Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design, Participants, and Procedures
2.2. Statistical Analysis
3. Results
3.1. Surgeons’ General Knowledge of Nutrition
3.2. Daily Practice and Case-Based Scenarios
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Argilés, J.M. Cancer-associated malnutrition. Eur. J. Oncol. Nurs. 2005, 9 (Suppl. S2), S39–S50. [Google Scholar] [CrossRef] [PubMed]
- Virizuela, J.A.; Camblor-Álvarez, M.; Luengo-Pérez, L.M.; Grande, E.; Álvarez-Hernández, J.; Sendrós-Madroño, M.J.; Jiménez-Fonseca, P.; Peris, M.C.; Ocón-Bretón, M.J. Nutritional support and parenteral nutrition in cancer patients: An expert consensus report. Clin. Transl. Oncol. 2018, 20, 619–629. [Google Scholar] [CrossRef] [PubMed]
- Omlin, A.; Blum, D.; Wierecky, J.; Haile, S.R.; Ottery, F.D.; Strasser, F. Nutrition impact symptoms in advanced cancer patients: Frequency and specific interventions, a case-control study. J. Cachexia Sarcopenia Muscle 2013, 4, 55–61. [Google Scholar] [CrossRef] [PubMed]
- Nicolini, A.; Ferrari, P.; Masoni, M.C.; Fini, M.; Pagani, S.; Giampietro, O.; Carpi, A. Malnutrition, anorexia and cachexia in cancer patients: A mini-review on pathogenesis and treatment. Biomed. Pharmacother. 2013, 67, 807–817. [Google Scholar] [CrossRef] [PubMed]
- Ni, J.; Zhang, L. Cancer cachexia: Definition, staging, and emerging treatments. Cancer Manag. Res. 2020, 12, 5597–5605. [Google Scholar] [CrossRef]
- Van Cutsem, E.; Arends, J. The causes and consequences of cancer-associated malnutrition. Eur. J. Oncol. Nurs. 2005, 9 (Suppl. S2), S51–S63. [Google Scholar] [CrossRef]
- Baracos, V.E. Cancer-associated malnutrition. Eur. J. Clin. Nutr. 2018, 72, 1255–1259. [Google Scholar] [CrossRef]
- Crowder, S.L.; Douglas, K.G.; Yanina Pepino, M.; Sarma, K.P.; Arthur, A.E. Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: A systematic review. J. Cancer Surviv. 2018, 12, 479–494. [Google Scholar] [CrossRef]
- Arends, J.; Baracos, V.; Bertz, H.; Bozzetti, F.; Calder, P.C.; Deutz, N.E.P.; Erickson, N.; Laviano, A.; Lisanti, M.P.; Lobo, D.N.; et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin. Nutr. 2017, 36, 1187–1196. [Google Scholar] [CrossRef] [Green Version]
- Huhmann, M.B.; August, D.A. Review of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines for Nutrition Support in Cancer Patients: Nutrition screening and assessment. Nutr. Clin. Pract. 2008, 23, 182–188. [Google Scholar] [CrossRef]
- De Las Peñas, R.; Majem, M.; Perez-Altozano, J.; Virizuela, J.A.; Cancer, E.; Diz, P.; Donnay, O.; Hurtado, A.; Jimenez-Fonseca, P.; Ocon, M.J. SEOM clinical guidelines on nutrition in cancer patients (2018). Clin. Transl. Oncol. 2019, 21, 87–93. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- National Cancer Institute. Nutrition in Cancer Care (PDQ®) Health Professional Version. Available online: https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq (accessed on 20 April 2022).
- Cancer.Net®. Nutrition Recommendations during and after Treatment. Available online: https://www.cancer.net/survivorship/healthy-living/nutrition-recommendations-during-and-after-treatment (accessed on 20 April 2022).
