Impact of Dietitian Delivered Intensive Nutrition Intervention on Dietary Intake and Weight Outcome Among Gynecology Cancer Outpatient Prior to Surgery

@#Introduction: This is open label randomised control trial, aimed to identify whether an early (commenced at the time of diagnosis) and intensive nutrition intervention (INI) (individualised dietary counselling, oral nutritional supplements [ONS], telephone, and home visit) can improve weight and dietary intake of gynaecological cancer (GC) patients preoperatively. Methods: Selected GC patients planned for surgery were randomly grouped into control group (CG) (n = 35) and intervention group (IG) (n = 34). Malnutrition screening tool (MST) was used as a screening tool, while Patient-Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool. IG received an intensive individualised dietary counselling with the supply of ONS at baseline (Day 1). This continued with telephone and home visit follow-up by research dietitian (Day 3 and Day 6). Meanwhile, CG only received general nutritional counselling without supply of ONS. Final assessment was conducted on Day 14. The primary outcomes included weight changes measured using TANITA and dietary intake assessment using 24-hour diet recall. Results: Mean duration of INI was 14 days. At the end of the treatment period, there was a significant weight change between groups (p < 0.001), with 0.14% weight gain in IG and 1.3% weight reduction in CG. Mean energy and protein intake of IG were higher compared to CG by +329 kcal/day and +12.2 g/day, respectively. Conclusion: This study showed that INI that incorporated individualised dietary counselling, ONS, telephone counselling, and home visit can increase energy and protein intake of GC patients, resulting in weight gain.

Clinical audit on adherence to using Malnutrition Screening Tool and dietitian referral in the Oncology Outpatient Clinic, National Cancer Institute, Malaysia

@# Introduction: Malnutrition is a frequent complication in cancer patients and can negatively affect treatment outcome. Preliminary audit conducted at the Oncology Clinic, National Cancer Institute (NCI), found that only 5.8% of outpatients underwent nutrition screening using the Malnutrition Screening Tool (MST), and only 2.6% of dietitian referrals were recorded. This audit aims to determine the rate of adherence to nutritional screening, and to implement remedial measures for improved patient care. Methods: This was a cross-sectional audit comprising three phases, namely initial audit, remedial measures and re-audit. Criteria audited include screening rate using MST and dietitian referral based on MST scores. Standards were set at 100% for both criteria. Data collected for initial audit were patients’ MST scores records and total dietitian referral forms retrieved from Electronic Medical Records. After initial audit, self-administered questionnaires for nurses and physicians were developed to identify barriers. Measures implemented for change included patientadministered MST to shorten screening time, and procedure flowchart to facilitate referral. After 6 months, a re-audit was conducted. Results: Total subjects for initial audit and re-audit were 349 and 390, respectively. Initial audit and re-audit showed screening rate using MST increased significantly from 6.3% to 79.5%, but there was no significant change for the dietitian referral rate. Conclusion: This clinical audit has led to a change in the policy in NCI outpatient clinics whereby nurses directly schedule dietitian referrals without going through physicians for patients with MST scores ≥2. Continuous audit and monitoring are necessary to facilitate improvement in MST implementation for better outpatient care.