagnosis.
Methods
A manual file audit (n=40) was completed for all patients undergoing treatment (radiotherapy and/or systemic therapy) for UGI cancer (pancreatic, oesophagogastric, gall bladder) during 2023 at a regional health service to investigate timeliness of malnutrition screening and dietitian referral.
Results
Only 1 patient had documentation of MST completion at diagnosis (endoscopy), hence initial oncologist appointment (IOA) was deemed the next pragmatic opportunity for nutritional screening. Whilst 64% of patients had documented evidence of MST completion, this ranged from 0 to 33 days from IOA and only 41% within 2 weeks of IOA. 10% of patients had evidence of an MST completed on the same date as the IOA, 51% at the pre-treatment planning/education session and 3% at commencement of treatment. Of those who had an MST completed, 87% scored 2 or above, warranting a dietitian referral. Although 89% of actively treated patients were referred to a dietitian, the time ranged for dietetic assessment from IOA from 0 to 49 days.
Discussion
Due to the known current variety of patient pathways to a UGI cancer diagnosis in Gippsland, it may not yet be feasible to embed malnutrition screening into diagnostic services. The initial oncology appointment provides the next pragmatic contact point to undertake nutritional screening. This audit indicates inconsistent nutritional screening at IOA and subsequent dietitian referral processes, which will inform a service improvement project aiming to improve consistency of malnutrition screening by embedding the MST into current supportive care screening tools at IOA. Following this, the integration of systemised referral pathways for dietitian assessment may optimise early nutrition interventions.