- Durán-Poveda, M.; Jimenez-Fonseca, P.; Sirvent-Ochando, M.; García-Luna, P.P.; Pereira-Cunill, J.L.; Lema-Marqués, B.; Parejo-Arrondo, M.T.; Belda-Iniesta, C. Integral nutritional approach to the care of cancer patients: Results from a Delphi panel. Clin. Transl. Oncol. 2018, 20, 1202–1211. [Google Scholar] [CrossRef] [PubMed]
- Williams, J.D.; Wischmeyer, P.E. Assessment of perioperative nutrition practices and attitudes-A national survey of colorectal and GI surgical oncology programs. Am. J. Surg. 2017, 213, 1010–1018. [Google Scholar] [CrossRef] [PubMed]
- Grass, F.; Cerantola, Y.; Schäfer, M.; Müller, S.; Demartines, N.; Hübner, M. Perioperative nutrition is still a surgical orphan: Results of a Swiss-Austrian survey. Eur. J. Clin. Nutr. 2011, 65, 642–647. [Google Scholar] [CrossRef]
- Bozkırlı, B.O.; Gündoğdu, R.H.; Akbaba, S.; Sayın, T.; Ersoy, P.E. Surgeons’ approach toward clinical nutrition: A survey-based study. Turk. J. Surg. 2017, 33, 147–152. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Naffouje, S.A.; De La Cruz, K.; Berard, D.; Guy, S.; Salti, G.I. Knowledge, attitudes and practice of surgeons regarding nutritional support in CRS and HIPEC patients: Are we missing something? Eur. J. Cancer Care (Engl.) 2019, 28, e12930. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lorenzon, L.; Brandl, A.; Guiral, D.C.; Hoogwater, F.; Lundon, D.; Marano, L.; Montagna, G.; Polom, K.; Primavesi, F.; Schrage, Y.; et al. Nutritional assessment in surgical oncology: An ESSO-EYSAC global survey. Eur. J. Surg. Oncol. 2020, 46, 2074–2082. [Google Scholar] [CrossRef] [PubMed]
- Yu, K.; Zheng, X.; Wang, G.; Liu, M.; Li, Y.; Yu, P.; Yang, M.; Guo, N.; Ma, X.; Bu, Y.; et al. Immunonutrition vs standard nutrition for cancer patients: A systematic review and meta-analysis (part 1). JPEN J. Parenter. Enter. Nutr. 2020, 44, 742–767. [Google Scholar] [CrossRef] [PubMed]
- Gao, B.; Luo, J.; Liu, Y.; Zhong, F.; Yang, X.; Gan, Y.; Su, S.; Li, B. Clinical efficacy of perioperative immunonutrition containing omega-3-fatty acids in patients undergoing hepatectomy: A systematic review and meta-analysis of randomized controlled trials. Ann. Nutr. Metab. 2020, 76, 375–386. [Google Scholar] [CrossRef] [PubMed]
- Kirbiyik, F.; Ozkan, E. Knowledge and practices of medical oncologists concerning nutrition therapy: A survey study. Clin. Nutr. ESPEN 2018, 27, 32–37. [Google Scholar] [CrossRef]
- Spiro, A.; Baldwin, C.; Patterson, A.; Thomas, J.; Andreyev, H.J. The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br. J. Cancer 2006, 95, 431–434. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Guerra, E.M.; Cortés-Salgado, A.; Mateo-Lobo, R.; Nattero, L.; Riveiro, J.; Veja-Piñero, B.; Valbuena, B.; Carabaña, F.; Carrero, C.; Grande, E.; et al. Role of parenteral nutrition in oncologic patients with intestinal occlusion and peritoneal carcinomatosis. Nutr. Hosp. 2015, 32, 1222–1227. [Google Scholar]
- Zhang, F.; Jin, Y.; Qiang, W. The effects of dietary advice on malnutrition in Cancer patients: A systematic review and meta-analysis. Support. Care Cancer 2020, 28, 1579–1585. [Google Scholar] [CrossRef] [PubMed]
- Vather, R.; Bissett, I. Management of prolonged post-operative ileus: Evidence-based recommendations. ANZ J. Surg. 2013, 83, 319–324. [Google Scholar] [CrossRef] [PubMed]
- Bullock, A.F.; Greenley, S.L.; McKenzie, G.A.G.; Paton, L.W.; Johnson, M.J. Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: Systematic review, narrative synthesis and meta-analysis. Eur. J. Clin. Nutr. 2020, 74, 1519–1535. [Google Scholar] [CrossRef]
- Weimann, A.; Braga, M.; Carli, F.; Higashiguchi, T.; Hübner, M.; Klek, S.; Laviano, A.; Ljungqvist, O.; Lobo, D.N.; Martindale, R.; et al. ESPEN guideline: Clinical nutrition in surgery. Clin. Nutr. 2017, 36, 623–650. [Google Scholar] [CrossRef] [Green Version]
- Weimann, A.; Braga, M.; Carli, F.; Higashiguchi, T.; Hübner, M.; Klek, S.; Laviano, A.; Ljungqvist, O.; Lobo, D.N.; Martindale, R.G.; et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin. Nutr. 2021, 40, 4745–4761. [Google Scholar] [CrossRef]
Items of the Questionnaire | Number of Responses (%) |
---|---|
What do you consider that is the most appropriate definition of malnutrition? | |
| 95 (81.9) |
| 1 (0.9) |
| 10 (8.6) |
| 9 (7.8) |
Don’t know/no answer | 1 (0.9) |
In your opinion, with what parameters is malnutrition most accurately diagnosed? | |
| 86 (74.1) |
| 14 (12.1) |
| 10 (8.6) |
| 4 (3.4) |
Don’t know/no answer | 2 (1.7) |
In your opinion, how malnutrition that occurs in the surgical patient should be classified? | |
| 21 (18.1) |
