School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.
Barwon Health Cachexia and Nutrition Support Service, Barwon Health, Geelong, Victoria, Australia.
Support Care Cancer. 2020 Jul;28(7):3041-3049. doi: 10.1007/s00520-019-05072-w. Epub 2019 Oct 2.
Cachexia is a wasting condition affecting approximately 50% of cancer patients, associated with decreased quality of life and survival. Barwon Health's Cachexia and Nutrition Support Service provides person-centred interdisciplinary care to assist the management of cachexia symptoms. This study describes a novel and effective service model established in a regional cachexia clinic and the patient population it serves.
A descriptive, retrospective longitudinal study was conducted of records from patients attending Barwon Health between 2008 and 2013 (n = 175), alongside the description of service refinement over this time. Patients with ≥ 2 attendance dates were assessed for anthropometric measures, follow-up intervals, and muscle function outcomes to describe patient trajectory during clinic involvement.
This is the first detailed description of a successful interdisciplinary clinic specific to cancer cachexia management, where patients are seen outside established 8- to 12-week structured programs which prevail in other cachexia clinics. Seventy-five patients (43%) attended one appointment only, with almost half of these (n = 33) first attending within 60 days of death. Of the 99 patients with two or more appointments, 49% displayed positive outcomes with > 2-kg weight gain between two consecutive appointments, and > 50% improved functional strength between two consecutive appointments.
The majority of patients attending clinic multiple times maintained or increased weight and functional status during their involvement with the service. However, successes of care provision were muted by high attrition, primarily due to delayed referral and expected high mortality within the study cohort. Planned future analyses with greater patient numbers and cancer stratification will establish cachectic populations most likely to benefit from this novel mode of interdisciplinary care. The Cachexia and Nutrition Support Service provides an effective and efficient service model for the provision of specialist cachexia care to community-dwelling patients in regional Australia.
恶病质是一种消耗性疾病，影响约 50%的癌症患者，导致生活质量下降和生存率降低。巴旺健康恶病质和营养支持服务提供以患者为中心的跨学科护理，以协助管理恶病质症状。本研究描述了在区域恶病质诊所建立的一种新颖有效的服务模式及其服务的患者人群。
对 2008 年至 2013 年期间在巴旺健康就诊的患者（n=175）的记录进行描述性、回顾性纵向研究，同时描述在此期间服务的改进。对≥2 次就诊的患者进行人体测量指标、随访间隔和肌肉功能结果评估，以描述患者在诊所参与期间的轨迹。
这是首次详细描述成功的专门针对癌症恶病质管理的跨学科诊所，患者就诊时间超出了其他恶病质诊所普遍采用的 8-12 周结构化方案。75 名患者（43%）仅就诊一次，其中近一半（n=33）首次就诊距离死亡时间不到 60 天。在 99 名有两次或两次以上就诊的患者中，49%的患者体重增加超过 2kg，两次连续就诊之间功能强度提高超过 50%。
大多数多次就诊的患者在参与服务期间保持或增加体重和功能状态。然而，由于延迟转诊和研究队列中预期的高死亡率，高退出率削弱了护理提供的成功。计划未来进行更多患者数量和癌症分层的分析，将确定最有可能从这种新的跨学科护理模式中受益的恶病质人群。恶病质和营养支持服务为澳大利亚偏远地区社区居住的患者提供了一种有效的、高效率的专科恶病质护理服务模式。
