Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; Epsylon, EA 4556 Dynamics of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France.
Epsylon, EA 4556 Dynamics of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France.
J Pain Symptom Manage. 2017 Sep;54(3):387-393.e3. doi: 10.1016/j.jpainsymman.2017.01.010. Epub 2017 Aug 1.
Cancer-associated cachexia is correlated with survival, side-effects, and alteration of the patients' well-being.
We implemented an institution-wide multidisciplinary supportive care team, a Cancer Nutrition Program (CNP), to screen and manage cachexia in accordance with the guidelines and evaluated the impact of this new organization on nutritional care and funding.
We estimated the workload associated with nutrition assessment and cachexia-related interventions and audited our clinical practice. We then planned, implemented, and evaluated the CNP, focusing on cachexia.
The audit showed a 70% prevalence of unscreened cachexia. Parenteral nutrition was prescribed to patients who did not meet the guideline criteria in 65% cases. From January 2009 to December 2011, the CNP team screened 3078 inpatients. The screened/total inpatient visits ratio was 87%, 80%, and 77% in 2009, 2010, and 2011, respectively. Cachexia was reported in 74.5% (n = 2253) patients, of which 94.4% (n = 1891) required dietary counseling. Over three years, the number of patients with artificial nutrition significantly decreased by 57.3% (P < 0.001), and the qualitative inpatients enteral/parenteral ratio significantly increased: 0.41 in 2009, 0.74 in 2010, and 1.52 in 2011. Between 2009 and 2011, the CNP costs decreased significantly for inpatients nutritional care from 528,895€ to 242,272€, thus financing the nutritional team (182,520€ per year).
Our results highlight the great benefits of implementing nutritional guidelines through a physician-led multidisciplinary team in charge of nutritional care in a comprehensive cancer center.
癌症相关性恶病质与患者的生存、副作用和生活质量改变相关。
我们建立了全院多学科支持治疗小组，即癌症营养计划（CNP），以根据指南筛查和管理恶病质，并评估这种新组织对营养治疗和资金的影响。
我们评估了营养评估和恶病质相关干预措施的工作量，并对我们的临床实践进行了审核。然后，我们专注于恶病质，计划、实施和评估了 CNP。
审核显示，未经筛查的恶病质患病率为 70%。在 65%的情况下，不符合指南标准的患者被开具了肠外营养。从 2009 年 1 月至 2011 年 12 月，CNP 团队筛查了 3078 名住院患者。2009、2010 和 2011 年，筛查/总住院患者就诊比例分别为 87%、80%和 77%。2253 例（74.5%）患者报告有恶病质，其中 1891 例（94.4%）需要饮食咨询。在三年内，接受人工营养的患者数量显著减少了 57.3%（P<0.001），而住院患者肠内/肠外比显著增加：2009 年为 0.41，2010 年为 0.74，2011 年为 1.52。2009 年至 2011 年，CNP 用于住院患者营养治疗的费用从 528,895 欧元降至 242,272 欧元，从而为营养团队（每年 182,520 欧元）提供了资金。
我们的结果突出表明，在综合癌症中心，通过医生领导的多学科小组实施营养指南，为营养治疗提供支持，可以带来巨大的益处。
