Parenteral Nutrition in Advanced Cancer: The Healthcare Providers’ Perspective

Introduction: The evidence base for parenteral nutrition (PN) in advanced cancer patients is limited. We studied healthcare providers’ (HCPs’) experiences with PN in cancer patients, focusing on perceived treatment benefits and challenges. Methods: An 18-item online survey was emailed to HCPs attending one of three regional palliative care seminars held within a 6-month period. The survey included single-response items, multiple-response items, and free text boxes concerning PN. Descriptive statistics and qualitative thematic content analysis were applied. Results: One hundred and two seminar participants completed the survey. Ninety-three percent were female, 86% were nurses/oncological nurses, and 80% worked in primary care. Respondents reported a well-functioning collaboration across levels of care. They perceived that PN may increase the patients’ level of energy, improve the general condition, and reduce eating-related distress. On the downside, HCPs observed burdensome side effects, that the treatment was resource-demanding, and that decisions on PN withdrawal were difficult. Conclusion: The study results are based on the perspectives of more than 100 HCPs with comprehensive clinical experience with PN. Their knowledge represents an important experience base for improvement of healthcare services and advanced care planning.publishedVersio

Fish intake and pre-frailty in Norwegian older adults - a prospective cohort study: the Tromsø Study 1994–2016

Background Pre-frailty is an intermediate, potentially reversible state before the onset of frailty. Healthy dietary choices may prevent pre-frailty. Fish is included in most healthy diets, but little is known about the association between long-term habitual fish intake and pre-frailty. We aimed to elucidate the longitudinal association between the frequency of fish intake and pre-frailty in a cohort of older adults in Norway. Methods 4350 participants (52% women,≥65 years at follow-up) were included in this prospective cohort study. Data was obtained from three waves of the population-based Tromsø Study in Norway; Tromsø4 (1994–1995), Tromsø6 (2007–2008) and Tromsø7 (follow-up, 2015–2016). Frailty status at follow-up was defined by a modifed version of Fried’s phenotype. Fish intake was self-reported in the three surveys and assessed as three levels of frequency of intake: low (0–3 times/month), medium (1–3 times/week) and high (≥4 times/week). The fsh–pre-frailty association was analysed using multivariable logistic regression in two ways; (1) frequency of intake of lean, fatty and total fish in Tromsø6 and pre-frailty at follow-up, and (2) patterns of total fsh intake across the three surveys and pre-frailty at follow-up. Results At follow-up, 28% (n=1124) were pre-frail. Participants with a higher frequency of lean, fatty and total fish intake had 28% (odds ratio (OR)=0.72, 95% confidence interval (CI)=0.53, 0.97), 37% (OR=0.63, 95% CI=0.43, 0.91) and 31% (OR=0.69, 95% CI=0.52, 0.91) lower odds of pre-frailty 8 years later compared with those with a low intake, respectively. A pattern of stable high fish intake over 21 years was associated with 41% (OR=0.59, 95% CI=0.38, 0.91) lower odds of pre-frailty compared with a stable low intake. Conclusions A higher frequency of intake of lean, fatty and total fish, and a pattern of consistent frequent fish intake over time, were associated with lower odds of pre-frailty in older community-dwelling Norwegian adults. These results emphasise the important role of fish in a healthy diet and that a frequent fish intake should be promoted to facilitate healthy ageing

Nasjonale faglige retningslinjer for forebygging og behandling av underernæring

Retningslinjen omfatter anbefalinger om identifisering og behandling av underernærte samt pasienter i ernæringsmessig risiko i sykehus, sykehjem og hjemmebaserte tjenester

Nutrition Care in Cancer Patients: Nutrition assessment: diagnostic criteria and theassociation to survival and health-related quality oflife in patients with advanced colorectal carcinoma.

