Background: Malnutrition is a significant problem for patients with Upper Gastrointestinal (UGI) malignancy, and is associated with increased morbidity and mortality. Best practice guidelines recommend nutritional therapy for patients undergoing curative resection, however evidence is not adequately implemented into clinical practice.
Aims: This study aimed to investigate the implementation and effect on clinical outcomes of a standardised preoperative Nutrition Care Pathway (NCP) for UGI cancer patients undergoing curative resection across three Victorian health services, compared to a retrospective control group.
Methods: A NCP was developed and implemented using a facilitated implementation strategy for 6 months in 2019. The pathway provided a structured approach to dietitian interventions at key perioperative time points. Fisher’s exact test and Mann-Whitney U tests were used to determine differences in access to dietetics care, and nutritional/surgical outcomes between groups.
Results: Thirty-five patients entered the pathway (51% male, mean age 65, standard deviation (SD) 11), and were compared with 35 retrospective controls (71% male, mean age 66, SD 12). The percentage of participants receiving dietetic intervention before surgery increased from 55% to 100%; p<0.001, with mean (SD) dietetics occasions of service increasing from 2.2 (3.7) to 5.9 (3.9); p<0.001, mean difference 3.7, 95% CI 1.9-5.6. The percentage of patients receiving dietetic intervention within one week of diagnosis increased from 31% to 77%; p<0.001. No significant changes were observed for other clinical outcomes including weight change and length of stay, however the sample size is small. Of clinical significance, incidence of nutrition related hospital admissions for patients undergoing neoadjuvant therapy decreased by 50% following introduction of the NCP (36% versus 17%); p=0.25.
Conclusions: Implementing a standardised NCP increased access and timeliness of dietetics care across three major Victorian health services. The results will inform improvements in dietetics service delivery, and future research trials for this vulnerable patient group.