Plate wastage among hospitalized cancer patients

Introduction: Plate wastage in hospital contributes to malnutrition-related complications including longer hospitalization among cancer patients. The objective of this study was to determine the relationship between patients’ experiences of access to food hospital and plate wastage among hospitalized cancer patients. Methods: Two hundred and thirty-one cancer patients in the National Cancer Institute, Malaysia were recruited for this study. All eligible patients were undergoing cancer treatments and provided with informed consent. Data obtained included socio-demographic characteristics and patients’ experiences of access to food hospital which will contribute to plate wastage. Plate wastage was determined by weighing the unwanted food left on the plate. Results: Prevalence of plate wastage among cancer patients was high at approximately 54%. The appearance of food served was associated with higher plate wastage (p<0.01). Conclusion: This finding shows that the prevalence of plate wastage was high which may inhibit food consumption and affecting nutritional status among cancer patients with oncologic treatment. Effective strategies that address factors associated with plate wastage should be taken among hospitalized cancer patients

Integrate Partial Hydrolyzed Guar Gum in Postoperative Ileostomy Nutritional Management

Objective: This case report aimed to share our clinical practice about the Partially Hydrolysed Guar Gum (PHGG) incorporation in conventional ileostomy management. Case presentation: Patients A and B, who diagnosed with Diabetic Mellitus and Hypertension recto-sigmoid adenocarcinoma stage III, had high stoma output after anterior resection with covering ileostomy (more than 1200ml per day). PHGG was integrated into nutritional management and showed a positive effect in normalizing volume and the consistency of ileostomy stoma output. Discussion: Postoperative ileostomy patients often faced a higher risk for malnutrition among cancer patients. Persistent high stoma output without proper management could cause dehydration, depletion of magnesium and sodium, acute renal injury and malnutrition. High protein and high calories normal diet would normally be prescribed to postoperative colorectal cancer patients with an ileostomy. The addition of PHGG showed a positive effect in improving ileostomy consistency and output. Conclusion: The PHGG incorporation in the post-operative nutritional management for ileostomy revealed positive outcomes in consistency and volume of stoma output and nutritional intake

Feasibility study of smartphone application for self-monitoring dietary intake among cancer patients

Objective: Evidence accumulates that optimal nutrition status positively influences cancer treatment outcomes. A "smartphone application" (intelligent dietitian support apps, iDSA) was developed to act as a tool to assist patients in terms of dietary monitoring. This study aimed to examine the feasibility of iDSA for self-monitoring dietary intake among cancer patients. Method: This was a pilot study. Eligible patients were approached and recruited. Dietitian entered individual estimated energy protein requirement into iDSA after installation. Participants recorded and monitored own daily dietary intake. Dietitian arranged for a two-week follow up to monitor nutritional status (weight and dietary intake). Results: This study enrolled 14 participants, six males and eight females, with a mean age of 36.4 ± 10.1 years. iDSA improved participants’ nutritional outcomes significantly; weight gained 1.2 ± 0.2 kg, increased energy intake 215 ± 100 kcal/day and protein intake 8 ± 5.1 g/day. There were 92.9% of participants agreed or totally agreed that they were able to monitor and increase dietary intake during using iDSA. However, about 57.1% reported that it was burdensome to record their diet daily and sometimes they forgot to record their food intake. Conclusion: Self-monitoring dietary intake via intelligent dietitian support apps was feasible among cancer patients. With compliance to iDSA resulted in an increase in dietary intake and body weight after two-week. iDSA usability was rated good and can be used to study dietary intake among cancer patients

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

Effectiveness of intensive nutrition intervention on nutritional, side-effects and functional outcomes among head and neck cancer outpatients on radiotheraphy

