Translating Evidence-Based Guidelines into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Setting and Population
2.2. Outcomes
2.3. Data Collection
2.4. Statistical Analysis
2.5. Ethics Approval and Reporting
3. Results
3.1. Baseline Characteristics
3.2. Adherence to Evidence-Based Guideline Recommendations
3.3. Unplanned Admissions, Treatment Completion and Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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First Author, Year | Origin | Organisation | Guideline Focus | Appraisal Method |
---|---|---|---|---|
Arends, 2017 [14] | Europe | ESPEN a | Cancer | GRADE b |
Dort, 2017 [10] | International | ERAS c Society | Surgery–HNC d | GRADE |
Thompson, 2017 [15] | USA e | AND f | Cancer | AND EAL g |
Weimann, 2017 [11] | Europe | ESPEN | Surgery | SIGN h, AHCPR i |
Talwar, 2016 [16] | UK j | BAHNO k | HNC | ns l |
Isenring, 2013 [9] | Australia | DAA m | RT n, CTx o | NHMRC p |
Findlay, 2011 [8] | Australia * | COSA q | HNC | NHMRC |
Braga, 2009 [12] ** | Europe | ESPEN | Surgery-PN r | ns |
Weimann, 2006 [13] ** | Europe | ESPEN | Surgery | ESPEN |
Nutrition Care Model [28,29] | Recommendation | Guideline | Evidence * | Adherence Criteria |
---|---|---|---|---|
ACCESS TO CARE Screening Assessment |
| COSA a [8], DAA b [9] ESPEN c, 2017 [14] AND d [15] ESPEN, 2017 [11] | B V Low/Strong Strong/Imperative Not specified |
|
| DAA, COSA | A |
| |
| DAA, COSA AND | B Strong/Imperative |
| |
| DAA, COSA AND | B Strong/Imperative |
| |
QUALITY NUTRITION CARE Nutrition intervention, prescription, implementation | Intervention
| DAA, COSA | A |
|
Prescription
| DAA, COSA | C | Radiotherapy
| |
| COSA ESPEN 2017 [14] ESPEN 2009 [12] ESPEN 2009 [12] | C Low/Strong B B | Surgery
| |
Implementation
| COSA ERAS j [10] ESPEN 2017 [11] | A Mod/Strong A/GPP k |
| |
NUTRITION MONITORING EVALUATION |
| DAA, COSA | A |
|
| DAA, COSA | A |
|
Characteristic | Head and Neck (n = 119) n (%) | Esophageal (n = 51) n (%) | All (n = 170) n (%) |
---|---|---|---|
Centre (Country–City) | |||
Australia–Brisbane | 10 (8.4%) | 0 (0.0%) | 10 (5.9%) |
Australia–Sydney | 20 (16.8%) | 0 (0.0%) | 20 (11.8%) |
Canada-Calgary * | 21 (17.6%) | 10 (19.6%) | 31 (18.2%) |
Canada–Edmonton * | 20 (16.8%) | 18 (35.3%) | 38 (22.4%) |
Italy–Rome | 19 (16.0%) | 0 (0.0%) | 19 (11.2%) |
Netherlands-Amsterdam | 20 (16.8%) | 23 (45.1%) | 43 (25.3%) |
USA-Sacramento | 9 (7.6%) | 0 (0.0%) | 9 (5.3%) |
Age, years | |||
median [Q1, Q3] | 62 [58, 69] | 65 [56, 71] | 63 [57, 70] |
Sex | |||
Male | 93 (78.2%) | 41 (80.4%) | 134 (78.8%) |
Female | 26 (21.8%) | 10 (19.6%) | 36 (21.2%) |
Ethnicity | |||
Caucasian | 111 (93.3%) | 50 (98.0%) | 161 (94.7%) |
First Nations | 1 (0.8%) | 0 (0.0%) | 1 (0.6%) |
Hispanic | 2 (1.7%) | 0 (0.0%) | 2 (1.2%) |
