Calls for more dieticians to support cancer patients

New research has identified a major gap in nutritional support for cancer patients, with more than a third reporting unintentional weight loss, which can lead to poorer outcomes.

The survey of more than 1,000 cancer patients across 25 clinical sites in Ireland found that nearly half (45%) report significant nutritional and eating problems since diagnosis, with loss of appetite most common.

Yet despite the high prevalence of appetite loss, weight loss and other side effects of the disease or its treatment, more than three in five patients reported that they were not asked about diet by their medical team - and just two in five were seen by a dietician at some point.

Patients themselves recognise the significance of nutritional support, with nine in 10 saying it is either “very important” or “extremely important”.

The survey was conducted by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN) in collaboration with University College Cork (UCC).

IrSPEN director and nutrition consultant, Niamh Rice, said the findings indicate a major gap in cancer care that needs to be immediately addressed because poor nutritional intake and weight loss in cancer is associated with higher risks of complications, poorer response to treatments like chemotherapy – and even reduced survival.

She said addressing the shortage of dieticians specialising in cancer care is “a clear starting point”.

There are currently 33 whole time equivalent dieticians, or one dietitian to approximately 4,500 patients living with invasive cancer, and just three clinical specialist dietitians.

The IrSPEN is calling for the immediate appointment of 10 specialist dietitians, as well as making the prevention of cancer-related malnutrition a recognised goal of cancer care and nutrition screening at point of care.

Pofessor John Reynolds, academic head of Department of Clinical Surgery, Trinity College Dublin and IrSPEN President, said cancer patients have the highest rate and severity of malnutrition of any patient group:

Yet even those with evident serious nutritional problems are frequently not receiving the right information, advice or support at the right time.

UCC lecturer in Nutritional Sciences, Dr Aoife Ryan, who led the research team in UCC, said one in two cancer patients (52%) reported muscle loss which she said is linked to poorer response to treatment and a poorer survival outlook.

However, many were not made aware of the association between muscle loss, cancer presence, treatments and outcomes, suggesting that muscle loss and weight loss is not being discussed with patients.

“Apart from undermining the effectiveness of expensive therapies, it increases healthcare costs. This doesn’t make any sense, since the costs of providing good nutritional care are very modest in comparison,” Dr Ryan said.

Irish Cancer Society chief executive, Averil Power, said the research shows that patients need clearer, more accessible information on diet and cancer which they can seek from registered dietitians, or use the website www.cancer.ie to get information they can rely on.

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