Evaluation of telehealth based nutrition counselling to improve dietary compliance and nutritional status of cancer patients.

Abstract

e13619 Background: According to published literature, regardless of the cancer type, the overall prevalence of malnutrition in cancer is about 40% (range 30%-70%). Malnutrition is known to adversely affect the treatment compliance, quality of life and survival outcomes for cancer patients. Onco.com provides telehealth based nutrition care support (NCS) as a part of cancer care management program. We sought to evaluate impact of telehealth based nutrition counselling on diet compliance and overall nutritional status of patients. Methods: NCS includes virtual nutrition screening, nutrition diagnosis and nutrition intervention. Virtual nutrition screening was done using modified patient generated subjective global assessment (PG-SGA) tool developed by Ottery. An initial nutrition screening was initially performed for 165 patients. After nutrition screening, patients were divided as malnourished (category 1- 47%), nutritionally at risk (category 2- 34%) and well nourished (category 3- 19%). Patients in category 1 & 2 were analysed for the purpose of study. Diet counselling and customized diet plans were provided to the patients between the age group of 12 to 83 years for a period of 3 months from October to December 2020. On follow up, 24 hour diet recall method and food frequency method were used to assess the compliance to the diet plan. One day prior 24 hour diet recall and food frequency method for two weeks was used to analyse the adherence to the plan. If the patient consumed ≥75% of the recommended diet for a minimum of 5 days in a week, he/she was considered a ‘compliant’, while those who consumed < 75% of the recommended diet were considered to be ‘non-compliant’. Data on body weight and performance status (PS) was documented during follow up to track changes. Results: Of 134 study participants, 35.1% were in the early (I & II) stage, 38.7 % were in the locally advanced (III) stage, 21.2 % were in the metastatic stage, and 4.8 % were in the recurrent stage of disease. After 3 months of initiation of the nutrition counselling, 40% of the patients had gained weight, whereas 38% could maintain the body weight and 22 % had lost weight. Change in physical activity, appetite, management of side effects after diet plan initiation were also assessed during the reassessment calls. Overall, 67% patients showed improvement in diet compliance across all stages of disease. Majority of dietary non-compliance was noted in patients with head and neck, upper GI cancers or those with poor PS. Conclusions: Telehealth based nutritional counselling is an effective tool to help cancer patients achieve better diet compliance and nutrition outcomes across all stages of disease. Dietary non-compliance in head and neck cancers and upper gastrointestinal cancers or poos PS could correlate with difficulty in oral intake. Getting accurate information could be one of the challenges in virtual mode of counselling.