| 10 (8.6) |
| 36 (31.0) |
| 40 (34.5) |
Don’t know/no answer | 9 (7.8) |
Which of the following questionnaires would you NOT use for nutritional screening? | |
| 4 (3.4) |
| 6 (5.2) |
| 63 (54.3) |
| 12 (10.3) |
Don’t know/no answer | 31 (26.7) |
What definition of enteral nutrition do you consider most appropriate? | |
| 9 (7.8) |
| 70 (60.3) |
| 22 (19.0) |
| 15 (12.9) |
In your opinion, where should the tip of a central venous catheter be placed in order to start total parenteral nutrition? | |
| 25 (21.6) |
| 1 (0.9) |
| 80 (69.0) |
| 9 (7.8) |
Don’t know/no answer | 1 (0.9) |
In relation to preoperative nutritional support in patients undergoing a major abdominal surgical procedure, which of the following statements do you consider to be true? | |
| 64 (55.2) |
| 1 (0.9) |
| 1 (0.9) |
| 44 (37.9) |
Don’t know/no answer | 6 (5.2) |
How long do you consider it is necessary to maintain total parenteral nutrition (TPN) to achieve any postoperative clinical benefit? | |
| 14 (12.1) |
| 72 (62.1) |
| 22 (19.0) |
| 5 (4.3) |
Don’t know/no answer | 3 (2.6) |
What do you consider that are the advantages of enteral infusion of nutrients in the early postoperative period? Mark all options that apply | |
| 109 (93.7) |
| 68 (58.6) |
| 93 (80.2) |
In your opinion, which of the following statements regarding postoperative nutritional support is correct? | |
| 0 |
| 37 (31.9) |
| 26 (22.4) |
| 47 (40.5) |
Don’t know/no answer | 6 (5.2) |
In most patients, when do you consider that oral diet should be started after major abdominal surgery? | |
| 111 (95.7) |
| 0 |
| 2 (1.7) |
| 1 (0.9) |
Don’t know/no answer | 2 (1.7) |
Regarding immunonutrition, add those statements that in your opinion are correct. Mark all options that apply | |
| 29 (25.0) |
| 78 (67.2) |
| 81 (69.8) |
| 2 (1.7) |
Don’t know/no answer | 6 (5.2) |
In relation to peripheral parenteral nutrition, select those statements that in your opinion are correct. Mark all options that apply | |
| 100 (86.2) |
| 87 (75.0) |
| 95 (81.9) |
| 10 (8.6) |
Items of the Questionnaire | Number of Responses (%) |
---|---|
In a patient presenting with intestinal occlusion requiring a surgical operation, when would you indicate preoperative TPN? | |
| 20 (17.2) |
| 12 (10.3) |
| 68 (58.6) |
| 9 (7.8) |
Don’t know/no answer | 7 (6.0) |
In a patient with carcinoma of the esophagus without preoperative weight loss who will undergo esophagectomy, which of the following attitudes do you consider that are correct? | |
| 0 |
| 56 (48.3) |
| 21 (18.1) |
| 27 (23.3) |
Don’t know/no answer | 12 (10.3) |
According to the protocol of your hospital, what is the procedure to follow when faced with a patient with cancer of the pancreas and weight loss of 20 kg in the last 3 months and BMI of 18 kg/m2? | |
| 19 (16.4) |
| 11 (9.5) |
| 69 (59.5) |
| 8 (6.9) |
Don’t know/no answer | 9 (7.8) |
When faced with a patient with obstructive and locally advanced gastric cancer, indicate the attitude that seems most appropriate to you | |
| 26 (22.4) |
| 10 (8.6) |
| 74 (63.8) |
| 2 (1.7) |
Don’t know/no answer | 4 (3.4) |
A patient who had undergone laparoscopic right hemicolectomy presents a paralytic ileus during 5 days, what would be the attitude to follow? | |
| 53 (45.7) |
| 24 (20.7) |
| 17 (14.6) |
| 19 (16.4) |
Don’t know/no answer | 3 (2.6) |
When faced with an obese patient diagnosed with colon cancer, what would be your attitude in the consultation? | |
| 3 (2.6) |
| 1 (0.9) |
| 92 (79.3) |
| 15 (4.3) |
Don’t know/no answer | 5 (4.3) |
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Durán-Poveda, M.; Suárez-de-la-Rica, A.; Cancer Minchot, E.; Ocón-Bretón, J.; Sánchez-Pernaute, A.; Rodríguez-Caravaca, G. Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study. Nutrients 2022, 14, 4764. https://doi.org/10.3390/nu14224764
Durán-Poveda M, Suárez-de-la-Rica A, Cancer Minchot E, Ocón-Bretón J, Sánchez-Pernaute A, Rodríguez-Caravaca G. Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study. Nutrients. 2022; 14(22):4764. https://doi.org/10.3390/nu14224764
Chicago/Turabian StyleDurán-Poveda, Manuel, Alejandro Suárez-de-la-Rica, Emilia Cancer Minchot, Julia Ocón-Bretón, Andrés Sánchez-Pernaute, and Gil Rodríguez-Caravaca. 2022. "Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study" Nutrients 14, no. 22: 4764. https://doi.org/10.3390/nu14224764
APA StyleDurán-Poveda, M., Suárez-de-la-Rica, A., Cancer Minchot, E., Ocón-Bretón, J., Sánchez-Pernaute, A., & Rodríguez-Caravaca, G. (2022). Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study. Nutrients, 14(22), 4764. https://doi.org/10.3390/nu14224764