Malnutrition is common in head and neck cancer (HNC) patients even prior to treatment. An intensive nutrition intervention (INI) might able to improve their nutritional status. However, malnutrition risk is greater among HNC outpatients due to the limited contact time with dietitian, absence of close monitoring and oral nutrition supplement (ONS) provision compared to HNC inpatients plus that there was limited research on the effectiveness of INI among HNC outpatients. Thus, this leads to significant gap in optimising the deliverance of dietitians’ services in this area. An open labelled pragmatic randomised controlled trial study was conducted to ascertain the effectiveness of INI (prescription and provision of ONS, dietary consultation and frequent follow-up) vs routine care (RC) which includes dietary consultation, frequent follow up and ONS prescription only, among HNC outpatients towards nutritional, side effects and functional outcome. A total of 36 subjects were recruited from the HNC outpatients list in radiotherapy clinic at National Cancer Institute, Putrajaya, obtained from the online system and randomised into the INI and RC group using online randomiser software. Patients who already started on ONS, tube feeding and cancer treatments prior to the study period were excluded. Patient Generated Subjective Global Assessment (PG-SGA) and Head and Neck Symptoms Checklist (HSNC) were used to assess nutritional and side effect status whilst handgrip strength (HGS) was used to assess the functional status of study subjects. Parametric test was used for normally distributed data unless otherwise stated and univariate analysis was used for repetitive measurements. A modified intention to treat principle (ITT) and per protocol (PP) principle were used for fair comparisons among treatment groups which reflects clinical effectiveness in actual practices and built confidence in study results when both analyses came into same conclusions. Changes in nutrition outcomes including weight, body mass index (BMI), fat mass (FM) and muscle mass (MM); side-effects outcome (nutrition impact symptoms (NIS) and HGS were observed and analysed. Overall median weight was 70.6±16.8kg with 52.8% overweight. Most subjects were well-nourished, yet the NIS score was 21+5 before treatment started. Significant weight loss (p<0.001), reduction in BMI (p<0.001), lower FM (p<0.001), reduction in MM (p<0.001), and higher NIS score (p<0.001) within subjects in both groups were observed. The provision of INI produced positive changes in handgrip strength (HGS). Improvements in HGS were reported in INI subjects. Inadequate overall intake in energy (< 25kcal/kg body weight) and protein in both groups (< 0.8gram protein/ kg body weight) compared to the recommended requirement of 30kcal/kg body weight and 1.2-gram protein/kg body weight were observed. FM reduction was significantly different (p=0.013) between groups. The INI group had a lower percentage of weight loss, FM loss, BMI loss and MM loss compared to the RC group. Combination of ONS prescription and provision, dietary consultation and frequent follow-up could prevent further deterioration in nutritional, side effects and functional outcomes among HNC outpatients and can be adapted in outpatient setting as standard procedures in HNC dietary care against malnutrition

Changes in nutrition impact symptoms, nutritional and functional status during head and neck cancer treatment

Background: The purpose of this study is to evaluate changes in nutrition impact symptoms (NIS) and nutritional and functional status that occur throughout radiotherapy in head and neck cancer (HNC) patients. Methods: A prospective observational study of HNC inpatients who underwent radiotherapy with or without chemotherapy were recruited to participate. Fifty patients were followed for the periods before, in the middle and at the end of radiotherapy. Nutritional parameters were collected throughout radiotherapy. Results: According to Patient-Generated Subjective Global Assessment (PG-SGA), there was an increase from a baseline of 56% malnourished HNC patients to 100% malnourished with mean weight loss of 4.53 ± 0.41kg (7.39%) at the end of radiotherapy. Nutritional parameters such as muscle mass, fat mass, body mass index, dietary energy and protein intake decrease significantly (p < 0.0001) while NIS score, energy and protein intake from oral nutritional supplements (ONS) increased significantly (p < 0.0001). Hand grip strength did not differ significantly. All HNC patients experienced taste changes and dry mouth that required ONS at the end of treatment. ONS compliance affected the percentage of weight loss (p = 0.013). Conclusions: The intensive nutritional care time point was the middle of RT. The PG-SGA and NIS checklist are useful for monitoring nutrition for HNC patients

