e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Implementation and evaluation of a nutrition care pathway for patients with retroperitoneal sarcoma. (#384)

Kate Graham 1 , Jane Harrowfield 1 , Shani Drake 1
  1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Retroperitoneal sarcomas (RPS) are rare mesenchymal malignancies affecting <1% of the Australian population1. Surgery including en-bloc resection of the tumour and surrounding organs is the primary treatment for these malignancies2. The reported malnutrition prevalence in RPS patients is 27-46%2,3. Malnutrition is associated with longer hospital length of stay (LOS), higher rates of post-operative complications and increased mortality3. These can be reduced by timely delivery of appropriate evidenced based nutrition care, however no standardised nutrition care pathway (NCP) exists for post-surgical RPS patients. This study aimed to develop, implement and evaluate an NCP for RPS patients undergoing surgical resection at Peter MacCallum Cancer Centre, Melbourne, Victoria. A retrospective audit, pre and post implementation of the NCP, was conducted and the timing of dietitian assessment, % weight loss, malnutrition prevalence, post-operative ileus presence, parenteral nutrition administration and LOS data collected. In the 18 months pre implementation 55 patients underwent RPS resection. Of these only 27 (49%) were assessed by a dietitian with a median time frame of 4 days (range 1-9 days). Of those assessed the mean percentage weight loss was 8.43% (range 1.9-12.85) and malnutrition prevalence 51.8%. In this group 26.6% developed post-operative ileus and 33% required parenteral nutrition. Post implementation, 92.3% (24/26) of patients were assessed within 2-5 days of admission (median = 2 days). The mean percentage weight loss reduced to 5.72% and malnutrition prevalence reduced to 34.6%. Post-operative ileus and need for parenteral nutrition also reduced to 3.8%. The average LOS remained similar at 10 days. Although not statistically significant (due to the small sample size available) the outcomes show clinically significant improvements in these patients. Overall, the study demonstrates the positive impact implementation of an evidence-based NCP can have on the nutritional status and outcomes in post-surgical RPS patients and has identified further areas for improvements.

  1. 1. Cancer Council Australia Sarcoma Guidelines Working Party. Clinical practice guidelines for the management of adult onset sarcoma. Sydney: Cancer Council Australia. [Version URL: https://wiki.cancer.org.au/australiawiki/index.php?oldid=138276, cited 2020 Jun 17]. Available from: https://wiki.cancer.org.au/australia/Guidelines:Sarcoma.
  2. 3. Previtali P, Fiore M, Colombo J, Arendar I, Fumagalli L, Pizzocri M, Colombo C, Rampello N, Mariani L, Gronchi A, Codazzi D. Malnutrition and Perioperative Nutritional Support in Retroperitoneal Sarcoma Patients: Results from a Prospective Study. 2020. Ann Surg Oncol, 27(6), 2025-2032.
  3. 2. Marshall K, Loeliger J, Nolte L, Kelaart A, Kiss N. Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. 2019. Clinical Nutrition, 38 (2), 644-651.