WORLD CANCER DAY: MOVING RESEARCH INTO PRACTICE FOR UPPER GASTROINTESTINAL CANCER PATIENTS
World Cancer Day on 4 February invites us to imagine a world where millions of cancer deaths are prevented, and access to life-saving cancer treatment and care is equal for all. Key to improving the quality of life for people newly diagnosed with upper gastrointestinal is nutrition. Dr Kate Huggins is part of a Monash University collaboration translating research into practice by exploring innovative, practical mHealth (app) interventions that support more effective nourishment, particularly during cancer treatment.
We live in a world where we’ve all been touched by cancer in some way - with many of us painfully aware of the physical and emotional devastation left in its wake. February 4th is World Cancer Day. At the heart of World Cancer Day is the belief that individuals, together, can create change. One such individual is Monash University Department of Nutrition, Dietetics and Food researcher Dr Kate Huggins.
Since 2011, Kate and her peers have been working with the dietetics and surgical team at Monash Health to establish early nutritional interventions as common practice and as part of the standard of care during the diagnosis and treatment of upper gastrointestinal cancers. The research team is exploring mobile apps (mHealth) and phone consultations to transform nutritional care for cancer patients.
Worldwide, cancers of the stomach, oesophagus and pancreas are leading causes of cancer deaths [1]. A major challenge for those living with these particular cancers is the impact on nutritional status and ultimately, quality of life. Cancers of the upper digestive tract typically lead to an inability to absorb and use a range of nutrients — often well before any symptoms appear or diagnosis occurs. This often leads to sustained weight loss and malnutrition.
For upper gastrointestinal cancers, and in fact many cancers, malnutrition is a strong prognostic indicator of mortality [2]. Cancer patients experiencing malnutrition have a greater risk of post-surgery morbidity [3], debility, compromised immunity, a higher rate of hospital readmission, a longer duration of hospital stay [4], and a poorer quality of life [5]. In fact, the prevalence of malnutrition at the time of diagnosis for people with upper gastrointestinal cancer is as high as 90% [6].
Alarmingly, it is only after experiencing substantial weight loss that patients are often prompted to seek medical advice - and herein lies the problem. Kate said that poor nourishment and malnutrition often aren’t identified early, resulting in poorer outcomes for patients during treatment. “We’re hoping to improve access to guidance and nutritional support at the time of diagnosis - and prior to admission to hospital for treatment. Because by that time, the patient may already be suffering from malnutrition,” she said.
Kate and her team are currently building on their recent pilot study published in Supportive Care in Cancer, which found that early and intensive dietetic intervention, initiated at the time of diagnosis of gastric or oesophageal cancer was beneficial [6]. Compared with the usual standard of care, patients who received an intensive tele-dietetic intervention (i.e. over the phone) experienced a significantly better nutrition status [6].
“This finding is important, indicating that our early and intensive tele-dietetic intervention may have an impact on malnutrition that develops prior to the commencement of cancer treatment,” explained Kate. The long term follow-up of this group of patients found that there may be a slower rate of mortality amongst those receiving the tele-dietetic intervention [7].
The next stage of their research will see the team comparing the tele-dietetic intervention to a mHealth intervention through the use of an app. Kate pointed out that “both approaches allow personalised dietary counselling, employing behaviour change techniques and the initiation of nutritional supplements if clinically indicated”. Telephone and mHealth delivery modes are scalable and they overcome the barrier of geography, provide greater flexibility for the patient and facilitate more equitable access to this service.
“We need to be doing research that has a pathway to impact. Research translation can include help from the research side with ways to tackle problems or providing a skill set that complements clinical skills. I really enjoy that,” explained Kate.
More information
Kate is a nutrition scientist, researcher and senior lecturer with the Monash University Department of Nutrition, Dietetics and Food. She leads research translation in nutrition. A current project funded by the Victorian Cancer Agency and the NHMRC is the implementation of earlier nutrition care for people with upper gastrointestinal cancer. You can access Kate’s research profile here.Stay connected with Monash Nutrition on Twitter (@MonashNutrition) and Facebook (@MonashNutrition).
Read more about the pilot study and the current study here:
Pilot study: Silvers MA, Savva J, Huggins CE, Truby H, Haines T. Potential benefits of early nutritional intervention in adults with upper gastrointestinal cancer: a pilot randomised trial. Support Care Cancer. 2014;22(11):3035–3044. doi: 10.1007/s00520-014-2311-3.
Current study (protocol paper): Hanna L, Huggins CE, Furness K, Silvers MA, Savva J, Frawley H, Croagh D, Cashin P, Low L, Bauer J, Truby H, Haines T. Effect of early and intensive nutrition care, delivered via telephone or mobile application, on quality of life in people with upper gastrointestinal cancer: study protocol of a randomised controlled trial. BMC Cancer. 2018 Jul 3;18(1):707. doi: 10.1186/s12885-018-4595-z.
Learn more about World Cancer Day here: https://www.worldcancerday.org/
References:
2. Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33(1):90–99. doi: 10.1200/JCO.2014.56.1894.
3. Di Fiore F, Lecleire S, Pop D, Rigal O, Hamidou H, Paillot B, Ducrotte P, Lerebours E, Michel P. Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol. 2007;102(11):2557–2563. doi: 10.1111/j.1572-0241.2007.01437.x.
4. Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, Gillies J, Collins CE. Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer. Clin Oncol (R Coll Radiol) 2005;17(8):639–645. doi: 10.1016/j.clon.2005.03.015
5. Marin Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007;26(3):289–301. doi: 10.1016/j.clnu.2007.01.005.
6. Silvers MA, Savva J, Huggins CE, Truby H, Haines T. Potential benefits of early nutritional intervention in adults with upper gastrointestinal cancer: a pilot randomised trial. Support Care Cancer. 2014;22(11):3035–3044. doi: 10.1007/s00520-014-2311-3.
7. Furness K, Silvers MA, Savva J, Huggins CE, Truby H, Haines T. Long-term follow-up of the potential benefits of early nutritional intervention in adults with upper gastrointestinal cancer: a pilot randomised trial. Support Care Cancer. 2017;25(11):3587–93.
