Pierre Senesse1, Agnès Isambert2, Chloé Janiszewski3, Stéphanie Fiore4, Nicolas Flori4, Sylvain Poujol5, Eric Arroyo6, Julie Courraud3, Vanessa Guillaumon7, Hélène Mathieu-Daudé8, Sophie Colasse9, Vickie Baracos10, Hélène de Forges3, Simon Thezenas11. 1. 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. Electronic address: pierre.senesse@icm.unicancer.fr. 2. Epsylon, EA 4556 Dynamics of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France. 3. Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France. 4. Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France. 5. Department of Pharmacy, Institut régional du Cancer de Montpellier (ICM), Montpellier, France. 6. Computer Information Organisation, Institut régional du Cancer de Montpellier (ICM), Montpellier, France. 7. SIRIC Montpellier Cancer, Institut régional du Cancer de Montpellier (ICM), Montpellier, France. 8. Medical Information Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France. 9. Financial Affairs, Institut régional du Cancer de Montpellier (ICM), Montpellier, France. 10. Department of Oncology, University of Alberta, Edmonton, Canada. 11. Biometrics Unit, Institut régional du Cancer de Montpellier (ICM), Montpellier, France.
Abstract
CONTEXT: Cancer-associated cachexia is correlated with survival, side-effects, and alteration of the patients' well-being. OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
CONTEXT: Cancer-associated cachexia is correlated with survival, side-effects, and alteration of the patients' well-being. OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.