Asian | 3 (2.5%) | 1 (2.0%) | 4 (2.4%) |
East Indian | 1 (0.8%) | 0 (0.0%) | 1 (0.6%) |
Other | 1 (0.8%) | 0 (0.0%) | 1 (0.6%) |
Current Smoker | |||
Yes | 44 (37.0%) | 13 (25.5%) | 57 (33.5%) |
No | 75 (63.0%) | 38 (74.5%) | 113 (66.5%) |
Alcohol use | |||
Yes | 47 (39.5%) | 9 (17.6%) | 56 (32.9%) |
No | 72 (60.5%) | 42 (82.4%) | 114 (67.1%) |
ECOG a Performance Status | |||
0 | 78 (65.5%) | 32 (62.7%) | 110 (64.7%) |
1 | 32 (26.9%) | 16 (31.4%) | 48 (28.2%) |
2 | 6 (5.0%) | 3 (5.9%) | 9 (5.3%) |
3 | 3 (2.5%) | 0 (0.0%) | 3 (1.8%) |
Clinical Stage | |||
1 | 5 (4.2%) | 4 (7.8%) | 9 (5.3%) |
2 | 8 (6.7%) | 13 (25.5%) | 21 (12.4%) |
3 | 18 (15.1%) | 15 (29.4%) | 33 (19.4%) |
4 (Any) | 74 (62.2%) | 4 (7.8%) | 78 (45.9%) |
Could not assess stage | 7 (5.9%) | 11 (21.6%) | 16 (10.6%) |
Not staged | 7 (5.9%) | 4 (7.8%) | 11 (6.5%) |
Tumor Site–Head and Neck | |||
Primary unknown | 3 (2.5%) | 3 (1.8%) | |
Hypopharynx | 10 (8.4%) | 10 (5.9%) | |
Larynx | 22 (18.5%) | 22 (12.9%) | |
Nasopharynx | 5 (4.2%) | 5 (2.9%) | |
Oral cavity | 32 (26.9%) | 32 (18.8%) | |
Oropharynx | 39 (32.8%) | 39 (22.9%) | |
Other | 3(2.5%) | 3 (1.8%) | |
Salivary gland | 5 (4.2%) | 5 (2.9%) | |
Treatment Modality b | |||
None | 5 (5.0%) | 5 (9.8%) | 10 (6.6%) |
Chemotherapy-definitive | 0 (0.0%) | 2 (3.9%) | 2 (1.3%) |
Chemotherapy-adjuvant | 0 (0.0%) | 1 (2.0%) | 1(0.7%) |
Radiotherapy-definitive | 15 (15.0%) | 0 (0.0%) | 15 (9.9%) |
Surgery | 10 (10.0%) | 2 (3.9%) | 12 (7.9%) |
Chemoradiotherapy-definitive | 54 (54.0%) | 6 (11.8%) | 60 (39.7%) |
Surgery + adj c/neoadj d RT e | 7 (7.0%) | 0 (0.0%) | 7 (4.6%) |
Surgery + adj/neoadj CRT f | 9 (9.0%) | 35 (68.6%) | 44 (29.1%) |
Nutritional Characteristics | Head and Neck (n = 119) n (%) | Esophageal (n = 51) n (%) | All (n = 170) n (%) | |
---|---|---|---|---|
Weight (kg) | ||||
median [Q1, Q3] | 77 [67, 91] | 85 [75, 95] | 81 [70, 91] | |
Height (cm) | ||||
median [Q1, Q3] | 173 [168, 178] | 176 [170, 182] | 174 [169, 179] | |
BMI a (kg/m2) | ||||
median [Q1, Q3] | 26 [23, 30] | 27 [25, 31] | 26 [23, 30] | |
Was a nutrition diagnosis made? | ||||
Yes | 52 (43.7%) | 33 (64.7%) | 85 (50.0%) | |
No | 27 (22.7%) | 1 (2.0%) | 28 (16.5%) | |
No data | 40 (33.6%) | 17 (33.3%) | 57 (33.5%) | |
Nutritional Risk, PG-SGA b Short Form Score | ||||
(n) median [Q1, Q3] | (116) 5 [1, 10] | (47) 8 [4, 11] | 6 [2, 11] | |
Location patient first introduced to cancer care setting | ||||
Inpatient | 14 (11.8%) | 4 (7.8%) | 18 (10.6%) | |
Outpatient | 105 (88.2%) | 47 (92.2%) | 152 (89.4%) | |
Did patient receive EN c or PN d within the last month prior to study enrollment? | ||||
Yes | 16 (13.4%) | 6 (11.8%) | 22 (12.9%) | |
No | 103 (86.6%) | 45 (88.2%) | 148 (87.1%) |
Nutrition Care Model [27,28] | Measure–System Level (Usual Practice in Centre at Study Enrollment) | N (n = 11) | % | ||
