Validated screening tools for malnutrition help to improve a patient’s quality of life. CANCER BUZZ spoke to Dr. Christina Bowen, Chief Well-being Officer for Vidant Health in Greenville, NC, Dr. Egidio Del Fabbro, Professor of Internal Medicine
and Director of Palliative Medicine at the Medical College of Georgia in Augusta, GA and Kelay Trentham, registered dietician, nutritionist, and administrative fellow for the MultiCare Health System in Tacoma, WA. Hear about how to implement validated
screening tools into your cancer program. This is the third episode in a three-part series on malnutrition in cancer care.
Christina Bowen, MD
Chief Well-being Officer
Egidio Del Fabbro, MD
Professor of Internal Medicine
Director of Palliative Medicine
Medical College of Georgia
Kelay Trentham, MS, RDN, CSO, FAND
Senior Operations Specialist
MultiCare Health System
CANCER BUZZ: Welcome back to CANCER BUZZ TV. I'm your host Summer Johnson. CANCER BUZZ is a resource of the Association of Community Cancer Centers (ACCC) just for oncology professionals. This is the final episode of our three-part series on malnutrition in cancer care. Validated screening tools for malnutrition help us improve the quality of life for patients. Unfortunately, using the screening tools and instilling nutritional pathways isn't easy for many community practices today.
We'll talk about those barriers and what we can do to address malnutrition in more patients. We are once again, joined by Dr. Christina Bowen, the Chief Well Being officer at Vidant Health in the Outer Banks. Kelay Trentham, a Registered Dietician Nutritionist for the MultiCare Health System in Tacoma, Washington. And Dr. Egidio Del Fabbro – he's the director of Palliative Medicine at the Medical College of Georgia in Augusta. Dr. Del Fabbro, let's start with you. What are some of the barriers to Interventional Screening tools in community practice?
Egidio Del Fabbro, MD: Yeah, I think there are multiple barriers. Sometimes it's just the lack of awareness as to how important nutrition is it's important, especially to the patient. But I think one could argue that it's also important to physicians and especially oncologists. So, I think increasing the awareness, improving education, I think the other aspect that's important is getting our professional organizations to be more active in providing guidelines and not necessarily mandating, but definitely recommending that these screening tools be implemented and maybe the last barrier might be reimbursement.
This is yet another assessment to be done by nursing or clinic staff and reimbursement in time is always an issue.
CANCER BUZZ: Ms. Trentham, what is the best way for a care team with limited resources to implement malnutrition screening? Is there an ideal team member?
Kelay Trentham, MS, RDN, CSO, FAND: The reality is, is that anyone can utilize a screening tool to determine if their patient population is experiencing malnutrition or risk for malnutrition. The question really is what do you do after implementing a screening if you don't have access to a registered dietician to address that? So that's really the big question. And what I would offer is that if you aren't looking at the problem, you don't know the degree to which the problem exists in your practice, in your community.
You almost need to implement a screening to see how big the problem is for your practice. And that may actually give you some data upon which to make a case to say, “Hey, 60% of our patients in this, you know, three-month period, when we piloted a screening were at risk for malnutrition, this is a real issue for our population.” And we really need to figure out how to address it and get the right person in here to do that, which is a registered dietician nutritionist with who's a specialist in oncology nutrition care.
CANCER BUZZ: Dr. Bowen, what is the clinical value of malnutrition interventions?
Christina Bowen, MD: I definitely think we can see, and we've talked about, you know, that it's, it's helpful because we think about this and it improving the quality of life, right? And it also helps with decreasing the risk of infection. And when we think about a quality of life, just like Dr. Del Fabbro was saying—it's very important to the patient because I think it's empowering to the patient. It helps them with their energy. And we know fatigue is one of the main symptoms that we see in our patients, but it's also important to the clinicians and the oncologist as we're treating these patients, we really want to optimize the treatment that they're getting.
And this is one of the ways that we can do that by utilizing nutrition interventions.
CANCER BUZZ: Dr. Del Fabbro, what are some strategies to address these barriers that keep care teams from using malnutrition screening?
Egidio Del Fabbro, MD: Increasing the awareness of clinicians is important. And I think we should start early and there's been a wonderful move on the part of Aspen to begin educating medical students. I think right from the beginning in our medical school education, perhaps nutrition exercise, these non-pharmacological aspects of treatment are underemphasized and sometimes entirely neglected.
I applaud Aspen for implementing this strategy to educate medical students regarding the importance of nutrition. We should start at the beginning and, and perhaps also advocate for reimbursement and not only for nutrition screening, but also for dieticians, perhaps I think that would also go a long way in decreasing those barriers.
CANCER BUZZ: Ms. Trentham, what is the best way for a care team with limited resources to implement malnutrition screenings? Is there an ideal team member?
Kelay Trentham, MS, RDN, CSO, FAND: Due to our training, being so specialized in nutrition, which is not the case for most other medical professionals, while it can be daunting to try to find the funding, to have access to a dietician for your patients, I really believe, and again, my opinion that the best person to be addressing nutrition care issues for oncology patients is a registered dietician nutritionist.
CANCER BUZZ: Thank you, Ms. Trentham, Dr. Bowen and Dr. Del Fabbro for your insights and for sharing your experiences with our viewers. For more information on malnutrition screenings, you can find links in the show notes, or you can visit the ACCC website: accc-cancer.org.
If you liked what you heard today, make sure to follow the show, to keep up with new episodes as they come out. You can also check out the CANCER BUZZ audio podcast for more news and trends in cancer care from your colleagues across the country. From all of us here at CANCER BUZZ TV. Thank you for watching I'm Summer Johnson.
The views and opinions expressed herein are those of the author(s)/faculty member(s) and do not reflect the official policy or position of their employer(s) or the Association of Community Cancer Centers.