Impact of implementation of a nutrition support program in ovarian cancer patients

Abstract

<h3>Objectives:</h3> A nutrition support program for ovarian cancer patients via early consultation with a registered dietician was developed in 2016 at our institution. The initial goal of our nutrition support program was focused on optimizing nutrition counseling for patients receiving NACT, though it has been broadened to include the majority of newly diagnosed ovarian cancer patients. Follow-up visits are patient-initiated. We sought to evaluate outcomes of consultation in these patients to identify how to improve the program and better meet patient needs. <h3>Methods:</h3> We retrospectively reviewed data from ovarian cancer patients receiving chemotherapy at our institution who ≥1 consult with a registered dietician from 12/2016-5/2020. We reviewed weight at baseline (time of initial consult) and at 6 months and baseline albumin. Patients were categorized using body mass index (BMI) as underweight (BMI <18.5), normal weight (18.5-24.9), overweight (BMI 25-29.9), or obese (BMI ≥30). Follow-up visits were reviewed to investigate reasons for patients seeking additional nutrition support. Descriptive statistics were performed. <h3>Results:</h3> 227 patients were included; 216 were actively receiving chemotherapy and 11 were initiating chemotherapy. There were 113 (50%) receiving NACT. Average age was 62 (range 20-92), 44 (19%) patients were BlackBlack, and average baseline BMI was 28 (range 16-55). At initial consultation, 6 (3%) patients were underweight, 73 (32%) were normal weight, 73 (32%) were overweight, and 75 (33%) were obese. Table 1 details weight change data in patients with 6-month weight follow-up. The average weight change from baseline to 6m was -1.67 kg for underweight, -0.27 kg for normal weight, -0.16 kg for overweight, and -1.6 kg for obese patients. Among 116 patients receiving NACT, an initial albumin level was recorded in 83 patients (average 3.8). In 108 patients who underwent primary debulking surgery, initial albumin was obtained in 66 patients (average 3.9). Most patients (180/227, 79%) had a single nutrition consult. Of 47 patients who had at least one follow-up visit, 34 (72%) were receiving NACT. Follow-up visits were problem focused and primarily conducted in-person except for 3 telephone follow-up visits. Review of visit documentation identified several themes, including poor appetite, concerns about weight, and symptom management. <h3>Conclusions:</h3> Given the large proportion of obese patients in our cohort, weight goals (maintain, lose, gain) differ based on patient BMI. Average baseline albumin was similar between patients receiving NACT versus primary debulking surgery and has an unclear role as it was inconsistently followed and can be modified by multiple variables. As more patients who received NACT had patient-initiated follow-up visits, implementing scheduled follow-up for this group of patients would more proactively address a population to improve symptom management.