A new practical guide for lung cancer nutritional care including a lung cancer nutritional care pathway has been launched to assist the multidisciplinary team involved in the management of patients with lung cancer. The document aims to assist with assessing and monitoring the nutritional status of patients with lung cancer in order to maximise treatment outcomes and improve patient experience. A nutrition starter information pack for patients has also been developed in conjunction with the National Lung Cancer Forum for Nurses (NLCFN) and the Roy Castle Lung Cancer Foundation (RCLCF) to support the guide.
The guide ‘A Practical Guide for Lung Cancer Nutritional Care’ has been developed by a multi-professional team and is supported/endorsed by the Roy Castle Lung Foundation and ten key professional organisations including the National Lung Cancer Forum for Nurses (NLCFN), the Royal College of Nursing (RCN) and the National Nurses Nutrition Group (NNNG)1. Centred around the patient pathway, the document includes a pathway to assist healthcare professionals in optimising the nutritional status of patients with lung cancer using clinical experience and the evidence base, alongside accepted best practice in order to maximise treatment outcomes and patient experience throughout their cancer journey.
The emergence of highly specialised treatments and new developments in different therapies to treat lung cancer contribute towards more patients having the opportunity to be treated with potentially curative therapies2. However the impact of treatment together with unintentional weight loss, pain, changes in appetite and breathlessness, along with the potential side effects of cancer treatment, all add to the decline in the nutritional status of patients with lung cancer.
Disease-related malnutrition occurs frequently in patients with cancer and is a major cause of morbidity and mortality3. The consequences of malnutrition in cancer patients include the impairment of immune function, performance status, muscle function and associated debilitating morbidities such as depression and fatigue3. The major consequence of progressive weight loss and decline in nutritional status is reduced survival3.
Early nutrition screening can help to identify malnutrition risk and any problems that may affect how well the patient’s body can deal with the impact of the subsequent cancer treatment4.
The mainstay of nutritional interventions can include dietary advice, oral nutritional supplements (ONS), and in some instances enteral tube feeding (ETF). Nutritional intervention with ONS can improved quality of life in patients who are malnourished and may also result in cost savings5-8.
“This national nutritional management pathway for patients with lung cancer aims to ensure that lung cancer nurses and other members of the multidisciplinary team have a consistent approach to the nutritional assessment and management of patients,” says Diana Borthwick, Clinical Nurse Specialist and Chair of the National Lung Cancer Forum for Nurses (NLCFN) who was involved in the development of the guidance. “The supporting patient materials have been developed to give patients and their carers simple hints and tips to deal with common symptoms and to assist them in meeting their nutritional needs.”
“Improved nutritional care of this group of patients can show great benefits in both improved quality of life as well as assisting in enabling patients to deal with the impact of cancer treatment” says Dr Rohit Lal, Clinical Lead for Medical Oncology at Guy’s and St Thomas’ Foundation Trust and contributor to the document. “I think this document will be very helpful in assisting the multidisciplinary team in screening and monitoring the nutritional status of patients.”
“We are delighted to involved in the development of this document and patient materials” says Lorraine Dallas, Director of Information & Support at the Roy Castle Lung Cancer Foundation (RCLCF), “We hope that it will raise awareness of the issues faced by patients with lung cancer and will assist in ensuring that they get a better quality of life.”
“Patients with lung cancer experience a wide range of nutritional problems and a full nutritional assessment at diagnosis and monitoring throughout the patient pathway is recommended best practice” says Mhairi Donald, Macmillan Consultant Dietitian at the Sussex Cancer Centre, member of the Oncology Group of the British Dietetic Association and one of the experts involved in the development of the guidance. “Weight loss should not be accepted as a given in this patient group, in order to improve outcomes nutritional interventions should be started early to improve patient experience and quality of life. Where access to a Specialist Oncology Dietitian is limited other members of the multidisciplinary team need to be advised as to when to provide appropriate advice and it is hoped this guidance will assist in this.”
‘A Practical Guide for Lung Cancer Nutritional Care’ includes:
- An overview of the clinical consequences of malnutrition in cancer
- Information on the importance of nutritional screening and support for lung cancer patients
- Guidance on offering dietary advice and oral nutritional supplements to patients with lung cancer
- A practical Lung Cancer Nutritional Care Pathway which covers patients at low, medium and high risk of malnutrition as well as those requiring active supportive care
The three supporting patient leaflets produced in conjunction with the NLCFN and the RCLCF are:
- Living with Lung Cancer – Practical Tips for Eating – gives tips on what to do if you have lost your appetite and how to fortify everyday foods and drinks
- Living with Lung Cancer – Practical Tips for Using Oral Nutritional Supplements – including information on when and how to take Oral Nutritional Supplements (ONS) as well as heating, freezing and storing ONS
- Living with Lung Cancer – Practical Tips for Managing Common Symptoms – covering issues such as breathlessness, dry or sore mouth or throat and feeling tired
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For further information please contact:
Hilary Franklin Healthcare Communications
Tel: 020 8398 8551
Mobile: 07958 607898
- The document has been supported by the Roy Castle Lung Foundation and ten key professional associations:
- British Association for Parenteral and Enteral Nutrition (BAPEN)
- British Dietetic Association (BDA)/The Oncology Group of the BDA
- British Thoracic Oncology Group (BTOG)
- British Oncology Pharmacy Association (BOPA)
- British Pharmaceutical Nutrition Group (BPNG)
- National Lung Cancer Forum for Nurses (NLCFN)
- National Nurses Nutrition Group (NNNG)
- Royal College of General Practitioners (RCGP)
- Royal College of Nursing (RCN)
- Royal Pharmaceutical Society (RPS)
- Bennett A and White J. Improving care and quality of life for patients with lung cancer. Nursing Standard. 2013;28 (9): 50-58.
- Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. European Journal of Oncology Nursing 2005;9:S51-S63. Suppl 2:S51-63
- Arrieta O, Ortega RMM, Vilanueva-Rodriguez G et al. Association of nutritional status and serum albumin levels with development of toxicity in patients with advance non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer 2010;10:50
- Baldwin C, Spiro A, Ahern R et al. Oral Nutritional interventions in malnourished patients with cancer; a systematic review and meta-analysis. Journal of National Cancer Institute 2012;104(5):371-385
- Lee H, Havrilla C, Bravo V et al. Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma. Support Cancer Care 2008;16(3):285-289.
- Isenring EA, Bauer JD, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. Journal of American Dietetic Association 2007;107(3):404-412.
- Elia M (ed). The cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults. A report by BAPEN. 2005.