Comparison of a newly established dietetic clinic for upper gastrointestinal malignancy with a general oncology clinic
Authors: Chowdhury S. 
Published: July 2008

Background:  Undernutrition in upper gastrointestinal (UGI) malignancy is common. Research shows weight loss to be associated with increased toxicity from chemotherapy and a poorer prognosis (Andreyev et al., 1998). Timely dietetic intervention is therefore pertinent to optimising treatment outcome, particularly when treatment is multimodal and radical. Prior to 2006, all patients with a UGI malignancy who were referred to a dietitian at our NHS Trust were seen in a general oncology dietetic clinic. In response to growing referrals, a dietetic clinic dedicated to UGI malignancy was established in January 2007. This clinic joined the UGI multidisciplinary team (MDT) medical oncology clinics. This review aimed to evaluate the profile of this new clinic in its first year and explore the changes needed to improve the delivery of this new service to patients.

Methods:  All patients with an UGI malignancy who were booked into this new dietetic UGI oncology clinic were included in the survey. Data were collected retrospectively for the period 1st of January 2006 – 31st December 2007. Clinic lists were identified using the trust patient information management system. This provided the patient's name and hospital identification number, and age. Tumour type attendance, dietary advice and referral source were found using dietetic case notes. This data was analysed using Microsoft Excel and Chi squared analysis.

Results:  In 2006, 133 appointments were made across 38 clinics for 68 patients with a UGI malignancy and in 2007, 373 appointments were made in 44 clinics for 169 patients. The mean (SD) age was 64 (11) years and 66 (11) years for 2006 and 2007 respectively. Table 1 shows a summary of the clinic characteristics.

 Comparison of clinic characteristics between 2006 and 2007

2006
2007

2006
2007

Dietary advice

Attendance

Oral Nutritional Support (%)
125 (94)
356 (95)
Attended (%)
86 (64)
268 (72)

Artificial nutritional support (%)
8 (6)
14 (4)
Failed to attend (%)
41 (31)
95 (25)

General advice (%)
0 (0)
3 (1)
Cancelled (%)
6 (5)
10 (3)

Tumour type

Referral source‡

Oesophageal (%)
97 (73)
227 (61)
Out‐patients (%)
51 (39)
253 (68)

Gastric (%)
21 (16)
56 (15)
In‐patient admission &
49 (36)
35 (9)

Pancreatic (%)
15 (11)
69 (18)
Radiotherapy Clinic (%)
28 (21)
30 (8)

Other cancers* (%)
0 (0)
21 (6)
UGI Multidisciplinary meeting (%)
5 (4)
55 (15)

*Ampullary cancer, cholangiocarcinoma & cancer of an unknown primary.

‡
P < 0.001 2006 data compared with 2007.

Discussion:  This new clinic has allowed patients to access nutritional advice in outpatients within a service that largely provides ambulatory care at all stages of treatment. The significant increase in referrals from outpatients may suggest nutritional intervention is being provided earlier in the patients’ treatment pathway. This new clinic enables patients to visit the dietitian and other MDT member on the same day thus minimising hospital visits which could explain the small although non significant increase in attendance in 2007. The provision of dietetic intervention within an MDT could help to provide more comprehensive care in a single supportive environment which may enhance patient satisfaction. Furthermore, this new clinic supports national recommendations for multidisciplinary working.

Conclusion:  This analysis shows there are sufficient patient numbers to sustain this specialist clinic. User involvement and measurement of clinical effectiveness could provide useful information to further develop this service.

Reference  Andreyev, H.J.N., Norman, A.R., Oates, J. & Cunningham, D. (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur. J. Cancer, 34, 503–509.