Jane Stewart

Purpose Nutrition is essential within cancer care, yet patient and carer access to nutrition care and information is variable. This study aimed to (1) investigate patient and carer access and perceptions, and health professional views and practices, relating to cancer nutrition information and care; and (2) co-design interactive resources to support optimal nutrition care. Methods Patients and carers completed a survey regarding access to nutrition care and information. Seven multidisciplinary health service teams were invited to participate in a survey and focus group to assess barriers and enablers in nutrition practices. Focus groups were recorded, transcribed and thematically analyzed. Eligible patients, carers, and health professionals were invited to four virtual workshops utilizing experience-based co-design methods to identify nutrition priority areas and design resources. Workshop participant acceptability of the resources was measured. Results Of 104 consumer survey respondents (n = 97 patients, n = 7 carers), 61% agreed that it “took too much time to find evidence-based nutrition and cancer information”, and 46% had seen a dietitian. Thirty-four of 38 health professionals completed the survey and 30 participated in a focus group, and it was identified the greatest barriers to delivering nutrition care were lack of referral services, knowledge or skill gaps, and time. Twenty participants (n = 10 patients and carers, n = 10 health professionals) attended four workshops and co-designed a suite of 46 novel resources rated as highly acceptable. Conclusion Improved communication, training, and availability of suitable resources could improve access to and support cancer nutrition information and care. New, co-designed cancer nutrition resources were created and deemed highly acceptable to patients, carers, and health professionals.

Purpose: Limited practical resources exist to guide optimal nutrition care for patients, carers, and health professionals (HPs). This study aimed to co-design a cancer nutrition care pathway to guide and improve the provision of consistent, evidence-based care with consumers and HPs. Methods: This study utilised an experienced-based co-design (EBCD) approach over five stages. Stage 1 involved stakeholder engagement and a literature review. Stage 2 included a survey and focus groups with patients/carers. Co-design workshops were conducted within stage 3, key stakeholder consultation within stage 4, and the finalisation and dissemination of the cancer nutrition care pathway formed stage 5. Results of stages 3 to 5 are the focus of this paper. Results: Two co-design workshops were held with patients, carers, and HPs (n = 32 workshop 1; n = 32 workshop 2), who collectively agreed on areas of focus and key priorities. Following this, a consultation period was completed with patients, carers, and HPs (n = 45) to refine the pathway. The collective outcome of all study stages was the co-design of a cancer nutrition care pathway (the CanEAT pathway) defining optimal cancer nutrition care that combines evidence-based practice tips into a centralised suite of resources, tools, and clinical guidance. Conclusion: The CanEAT pathway was co-designed by patients, carers, and HPs. The EBCD approach is a meaningful way to develop targeted improvements in cancer care. The CanEAT pathway is freely available to guide and support patients, carers, and HPs to aid the implementation of optimal nutrition care into clinical practice.

Purpose Cancer-related malnutrition remains a prevalent issue in cancer survivorship. This study aimed to understand cancer-related malnutrition practice, knowledge and education needs in the primary care and community sectors, as well as the transition of nutrition care from hospital cancer services following cancer treatment. Methods A cross-sectional survey was conducted with general practitioners (GPs), general practice nurses (GPNs) and dietitians in hospital cancer services, community services and primary care in Victoria, Australia. Results The 184 respondents represented dietitians (n = 152), GPs (n = 22) and GPNs (n = 10). GPs and GPNs, and dietitians working in primary care and community settings (78% and 63%, respectively) agree cancer malnutrition is going unrecognised in their service. Only 26% of community health services complete malnutrition risk screening and 35% of GPs and GPNs frequently weigh their patients with cancer. Most GPs and GPNs (88%) believe responsibility for malnutrition risk screening should be shared across disciplines and 94% would like access to a malnutrition screening tool. Only 32% of hospital oncology dietitians and 44% of GPs and GPNs frequently refer their patients to primary care or community dietitians. Conclusion Implementation of routine malnutrition risk screening in primary care and community services and improved transition of nutrition care between hospital, primary care and community practitioners is required. Targeted cancer malnutrition education and resources across all health sectors is warranted.

