Effect of Early and Intensive Telephone or Electronic Nutrition Counselling Delivered to People with Upper Gastrointestinal Cancer on Quality of Life: A Three-Arm Randomised Controlled Trial.

Catherine E Huggins, Lauren Hanna, Kate Furness, Mary Anne Silvers, June Savva, Helena Frawley, Daniel Croagh, Paul Cashin, Liang Low, Judy Bauer, Helen Truby, Terry P Haines

Journal: Nutrients 2022;14(15):3234

PMID: 35956410

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Abstract

BACKGROUND

Delay in dietetic service provision for upper gastrointestinal cancer exacerbates disease-related malnutrition and consequently increases morbidity and mortality. Dietetic services are usually referral-based and provided face-to-face in inpatient or outpatient settings, which can delay the commencement of nutrition care. The aim of this study was to provide intensive dietetic intervention close to the time of diagnosis for upper gastrointestinal cancer and assess the effect on quality-adjusted life years.

METHODS

A three-arm randomised controlled trial of adults newly diagnosed with upper gastrointestinal cancer was performed. A behavioural-based, individually tailored, symptom-directed nutrition intervention was provided in addition to usual care, delivered by a dietitian using a telephone (synchronously) or a mobile application (asynchronously) for 18 weeks, compared with a usual care control group. Data were collected at baseline, three, six, and twelve months post-randomisation. The primary outcome was quality-adjusted life years (EQ-5D-5L quality of life assessment tool). Data were analysed using linear mixed models.

RESULTS

One hundred and eleven participants were randomised. Quality-adjusted life years were not different in the intervention groups compared with control (telephone: mean (95% CI) 0.04 (0.43, 2.3), = 0.998; App: -0.08 (-0.18, 0.02), = 0.135) after adjustment for baseline, nutrition risk status, age, and gender. Survival was similar between groups over 12 months. The asynchronous mobile app group had a greater number of withdrawals compared with the telephone group.

CONCLUSION

Early and intensive nutrition counselling, delivered at home, during anticancer treatment did not change quality-adjusted life years or survival over 12 months compared with usual care. Behavioural counselling alone was unable to achieve nutritional adequacy. Dietetic services delivered asynchronously using a mobile app had low acceptance for patients undergoing anticancer treatment.

TRIAL REGISTRATION

27 January 2017 Australian and New Zealand Clinical Trial Registry, ACTRN12617000152325.

Address: Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC 3168, Australia.; Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.; Department of Nutrition and Dietetics, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia.; Department of Physiotherapy, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC 3199, Australia.; Upper Gastrointestinal and Hepatobiliary Surgery Unit, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia.; Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 5 Block E, 246 Clayton Road, Clayton, VIC 3168, Australia.; School of Human Movement and Nutrition Sciences, The University of Queensland, Level 2 Connell Building, St. Lucia, QLD 4072, Australia.; National Centre for Healthy Ageing, School of Primary and Allied Health Care, Monash University, Level 3 Building G, McMahons Road, Frankston, VIC 3199, Australia.

DOI: 10.3390/nu14153234

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MeSH Terms: Adult, Australia, Cost-Benefit Analysis, Counseling, Electronics, Gastrointestinal Neoplasms, Humans, Quality of Life, Telephone