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Malnutrition: Screen or Assess? — [VIDEO PODCAST] Ep 15

September 15, 2022

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Many cases of malnutrition are underdiagnosed and undertreated. 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 malnutrition detection processes and the use of validated screening tools. This is the second episode in a three-part series on malnutrition in cancer care.


Christina Bowen, MD
Chief Well-being Officer
Vidant Health
Greenville, NC

Egidio Del Fabbro, MD
Professor of Internal Medicine
Director of Palliative Medicine
Medical College of Georgia
Augusta, GA

Kelay Trentham, MS, RDN, CSO, FAND
Senior Operations Specialist
MultiCare Health System
Tacoma, WA

“[Conversations about nutrition are]…really empowering. [Patients] feel like there's something they can do…[that’s] going to impact their quality of life and potentially impact their prognosis in a positive way.” — Christina Bowen, MD

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CANCER BUZZ: Welcome back to CANCER BUZZ TV. I'm your host Summer Johnson. This show is a resource of the Association of Community Cancer Centers (ACCC) for oncology professionals. This is the second episode in a three-part series on malnutrition in cancer care.

Today we're diving into malnutrition detection processes and the use of validated screening tools. Here to help us is Christina Bowen, MD. She's the Chief Well Being Officer at Vidant Health Office of Experience and Medical Director of the Center for Healthy Living at the Outer Banks Hospital in Nags Head, North Carolina. Dr. Egidio Del Fabbro, MD, is the Professor of Internal Medicine and Director of Palliative Medicine at the Medical College of Georgia in Augusta, Georgia. Kelay Trentham, MS, RDN, CSO, FAND, a Registered Dietician, Nutritionist, and Administrative Fellow for the MultiCare Health System in Tacoma, Washington. Ms. Trentham let's start with you. Can you share the differences between nutrition screening and assessment?

Kelay Trentham, MS, RDN, CSO, FAND: Nutrition screening is something that is usually very quick, easy to administer, can be administered by any, any type of medical professional, such as a medical assistant or a nurse assistant or nursing usually is a staff that does it in patient. Outpatient consists of a few questions or pieces of, of data that might be an indicator of whether someone is at risk for malnutrition Nutrition assessment is a more complex and comprehensive assessment of the patient, and it includes a wide variety of factors, including weight history, food intake, history, medical history, medications, food allergies, all of those types of things.

So it's much more comprehensive, much more complex, and typically administered by a Nutrition professional, such as a registered dietician nutritionist,

CANCER BUZZ: Dr. Del Fabbro. Why is it so important to screen patients for malnutrition?

Egidio Del Fabbro, MD: Yeah, I, I think identifying malnutrition is key identifying patients who have had a loss of weight without I involuntarily. I think identifying these patients early, whether it be an inpatient setting or the outpatient setting is crucial. And we know if we identify them earlier, then they're able to experience fewer side effects during chemotherapy. Also, they're able to complete more cycles of chemotherapy and of course they have improved quality of life. So, identifying them early is, is key

CANCER BUZZ: Dr. Bowen, how does screening ultimately impact patient's quality of life during treatment?

Christina Bowen, MD: So I think that this helps with improving quality of life because just as Dr. Del Fabbro was saying just the utilization of the screening tool helps us as clinicians be aware that there's an opportunity for us to come alongside our patients and really talk to them about Nutrition opportunities, to assure that they have supportive care with their family members, people that might be helping to care for them at home and that they have, if there's any gaps.

So one of the things that we see in Eastern North Carolina is there might be some food insecurity or some gaps that are really impacting their quality of life and their ability to get adequate Nutrition. And so we can identify that. So it really opens up the door for us to ask a few more questions and to really share with our patients and partner with them on the importance of Nutrition and how that can improve their quality of life. It's also really empowering. That's what I found with my patients. They feel like there's something that they can do.

That's gonna give them more energy. It's gonna impact their quality of life and potentially to impact their prognosis in a positive way.

CANCER BUZZ: Dr. Del Fabbro. What about older adults with cancer and their nutritional considerations? Are there tools that are better suited for the geriatric patient population?

Egidio Del Fabbro, MD: Yeah, I think older adults are especially vulnerable in that we know that almost 90% of older adults when they are receiving chemotherapy are considered not, are not receiving adequate amounts of calories or protein. And, and this is based on, on a Canadian study from Montreal that that showed us. And so when you're undergoing treatment, it's likely that your metabolic requirements, your calorie requirements are increased.

So it's especially important to screen older adults. There are a number of screening tools available and perhaps one assessing sarcopenia and sarcopenia is a condition of muscle wasting and decreased function, especially muscle strengths. And also your ability to walk quickly. This is impacted as, as one gets older.

And so there are a few tools that look at sarcopenia specifically. One of them is the SARC-F tool that may be very useful for clinicians. It is a little longer, perhaps a little more burdensome than the malnutrition screening tool, but I think is especially important in older patients who often have sarcopenia

CANCER BUZZ: Ms. Trentham, can you explain what the nutritional pathway looks like for assessment?

Kelay Trentham, MS, RDN, CSO, FAND: So after it's been determined that a patient is at high nutrition risk and an assessment should be completed, you know, your key staffer that really should be a registered dietician nutritionist, ideally, because that is really the work that we do, that person should be responsible for conducting the assessment, determining what needs to happen for that patient to help address that nutrition risk. As far as referrals, the dietician may make referrals depending on what's going on with the patient to say speech and language pathologist.

If they're having issues with swallowing, they could make referrals back to a pharmacist. If they're not taking their medications properly, the dietician could also refer to physical therapy. If there are issues there or social work services, if people are having trouble with food security, for example. So follow up, usually the dietician will determine the frequency of follow up based on the severity of what's happening with the patient. And usually will either schedule follow ups themselves, or may rely on the screening recurring screening to let them know when the patient needs to be seen again,

CANCER BUZZ: Dr. Bowen, what are the benefits of multimodal interventions?

Christina Bowen, MD: Oh, well I think that, you know, a multidisciplinary approach to patient care is definitely beneficial. I know that here at our center, we have Dr. Del Fabbro and now we're talking about that, how it's so important when you have a clinic that's really supporting patients that you have, you utilize a multidisciplinary approach. So registered Dietitian, registered dietician, health coaches. We have a chronic disease nurse navigator, our cancer navigator that works with us as well as myself and a nurse practitioner that work in my office.

And, you know, I think it's really important because I think that they're gonna receive the same information, but it might be just a little bit different from the different members of the team. And they feel like at all levels they're supported. And so we see them at different, you know, our registered dietician often sees our oncology patients when they're in treatment downstairs in our ambulatory oncology unit for chemotherapy, and that's really helpful. And then they'll come upstairs and see me. And so, I just think it's really solidifying the importance of nutrition and, and then the health coach is so Vital to just access any barriers they might have and really help them overcome those barriers.

CANCER BUZZ: Thank you, Dr. Bowen and Dr. Del Fabbro and Ms. Trentham, you can find more resources related to malnutrition in cancer care in the show notes or on the ACCC website. And you can also go back and search the CANCER BUZZ channel for the first episode in this special series, while you're there, you may wanna check out the content on the, the CANCER BUZZ audio podcast for deep dives into the latest trends in cancer care until next time 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.