Evans T

Background: Malnutrition in cancer patients has a significant correlation with disability, dysfunction and death, as well as increased patient care costs, neutropenia, reduced quality of life, fall risk, fractures, nosocomial infections, and longer treatment durations 1-3. Registered dietitian (RD) involvement early on may increase recognition of malnutrition for at-risk patients. Guidelines for nutrition staffing in cancer centers is illdefined in the literature, with few existing recommendations.

Methods: In Phase 1, a survey of RDs across VHA was conducted to determine current referral and staffing practices surrounding nutrition care and services in outpatient oncology clinics. The survey was administered to RDs who devote some or all of their time to oncology nutrition in the outpatient setting and participate on 1 of 2 popular VHA listservs: a nutrition support listserv, and an oncology nutrition listserv.

Phase 2 will be a multi-site, retrospective, chart analysis among 20 VA facilities who treat cancer patients in the outpatient setting. Site investigators, divided into proactive vs. reactive nutrition practices based on Phase 1 survey results, will be instructed to obtain a list of patients diagnosed with high nutrition risk cancers during 2016 and 2017.

Primary outcomes measured will include weight loss, percent maximum weight change over speci ed timeframes, diagnosis of malnutrition, and reported breaks in treatment. Secondary outcomes include overall survival and disease-free survival. For all comparisons, P < 0.05 will be considered statistically signifcant.

Discussion: The data from 46 sites completing the national survey show that RD staffing practices vary widely across VA cancer centers. Few centers staff full time or dedicated oncology RDs independent of patient caseload, with the median oncology dedicated RD FTE being 0.5. Consult and referral practices dictating nutrition intervention were found to be reported as 17% proactive, 25% reactive, and 58% a combination of both practices. Phase 2 results seek to compare patient outcomes with RD staffing and nutrition care practices to determine much needed guidelines for effective nutrition delivery in VHA cancer centers across the U.S.

Background: Malnutrition in cancer patients has a significant correlation with disability, dysfunction and death, as well as increased patient care costs, neutropenia, reduced quality of life, fall risk, fractures, nosocomial infections, and longer treatment durations 1-3. Registered dietitian (RD) involvement early on may increase recognition of malnutrition for at-risk patients. Guidelines for nutrition staffing in cancer centers is illdefined in the literature, with few existing recommendations.

Methods: In Phase 1, a survey of RDs across VHA was conducted to determine current referral and staffing practices surrounding nutrition care and services in outpatient oncology clinics. The survey was administered to RDs who devote some or all of their time to oncology nutrition in the outpatient setting and participate on 1 of 2 popular VHA listservs: a nutrition support listserv, and an oncology nutrition listserv.

Phase 2 will be a multi-site, retrospective, chart analysis among 20 VA facilities who treat cancer patients in the outpatient setting. Site investigators, divided into proactive vs. reactive nutrition practices based on Phase 1 survey results, will be instructed to obtain a list of patients diagnosed with high nutrition risk cancers during 2016 and 2017.

Primary outcomes measured will include weight loss, percent maximum weight change over speci ed timeframes, diagnosis of malnutrition, and reported breaks in treatment. Secondary outcomes include overall survival and disease-free survival. For all comparisons, P < 0.05 will be considered statistically signifcant.

Discussion: The data from 46 sites completing the national survey show that RD staffing practices vary widely across VA cancer centers. Few centers staff full time or dedicated oncology RDs independent of patient caseload, with the median oncology dedicated RD FTE being 0.5. Consult and referral practices dictating nutrition intervention were found to be reported as 17% proactive, 25% reactive, and 58% a combination of both practices. Phase 2 results seek to compare patient outcomes with RD staffing and nutrition care practices to determine much needed guidelines for effective nutrition delivery in VHA cancer centers across the U.S.

Background: Malnutrition in cancer patients has a significant correlation with disability, dysfunction and death, as well as increased patient care costs, neutropenia, reduced quality of life, fall risk, fractures, nosocomial infections, and longer treatment durations 1-3. Registered dietitian (RD) involvement early on may increase recognition of malnutrition for at-risk patients. Guidelines for nutrition staffing in cancer centers is illdefined in the literature, with few existing recommendations.

Methods: In Phase 1, a survey of RDs across VHA was conducted to determine current referral and staffing practices surrounding nutrition care and services in outpatient oncology clinics. The survey was administered to RDs who devote some or all of their time to oncology nutrition in the outpatient setting and participate on 1 of 2 popular VHA listservs: a nutrition support listserv, and an oncology nutrition listserv.

Phase 2 will be a multi-site, retrospective, chart analysis among 20 VA facilities who treat cancer patients in the outpatient setting. Site investigators, divided into proactive vs. reactive nutrition practices based on Phase 1 survey results, will be instructed to obtain a list of patients diagnosed with high nutrition risk cancers during 2016 and 2017.

Primary outcomes measured will include weight loss, percent maximum weight change over speci ed timeframes, diagnosis of malnutrition, and reported breaks in treatment. Secondary outcomes include overall survival and disease-free survival. For all comparisons, P < 0.05 will be considered statistically signifcant.

