Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Implementing an evidenced based model of pre-operative nutrition care in patients undergoing oral cavity reconstruction surgeries for head and neck cancer (#444)

Shane McAuliffe 1 2 , Sarah Davies 1 , Kate White 3 4 5 , Jonathan Clark 1 2 6 , Merran Findlay 1 3 4 5 7
  1. Chris O'Brien Lifehouse, Camperdown, NSW, Australia
  2. Sydney Medical School, Faculty of Medicine and Health, University of Sydney , Research Affiliate, Sydney , NSW
  3. Cancer Care Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney , , Sydney, NSW
  4. Cancer Services, Sydney Local Health District , , Sydney, NSW
  5. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Australia , , Sydney, NSW
  6. Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia, , Sydney, NSW
  7. Maridulu Budyari Gumal (SPHERE) Cancer Clinical Academic Group, South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia , , Sydney, NSW

Aims:

To assess the feasibility of implementing a pre-operative evidence-based nutrition care pathway (EBCP) for patients undergoing oral cavity reconstruction surgery for head and neck cancer (HNC).

Methods:

Mixed-methods pre-post study in a retrospective cohort (1 January to 31 December 2023) prior to pilot implementation in a prospective cohort. Pre-implementation audit criteria included pre-admission processes (dietetic referral, nutrition screening and assessment) and clinical outcomes (complications, length of stay (LOS) and readmissions). 

A survey of multidisciplinary team (MDT) members explored i) participant background ii) perception of the importance of nutrition iii) roles and responsibilities iv) barriers to nutrition screening and assessment using the Capability, Opportunity, Motivation-Behaviour (COM-B) model. 

Quantitative data were analysed using descriptive statistics and qualitative data using summative content analysis.

Results:

Patients undergoing oral cavity reconstruction surgery (n=115; 51% female, median (IQR) age 65 (55,71) yrs) in the study period were included. Nutrition care processes (referral, screening and assessment with a validated tool) were completed for 60%, 91% and 13% of patients respectively. Malnutrition risk was identified in 19%, with false negative screening noted in 22%. Weight loss (0% vs >10%) was associated with increased LOS (22 vs. 12.5, p=0.01) and ICU LOS (4.5 vs. 2, p=0.048) days.

Full survey responses (n=11) were completed across four disciplines (speech pathology (n=4), surgeon (n=3), dietitian (n=2), and nursing (n=2)). Most (9/11) recognised the importance of nutrition, however, more than half (7/11) felt the current service does not meet patient’s needs. Frequently cited barriers to screening and assessment included resources (n=9), knowledge (n=8) and time (n=7).

Conclusions:

Evidence-practice gaps in nutrition care processes were identified, despite nutrition care consistently recognised as a priority. Barriers to nutrition screening and assessment were related to capability and opportunity, rather than motivation. Focus groups will further inform a tailored EBCP for prospective implementation.