---|---|---|---|---|---|
Access to Care | Screening | ||||
Malnutrition screening routinely performed. | 11 | 100% | |||
Validated nutrition screening tool used. | 7 | 64% | |||
Assessment | |||||
Nutrition assessment routinely performed. | 11 | 100% | |||
Validated nutrition assessment tool used. | 8 | 73% | |||
Quality Nutrition Care | Measure—Patient Level | HNC | EC | ||
Surgery | (n = 26) | (n = 38) | |||
n | % | n | % | ||
Nutrition assessment | |||||
Pre-operative | 6 | 23% | 37 | 97% | |
Post-operative | 24 | 92% | 36 | 95% | |
Nutrition support-tube feeding commenced | |||||
Pre-operative | 1 | 4% | 8 | 21% | |
Post-operative | |||||
within 24 h | 5 | 19% | 2 | 5% | |
within 1 to 7 days | 12 | 46% | 17 | 44% | |
Nutrition prescription, median [Q1, Q3] | |||||
Energy prescription (kcal/kg/d) | 30.8 [29.6, 32.7] | 26.3 [23.2, 28.1] | |||
Protein prescription (g/kg/d) | 1.3 [1.2, 1.5] | 1.4 [1.2, 1.5] | |||
Radiotherapy/Chemoradiotherapy | (n = 85) | (n = 41) | |||
n# | % | n# | % | ||
Nutrition prescription, median [Q1, Q3] | |||||
Energy prescription (kcal/kg/d) | 30.4 [26.7, 33.4] | 26.7 [23.3, 28.8] | |||
Protein prescription (g/kg/d) | 1.3 [1.2, 1.5] | 1.4 [1.2, 1.5] | |||
Nutrition Monitoring and Evaluation | Received recommended dietitian consultation: | ||||
Pre-treatment (Access to Care) | 54/85 | 64% | 27/41 | 66% | |
Weekly during treatment | 36/85 | 42% | 10/41 | 24% | |
Fortnightly for 6 weeks post-treatment | 11/85 | 13% | 17/41 | 17% |
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Findlay, M.; Bauer, J.D.; Dhaliwal, R.; de van der Schueren, M.; Laviano, A.; Widaman, A.; Martin, L.; Day, A.G.; Gramlich, L.M. Translating Evidence-Based Guidelines into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM). Nutrients 2020, 12, 3808. https://doi.org/10.3390/nu12123808
Findlay M, Bauer JD, Dhaliwal R, de van der Schueren M, Laviano A, Widaman A, Martin L, Day AG, Gramlich LM. Translating Evidence-Based Guidelines into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM). Nutrients. 2020; 12(12):3808. https://doi.org/10.3390/nu12123808
Chicago/Turabian StyleFindlay, Merran, Judith D. Bauer, Rupinder Dhaliwal, Marian de van der Schueren, Alessandro Laviano, Adrianne Widaman, Lisa Martin, Andrew G. Day, and Leah M. Gramlich. 2020. "Translating Evidence-Based Guidelines into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM)" Nutrients 12, no. 12: 3808. https://doi.org/10.3390/nu12123808
APA StyleFindlay, M., Bauer, J. D., Dhaliwal, R., de van der Schueren, M., Laviano, A., Widaman, A., Martin, L., Day, A. G., & Gramlich, L. M. (2020). Translating Evidence-Based Guidelines into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM). Nutrients, 12(12), 3808. https://doi.org/10.3390/nu12123808