God ernæringspraksis for kreftpasienter. Ernæringsutredning; diagnostiske kriterier og sammenheng med overlevelse og helserelatert livskvalitet hos pasienter med avansert tykk- og endetarmskreft. Avhandlingen bygger på fire studier. Artikkel 1. Denne studien undersøker meninger til 2759 sykepleiere, 1753 sykehusleger og 359 kliniske ernæringsfysiologer (kef) fra Skandinaviske sykehus om bruk av kef’enes fagkompetanse i sykehus. Sykepleiere og leger som ser kef to eller flere ganger per uke i motsetning til de som ser kef sjeldnere enn to ganger per uke prioriterte klinisk ernæring høyere i avdeling, hadde oftere internundervisning om ernæring, fant det enklere å identifisere underernærte pasienter og pasienter som trengte ernæringsstøtte. Studien viser at sykepleiere og leger som ser kef oftere enn to ganger per uke har større fokus på ernæring. Artikkel 2. I denne studien ble ernæringsstatus til 46 kreftpasienter som ble innlagt i en palliativ enhet undersøkt med hjelp av objektive kriterier og skjemaet ”Subjective Global Assessment” (SGA). I følge de objektive kriteriene; vekttap, BMI, hudfoldtykkelse, armmuskelomkrets, S-Albumin og S-Pre-albumin var 28 pasienter underernært. Med SGA var 30 pasienter vurdert som underernært. SGA hadde en sensitivitet på 96% for å påvise underernæring. Underernærte pasienter hadde flere spiserelaterte symptomer og spiste mindre matporsjoner. Vi fant at to tredjedeler av pasientene var underernært og at SGA var valid som metode for å undersøke ernæringsstatus blant kreftpasienter med avansert sykdom. Artikkel 3. Her er ulike metoder for å måle nedgang i ernæringsstatus hos 77 pasienter med avansert tykk- og endetarmskreft undersøkt. Videre ble metodenes evne til å predikere pasientenes overlevelse studert. 28 pasienter hadde sarkopeni, 32 hadde ernæringsrisiko, 26 var underernært og 16 hadde kakeksi (CCSG) mens 41 hadde kakeksi (EPCRC). De ulike metodene overlappet hverandre ufullstendig. Studien viste at en stor andel av pasientene hadde dårlig ernæringsstatus. Det å ha kakeksi (CCSG) eller å være underernært predikerte kortere overlevelse. Artikkel 4. I denne studien ble ernæringsstatus og livskvalitet undersøkt hos 50 nyhenviste pasienter til Kreftavdelingen for vurdering av kjemoterapi for avansert tykk- og endetarmskreft. Pasientene hadde lavere livskvalitet sammenliknet med normalbefolkningen. De som var underernærte eller hadde kakeksi (EPCRC-SGA) hadde både statistisk og klinisk signifikant dårligere livskvalitet enn de øvrige pasientene. Etter 3 måneder økte 13 pasienter vekt og de forbedret flere livskvalitetsparametre. Syv pasienter tapte vekt og de forverret livskvaliteten signifikant, mens de pasientene som var vektstabile hadde uendret livskvalitet. Tolking. Den høye andelen av underernæring blant pasientene indikerer at mer bør gjøres for å forebygge underernæring tidligere i pasientforløpet. Underernæring og kakeksi kunne ikke holdes i fra hverandre med de metodene som ble undersøkt. Vekttap som kriterium er for uspesifikt til å diagnostisere kakeksi. Det er behov for å utvikle metoder for å påvise nedbrytning av muskulatur som kjennetegner kakeksi. En undersøkelse av ernæringsstatus gjennom et pasientforløp vil kunne avdekke tidspunkter for når intervensjoner bør settes inn mot underernæring

Patient interpretation of the Patient-Generated Subjective Global Assessment (PG-SGA) Short Form

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Dietitians' experiences of nutrition assessment via TeleNutrition : "Video-calls are better than phone-calls, but it's probably difficult for patients to show their ankles on the screen"

Background & Aims: Nutrition assessment is integral to dietetic practice. TeleNutrition enabled dietitians to continue nutrition care provision during the COVID-19 pandemic but created challenges with undertaking nutrition assessment. The aim of the present study was to describe how dietitians in three Nordic countries perceived their nutrition assessment practice when physically distant from patients. Methods: The present study is a sub-analysis from one research project undertaken by the Global TeleNutrition Consortium, GTNC. Data was generated from a digital survey of a convenience sample of dietitians in Denmark, Norway, and Sweden who had a minimum of one adult patient interaction per week, distributed through the dietetic professional and/or regulatory bodies of each country, as well as closed social networks. Data from free-text questions were assessed using thematic analysis where the construction of final themes were guided by the Technology Acceptance Model (TAM). Results: In total, 146 dietitians participated in the study (Denmark 16%, Norway 34%, and Sweden 50%). The qualitative analysis of answers from 24 free-text questions resulted in four themes (key constructs) related to dietitians' experience of performing nutrition assessment using TeleNutrition: Perceived usefulness, Perceived ease of use, Perceived barriers, and Perceived facilitators. Each theme was divided into two to three sub-themes (explanatory dimensions). Conclusions: To best support dietitians in the new era of healthcare digitalisation, internationally accepted standards or protocols for performing nutrition assessment using TeleNutrition ought to be established. This is especially critical for nutrition assessment measures that require physical examination

Effects of current parenteral nutrition treatment on health-related quality of life, physical function, nutritional status, survival and adverse events exclusively in patients with advanced cancer: A systematic literature review

Background: The aim was to evaluate the effects of current parenteral nutrition (PN) treatment on clinical outcomes in patients with advanced cancer. Methods: This review was conducted according to the PRISMA guidelines (PROSPERO ID: 4201707915). Results: Two underpowered randomized controlled trials and six observational studies were retrieved (n = 894 patients). Health-related quality of life and physical function may improve during anti-neoplastic treatment in who PN treatment is the only feeding opportunity, but not necessarily in patients able to feed enterally. Nutritional status may improve in patients regardless of anti-neoplastic treatment and gastrointestinal function. PN treatment was neither superior to fluid in terminal patients nor to dietary counselling in patients able to feed enterally in regards to survival. The total incidence of adverse events was low. Conclusion: Current PN treatment in patients with advanced cancer is understudied and the level of evidence is weak