Translating Evidence-Based Practice Guidelines Into a Summary of Recommendations for the Nutrition Management of Upper Gastrointestinal Cancers.

Abstract

Background: Upper gastrointestinal (UGI) cancer has a profound effect on the function of major digestive organs with resulting deterioration in nutrition status. There are currently no known evidence-based guidelines specific to the nutrition management of people with UGI cancer. This article aimed to review the current guidelines related to the nutrition management of surgical and nonsurgical cancer patients with the aim to collate similar findings to produce a summary of recommendations for clinicians. Gaps in current evidence were also identified. Methods: Guidelines with evidence grading systems were identified from CINAHL, Medline, Web of Science, and a manual search. The quality of guidelines was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Results: Twenty-six guidelines were retrieved. Most guidelines showed strong rigor, but only 23% were considered current, having been developed or reviewed in the past 3 years. A summary of recommendations was extrapolated from retrieved guidelines, based on a standardized evidence grading system and the quality score for each guideline. Conclusion: This review of current guidelines shows that many areas of nutrition management still require more evidence to support high-level recommendations. These include immunonutrition, pancreatic enzyme replacement therapy, and postdischarge complication management. More research is needed before evidence-based guidelines can be developed.