Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy.
Champalimaud Centre for the Unknown, Digestive Unit, Lisbon, Portugal.
Eur J Surg Oncol. 2020 Nov;46(11):2074-2082. doi: 10.1016/j.ejso.2020.08.028. Epub 2020 Sep 3.
The majority of cancer patients report malnutrition, with a significant impact on patient's outcome. This study aimed to compare how nutritional assessment is conducted across different surgical oncology sub-specialties.
Survey modules were designed for breast, hepato-pancreato-biliary (HPB), upper-gastrointestinal (UGI), sarcoma, peritoneal and surface malignancies (PSM) and colorectal cancer (CRC) surgeries to describe 4 domains: participants' setting, evaluation of clinical factors, use of screening tools and clinical practice. Results were compared among sub-specialties and according to human development index (HDI) in the largest cohorts.
Out of 457 answers from 377 global participants (62% European), 35.0% were from breast and 28.9% were from CRC surgeons. Although MDTs management is consistently reported (64-88%), the presence of a nutritionist/dietician ranges from 14.1% to 44.2%. Breast surgeons seldom evaluate albumin (25.6%) and weight loss (30.6%), opposite to HPB, PSM and UGI groups (>70%, p 0.044). Overall, responders declared that the use of screening tools is largely neglected, that nutritional status is often assessed by the surgeons and that nutrition is not consistently modified according to risk factors (range among groups respectively: 1.9%-25.6%, 33.1%-51.4%, 33.1%-60.5%). Less than 20% of breast surgeons assess patients before/after surgery, comparing to >60% of PSM surgeons. However, no statistical differences were documented comparing groups for the majority of the items of the 4 domains. Nutritional evaluation is more often conducted by breast surgeons in medium/low HDI countries comparing very high/high HDI (p 0.04).
Nutritional assessment is largely neglected. These results identify target-issues for the implementation of clinical practice.
大多数癌症患者报告存在营养不良，这对患者的预后有重大影响。本研究旨在比较不同肿瘤外科亚专业如何进行营养评估。
为乳腺、肝胆胰腺（HPB）、上消化道（UGI）、肉瘤、腹膜和表面恶性肿瘤（PSM）以及结直肠癌（CRC）手术设计了调查模块，以描述 4 个领域：参与者的环境、临床因素评估、筛查工具使用和临床实践。根据最大队列中的人类发展指数（HDI），比较了各亚专业之间的结果。
来自 377 名全球参与者（62%来自欧洲）的 457 份回答中，35.0%来自乳腺外科医生，28.9%来自 CRC 外科医生。尽管 MDT 管理得到一致报告（64-88%），但营养师/饮食学家的存在范围从 14.1%到 44.2%不等。乳腺外科医生很少评估白蛋白（25.6%）和体重减轻（30.6%），而 HPB、PSM 和 UGI 组则相反（>70%，p 0.044）。总体而言，受访者表示筛查工具的使用被广泛忽视，营养状况通常由外科医生评估，营养状况并非根据危险因素进行一致调整（各组分别为：1.9%-25.6%、33.1%-51.4%、33.1%-60.5%）。少于 20%的乳腺外科医生在手术前后评估患者，而 PSM 外科医生中则有>60%的人这样做。然而，对于 4 个领域的大部分项目，没有记录到各小组之间的统计学差异。在中/低 HDI 国家，乳腺外科医生更经常进行营养评估，而在高/极高 HDI 国家则较少（p 0.04）。
营养评估被广泛忽视。这些结果确定了实施临床实践的目标问题。
