Ho Harriet, Cerullo Linda, Jin Rana, Monginot Susie, Alibhai Shabbir M H
Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON M5G 2C4, Canada.
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
Nutrients. 2025 May 6;17(9):1591. doi: 10.3390/nu17091591.
Canada's aging population is leading to an increased number of older adults being diagnosed with cancer. This population faces unique challenges, including frailty, comorbidities, polypharmacy, and malnutrition, which can negatively affect treatment outcomes. The role of registered dietitians (RDs) in managing nutrition-related issues in this population is well-documented, but there is limited research on their integration into geriatric oncology clinics. We evaluated the impact of integrating a registered dietitian (RD) into the Older Adult with Cancer Clinic (OACC) at the Princess Margaret Cancer Centre, Toronto, Canada.
A retrospective chart review was conducted of older adult cancer patients seen at the OACC, comparing outcomes before and after the RD's integration. The focus was on weight characteristics and change, malnutrition screening/identification, and management. The two-item Canadian Nutrition Screening Tool (CNST) was introduced during the RD's integration and was also examined to see its usefulness in identifying malnutrition risk. Chi-squared tests and t-tests were used for data analysis.
The pre-cohort (n = 140) had a mean age of 80.2 years, 48.6% female, and 77.9% vulnerable (Vulnerable Elders Survey (VES-13) ≥ 3). The post-cohort (n = 117) had a mean age of 81.4 years, 59.8% female, and 80.3% vulnerable (VES-13 ≥ 3). Weight change within 3 ± 1 months after the initial OACC consult was similar between pre and post groups with -1.4 kg and -1.2 kg, respectively ( = 0.77). Patients at nutritional risk, as determined by the OACC team, generated significantly more referrals to the RD in the post group (100% vs. 36.4%, < .001). Among patients who had CNST screening and saw the RD, there was a higher rate of high nutrition risk among CNST-positive compared to CNST-negative patients (67.2% versus 44.4%, respectively). After the integration of the RD, a greater number of patients at nutritional risk received nutritional education and referrals to other healthcare professionals (43 versus 1).
The integration of an RD into the OACC led to improved referral rates, nutritional education, and referrals to other healthcare professionals. Moreover, patients who were CNST positive were more likely to have high nutritional risk.
加拿大人口老龄化导致被诊断患有癌症的老年人数量增加。这一人群面临着独特的挑战，包括身体虚弱、合并症、多种药物治疗以及营养不良，这些都会对治疗结果产生负面影响。注册营养师（RD）在管理这一人群营养相关问题方面的作用已有充分记录，但关于他们融入老年肿瘤诊所的研究却很有限。我们评估了在加拿大多伦多玛格丽特公主癌症中心的老年癌症患者诊所（OACC）中引入注册营养师的影响。
对在OACC就诊的老年癌症患者进行回顾性病历审查，比较引入注册营养师前后的结果。重点关注体重特征及变化、营养不良筛查/识别和管理。在引入注册营养师期间引入了两项加拿大营养筛查工具（CNST），并对其在识别营养不良风险方面的有用性进行了评估。采用卡方检验和t检验进行数据分析。
队列前组（n = 140）的平均年龄为80.2岁，女性占48.6%，77.9%为脆弱人群（脆弱老年人调查（VES - 13）≥ 3）。队列后组（n = 其中文翻译为：117）的平均年龄为81.4岁，女性占59.8%，80.3%为脆弱人群（VES - 13 ≥ 3）。在初次OACC咨询后3 ± 1个月内，两组的体重变化相似，前组和后组分别为 - 1.4 kg和 - 1.2 kg（P = 0.77）。根据OACC团队的判断，处于营养风险的患者在队列后组中被转介给注册营养师的比例显著更高（100%对36.4%，P <.001）。在接受CNST筛查并见到注册营养师的患者中，CNST阳性患者的高营养风险率高于CNST阴性患者（分别为67.2%和44.4%）。引入注册营养师后，更多处于营养风险的患者接受了营养教育并被转介给其他医疗保健专业人员（43例对1例）。
在OACC引入注册营养师提高了转介率、营养教育水平以及向其他医疗保健专业人员的转介。此外，CNST阳性的患者更有可能具有高营养风险。
