Food for Thought: Are Radiation Therapists Able To Recognize Patients Who Would Benefit From Dietary Counseling?

Abstract

Malnutrition is commonly seen in cancer patients before starting treatment and can become worse as they undergo radiation therapy. Studies have found that cancer patients receiving radiation therapy treatment and individual dietary counseling have better treatment tolerance, treatment response and quality of life with less nutritional deterioration compared to those who continue on their regular diet or take supplements. At the Odette Cancer Centre, there is currently no protocol/guidelines to refer patients to dietitians by oncologists, nurses or radiation therapists (RT) prior or during treatment. Patients do not always receive relevant and correct information from outside resources. As part of their clinical practices, RT's should be able to assess the nutritional status of a patient and determine if they could benefit from dietary counseling. This can be difficult if they are not aware of key signs and symptoms as well as precursors to the need for a dietary referral. The aim of our study was to determine if RTs across Canada are able to identify/recognize nutrition-related side effects (in their patients during their course of radiation treatment) that would require/benefit from a referral to a dietitian for additional support. An email invitation with a link to the questionnaire was distributed to radiation therapists across Canada. The questionnaire itself was conducted through Surveymonkey where individuals were not identified. All information was kept confidential. Data was ranked by dietitians on our team from 1 (low grade) to 5 (high grade). The dietitians' responses were the gold standard. Data were analysed using simple discriptive statistics with comparisons made across individual questions. 137 RTs responded (11% response rate) from across the country with provincial representation. The majority of respondents practice as treatment delivery therapists (75%). 75% indicated they were asked for advice on nutrition-related issues by patients. Self evaluation revealed RTs are more knowledgeable than confident in both recognizing patients requiring dietary care and providing proper care. Preliminary analysis of open ended questions indicate that RTs are knowledgeable as the majority of their responses coincide with the dietitian rankings of 5. Preliminary findings suggest that therapists are knowledgeable in recognizing and providing the appropriate interventions for patients. As RTs are positioned to be the first line to screen patients they can provide quick and easy access to information and interventions in addition to making patient referrals to dietitians for additional support. To improve their confidence, educational sessions can be held with proper referal algorithms made available to RTs. As we move towards a more collaborative practice this will provide better quality of care and improve the continuity of care leading to improved patient care with better patient outcomes.