Discussion: The data from 46 sites completing the national survey show that RD staffing practices vary widely across VA cancer centers. Few centers staff full time or dedicated oncology RDs independent of patient caseload, with the median oncology dedicated RD FTE being 0.5. Consult and referral practices dictating nutrition intervention were found to be reported as 17% proactive, 25% reactive, and 58% a combination of both practices. Phase 2 results seek to compare patient outcomes with RD staffing and nutrition care practices to determine much needed guidelines for effective nutrition delivery in VHA cancer centers across the U.S.

Background: Prostate cancer is the most common cancer in the Veterans Health Administration. Radiation is an important treatment option for prostate cancer patients. Imaging is done before each daily radiation treatment to ensure the radiation beam is aimed accurately. Imaging can be inaccurate due to excess gas or stool in the rectum, which alters the treatment field and leads to delays in the daily treatment schedule, increased radiation exposure due to re-imaging, repetitive staff treatment delivery interventions, and an unsatisfactory veteran experience.

Methods: A quality improvement project utilizing A3.9 box process improvement methodology (problem solving template) was undertaken to address identified gastrointestinal concerns hindering daily treatment. A dietitian integrated services into the radiation oncology clinic by providing dietary education and counseling to avoid gasproducing foods and manage bowel regularity for prostate cancer patients. Daily images were reviewed for accuracy. For 3 months prior to intervention, we examined daily treatment images and documented any interruption in treatment delivery from gas or stool in the rectum as a nutrition-related defect. Initial data analysis revealed that 62 of 195 (31.79%) daily treatment deliveries experienced nutrition-related defects.

Results: As a result of changing the radiation therapy process to include dietary education to patients, we experienced a 53% reduction rate in nutrition-related defects (from 31.79% to 14.87%). Calculated cost avoidance showed an annual savings of approximately $19,300 with
implementation of a multidisciplinary approach. A total of 120 daily treatment visits and 90 patient treatment hours can be saved annually with this approach.

Conclusions: This project improved overall clinic function by implementing a multidisciplinary approach to prostate cancer radiation oncology care, increased patient’s satisfaction, reduced excess radiation exposure, and improved department efficiency.

Background: Prostate cancer is the most common cancer in the Veterans Health Administration. Radiation is an important treatment option for prostate cancer patients. Imaging is done before each daily radiation treatment to ensure the radiation beam is aimed accurately. Imaging can be inaccurate due to excess gas or stool in the rectum, which alters the treatment field and leads to delays in the daily treatment schedule, increased radiation exposure due to re-imaging, repetitive staff treatment delivery interventions, and an unsatisfactory veteran experience.

Methods: A quality improvement project utilizing A3.9 box process improvement methodology (problem solving template) was undertaken to address identified gastrointestinal concerns hindering daily treatment. A dietitian integrated services into the radiation oncology clinic by providing dietary education and counseling to avoid gasproducing foods and manage bowel regularity for prostate cancer patients. Daily images were reviewed for accuracy. For 3 months prior to intervention, we examined daily treatment images and documented any interruption in treatment delivery from gas or stool in the rectum as a nutrition-related defect. Initial data analysis revealed that 62 of 195 (31.79%) daily treatment deliveries experienced nutrition-related defects.

Results: As a result of changing the radiation therapy process to include dietary education to patients, we experienced a 53% reduction rate in nutrition-related defects (from 31.79% to 14.87%). Calculated cost avoidance showed an annual savings of approximately $19,300 with
implementation of a multidisciplinary approach. A total of 120 daily treatment visits and 90 patient treatment hours can be saved annually with this approach.

Conclusions: This project improved overall clinic function by implementing a multidisciplinary approach to prostate cancer radiation oncology care, increased patient’s satisfaction, reduced excess radiation exposure, and improved department efficiency.

Background: Prostate cancer is the most common cancer in the Veterans Health Administration. Radiation is an important treatment option for prostate cancer patients. Imaging is done before each daily radiation treatment to ensure the radiation beam is aimed accurately. Imaging can be inaccurate due to excess gas or stool in the rectum, which alters the treatment field and leads to delays in the daily treatment schedule, increased radiation exposure due to re-imaging, repetitive staff treatment delivery interventions, and an unsatisfactory veteran experience.

Methods: A quality improvement project utilizing A3.9 box process improvement methodology (problem solving template) was undertaken to address identified gastrointestinal concerns hindering daily treatment. A dietitian integrated services into the radiation oncology clinic by providing dietary education and counseling to avoid gasproducing foods and manage bowel regularity for prostate cancer patients. Daily images were reviewed for accuracy. For 3 months prior to intervention, we examined daily treatment images and documented any interruption in treatment delivery from gas or stool in the rectum as a nutrition-related defect. Initial data analysis revealed that 62 of 195 (31.79%) daily treatment deliveries experienced nutrition-related defects.

Results: As a result of changing the radiation therapy process to include dietary education to patients, we experienced a 53% reduction rate in nutrition-related defects (from 31.79% to 14.87%). Calculated cost avoidance showed an annual savings of approximately $19,300 with
implementation of a multidisciplinary approach. A total of 120 daily treatment visits and 90 patient treatment hours can be saved annually with this approach.

Conclusions: This project improved overall clinic function by implementing a multidisciplinary approach to prostate cancer radiation oncology care, increased patient’s satisfaction, reduced excess radiation exposure, and improved department efficiency.