Purpose: Cancer-related malnutrition remains a prevalent issue in cancer survivorship. This study aimed to understand cancer-related malnutrition practice, knowledge and education needs in the primary care and community sectors, as well as the transition of nutrition care from hospital cancer services following cancer treatment. Methods: A cross-sectional survey was conducted with general practitioners (GPs), general practice nurses (GPNs) and dietitians in hospital cancer services, community services and primary care in Victoria, Australia.Results: The 184 respondents represented dietitians (n=152), GPs (n=22) and GPNs (n=10). GPs and GPNs, and dietitians working in primary care and community settings (78% and 63%, respectively) agree cancer malnutrition is going unrecognised in their service. Only 26% of community health services complete malnutrition risk screening and 35% of GPs and GPNs frequently weigh their patients with cancer. Most GPs and GPNs (88%) believe responsibility for malnutrition risk screening should be shared across disciplines and 94% would like access to a malnutrition screening tool. Only 32% of hospital oncology dietitians and 44% of GPs and GPNs frequently refer their patients to primary care or community dietitians.Conclusion: Implementation of routine malnutrition risk screening in primary care and community services and improved transition of nutrition care between hospital, primary care and community practitioners is required. Targeted cancer malnutrition education and resources across all health sectors is warranted.Implications for cancer survivors: Barriers to identification and management of cancer-related malnutrition in primary and community care should be addressed to improve transition of care.

Cancer-related sarcopenia is a complex condition; however, no cancer-specific clinical model is available to guide clinical practice. This study aims to (1) develop an evidence-based care pathway for the management of cancer-related sarcopenia (“sarc-pathway”) and (2) pilot test the feasibility (reach, intervention fidelity, patient and clinician acceptability) of the sarc-pathway in an inpatient cancer ward. The sarc-pathway was developed using a care pathway format and informed by the current literature. Patients admitted to a 32-bed inpatient cancer ward were recruited to receive sarc-pathway care and the feasibility outcomes were assessed. Of the 317 participants admitted, 159 were recruited over 3.5-months (median age 61 years; 56.0% males). Participant consent was high (99.4% of those approached) and 30.2% were at risk of/had sarcopenia. The sarc-pathway screening, assessment and treatment components were delivered as intended; however, low completion of clinical assessment measures were observed for muscle mass (bioimpedance spectroscopy, 20.5%) and muscle function (5-times chair stand test, 50.0%). The sarc-pathway was demonstrated to be acceptable to patients and multidisciplinary clinicians. In an inpatient cancer ward, the sarc-pathway is a feasible and acceptable clinical model and method to deliver and adhere to the sarcopenia clinical parameters specified, albeit with further exploration of appropriate clinical assessment measures.

Purpose Evidence-based guidelines exist to guide health professionals and services about cancer nutrition care; however, the views of cancer patients and carers are not well understood. This study aimed to understand the experience and needs of cancer patients and carers regarding nutrition care across the care continuum. Methods Using a mixed-methods approach, cancer patients and carers completed a cross-sectional online survey and focus groups. Participants were recruited through health services and cancer organisation consumer networks via email distribution lists, e-newsletters, and social media. Focus groups were audio-recorded, transcribed, and analysed using content analysis. Results Of 165 survey respondents, only 51% (n=84) reported they talked to a health professional about their nutrition care at any time-point, and only 32% with a dietitian. The majority (84%) of patients and carers felt nutrition was important at one or more time-points in their cancer path, indicating during and after cancer treatment the most important. However, perceived support from health professionals for nutrition care was deemed low at all time-points. Five focus groups were held (n=20; 16 patients, 2 carers, 2 both patients/carers) and five themes emerged: nutrition information, experiences and need; control over diet and nutrition; importance and value of nutrition; access to support; what optimal nutrition care looks like. Conclusion Patients and carers felt nutrition was important during their cancer path, but perceived support from health professionals for nutrition care was low. This study has highlighted patient and carer nutrition experiences that will inform development of a co-designed optimal cancer nutrition care pathway.