Abstract
BackgroundA major challenge for those living with cancers of the upper gastrointestinal tract (oesophagus, stomach and pancreas), is the impact of the disease and treatment on nutritional status and quality of life. People with cancer and malnutrition have a greater risk of morbidity and mortality. Nutrition intervention is recommended to commence immediately in those who are malnourished or at risk of malnutrition. Novel cost-effective approaches that can deliver early, pre-hospital nutrition intervention before usual hospital dietetic service is commenced are needed. Linking clinicians and patients via mobile health (mHealth) and wireless technologies is a contemporary solution not yet tested for delivery of nutrition therapy to people with cancer. The aim of this study is to commence nutrition intervention earlier than usual care and evaluate the effects of using the telephone or mHealth for intervention delivery. It is hypothesised that participants allocated to receive the early and intensive pre-hospital dietetic service will have more quality-adjusted life years lived compared with control participants. This study will also demonstrate the feasibility and effectiveness of mHealth for the nutrition management of patients at home undergoing cancer treatment.MethodsThis study is a prospective three-group randomised controlled trial, with a concurrent economic evaluation. The 18 week intervention is provided in addition to usual care and is delivered by two different modes, via telephone (group 1) or via mHealth (group 2), The control group receives usual care alone (group 3). The intervention is an individually tailored, symptom-directed nutritional behavioural management program led by a dietitian. Participants will have at least fortnightly reviews. The primary outcome is quality adjusted life years lived and secondary outcomes include markers of nutritional status. Outcomes will be measured at three, six and 12 months follow up.DiscussionThe findings will provide evidence of a strategy to implement early and intensive nutrition intervention outside the hospital setting that can favourably impact on quality of life and nutritional status. This patient-centred approach is relevant to current health service provision and challenges the current reactive delivery model of care.Trial registration27th January 2017 Australian and New Zealand Clinical Trial Registry (ACTRN12617000152325).
Highlights
A major challenge for those living with cancers of the upper gastrointestinal tract, is the impact of the disease and treatment on nutritional status and quality of life
The novel mobile health (mHealth) model we propose here has advantages over telephone in that it tracks progress from both the patient and clinician perspective, for example reporting and documentation of symptoms, weight trajectory and Quality of Life (QoL) measures; it enables motivational short text messages to be delivered that support and remind the patient of the goals set at low cost; and access to the intervention advice by carers and other health professionals as the information is always available and not reliant on the patient memory of the advice they were given
It is hypothesised that participants allocated to receive the early and intensive pre-hospital dietetic service will have more quality-adjusted life years lived compared with control participants
Summary
A major challenge for those living with cancers of the upper gastrointestinal tract (oesophagus, stomach and pancreas), is the impact of the disease and treatment on nutritional status and quality of life. People with cancer and malnutrition have a greater risk of morbidity and mortality. Novel cost-effective approaches that can deliver early, pre-hospital nutrition intervention before usual hospital dietetic service is commenced are needed. A major challenge for those living with these cancers is the impact of the disease on nutritional status and quality of life. People with cancer and malnutrition have greater risk of post-surgery morbidity [7], debility, compromised immunity, a higher rate of hospital readmission, a longer duration of hospital stay [8], and poorer quality of life [9]. Malnutrition may become established before diagnosis, during or after treatment, and it exists in people with obesity [5]
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