Barriers to nutritional support in patients with cancer

Peer reviewed / Manuscript (original) submitted: 28 November 2019 / Revision accepted: 05 March 2020

Report on a project facing malnutrition in a German hospital

Introduction

Malnutrition in cancer patients is widespread and represents a major clinical challenge. The Subjective Global Assessment Questionnaire was used to assess the nutritional status of patients in German hospitals and found that 38% of tumor patients were malnourished [1]. A similarly high prevalence of malnutrition has also been observed in other studies [2]. It is well known that nutritional status, especially in the cancer patient population, is a key determinant of quality of life and a relevant prognostic marker for complication risk and life expectancy [3]. In addition, malnutrition in cancer patients is associated with longer hospital stays and significantly greater medical costs [1, 2, 4].

The problem of malnutrition in the cancer patient population is well known [5, 6] and evidence-based German and European guidelines are available to guide therapy plans [4, 7]. Despite many initiatives from professional and political committees, there has not been substantial progress toward improving care for cancer-related malnutrition, with the ultimate goal of early screening and appropriate therapy in the clinical setting. Although the prevalence of cancer-related malnutrition in the hospital setting is high, few clinics in Germany are staffed with a qualified nutrition team and other infrastructure to provide patients with modern nutritional therapy.

Abstract

This project sought to improve the nutritional management of cancer patients in a large hematology/oncology inpatient clinic. Patients were screened for the risk of malnutrition using the Nutritional Risk Screening (NRS) questionnaire (2002). In the first part of the project, the “status-quo” was assessed over a period of 8 months. During the second part, patients with an increased risk of malnutrition were offered nutritional therapy. Overall, 63.6% of all recruited patients had an increased risk of malnutrition (NRS ≥ 3). However, only 15 (14.6%) of the 103 patients included in the study consented to dietary therapy during part 2, which mainly consisted of consuming liquid nutritional supplements. The two main treatment barriers identified were inadequate hospital infrastructure to deliver inpatient nutritional management and the general lack of interest from many patients in receiving nutrition support. This project highlights the difficulties of implementing guidelines for nutrition management in the German healthcare system.

Keywords: malnutrition, Nutritional Risk Screening (NRS), nutritional therapy, oncology, tumor patients

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