Weight Loss in Post-Chemoradiotherapy Head and Neck Cancer Patients

Background: Weight loss is well-known among head and neck (HNC) patients during radiotherapy and could continue after the treatment is completed. Weight monitoring is essential for treatment outcomes and cancer surveillance. The purpose of the study is to evaluate the weight loss during and post-treatment among HNC patients. Methods: A total of 45 out of 50 patients post-treatment were included in this secondary treatment. Data were collected at baseline, at the completion of radiotherapy and one month after completion of radiotherapy. Results: The mean weight loss was 4.53 &plusmn; 2.87 kg (7.4%) during treatment and 1.38 &plusmn; 2.65 kg (2.1%) post-treatment. There were significant improvements one month after completion of radiotherapy in Patient-Generated Subjective Global Assessment (PGSGA), muscle mass, nutrition impact symptoms (NIS) score, energy and protein from oral intake (p &lt; 0.0001). Energy and protein from oral nutritional supplements (ONS) decreased significantly (p &lt; 0.0001). Conclusions: The results of this study underline the importance of early identification and monitoring post-treatment in HNC patients. The post-treatment recovery stage is very important for HNC patients to ensure a healing process

Weight loss in post-chemoradiotherapy head and neck cancer patients

Background: Weight loss is well-known among head and neck (HNC) patients during radiotherapy and could continue after the treatment is completed. Weight monitoring is essential for treatment outcomes and cancer surveillance. The purpose of the study is to evaluate the weight loss during and post-treatment among HNC patients. Methods: A total of 45 out of 50 patients post-treatment were included in this secondary treatment. Data were collected at baseline, at the completion of radiotherapy and one month after completion of radiotherapy. Results: The mean weight loss was 4.53 ± 2.87 kg (7.4%) during treatment and 1.38 ± 2.65 kg (2.1%) post-treatment. There were significant improvements one month after completion of radiotherapy in Patient-Generated Subjective Global Assessment (PGSGA), muscle mass, nutrition impact symptoms (NIS) score, energy and protein from oral intake (p < 0.0001). Energy and protein from oral nutritional supplements (ONS) decreased significantly (p < 0.0001). Conclusions: The results of this study underline the importance of early identification and monitoring post-treatment in HNC patients. The post-treatment recovery stage is very important for HNC patients to ensure a healing process

Association between quality of life and handgrip strength among malnourished gynaecological cancer outpatients, National Cancer Institute

Introduction: Malnutrition is common among cancer patients and it is reported in a significant proportion of patients with gynaecological cancer (GC). The aim of this study was to determine the association between quality of life (QOL) and hand grip strength (HGS) among malnourished GC outpatients in the National Cancer Institute (NCI). Methods: This study was carried out in a Multidisciplinary Clinic of NCI. HGS was measured using Jamar Hand Dynamometer. Nutritional status was assessed using the scored Patient-Generated Subjective Global Assessment (PGSGA). QOL was measured using the validated European Organisation for Research and Treatment of Cancer Questionnaire (EORTC-QLQ C30). Results: A total of 69 patients were selected for the study. Fifty eight (84.1%) were classified as moderately malnourished or at risk of malnutrition (PG-SGA B) and 11 (15.9%) were classified as severely malnourished (PG-SGA C). There was a moderate, significant positive relationship between HGS and functional status (rs=0.275, p=0.022) observed in this study. Besides, in malnourished GC patients with low HGS, results indicated that they had problems with social functioning as well (r=0.255, p=0.035). Appetite was suggested as a predicting factor for low HGS among malnourished GC patients (F=12.253, p=0.001). Conclusion: HGS is a simple objective indicator of functionality and is, therefore, a valid item to be measured when assessing QOL of malnourished GC outpatients

Impact of enhanced recovery after surgery with preoperative whey protein-infused carbohydrate loading and postoperative early oral feeding among surgical gynecologic cancer patients: an open-labelled randomized controlled trial

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes