We have detected you're using an outdated browser. Please upgrade to a major browser for the best experience.

Skip to main content

Awareness of the Critical Role of Nutrition Support for Upper GI Cancer Surgery

Published in Clinical Nutrition ESPEN, September 2021

View online here

Identifying and managing malnutrition with a multidisciplinary approach is critical in patients undergoing surgery for upper gastrointestinal (UGI) cancer, a group of patients who are at high risk of malnutrition. 

To better understand the nutritional care of these patients, this interesting online nutritional survey  included 130 health care professionals (56% dietitians, 25% surgeons, 11% nurses, 8% oncologists) working with adults undergoing surgery with curative intent for upper gastrointestinal (pancreatic, gastric, oesophageal) cancer in Australia.

Key findings of the survey included:

◽For preoperative outpatient malnutrition screening, it was most commonly performed by dietitians (56%) and nurses (47%) followed by surgeons (35%) and oncologists (24%). GPs (1%)  and allied health assistants (1%) were rarely involved. Around a fifth of participants reported patients were rarely screened as outpatients.

For inpatients, malnutrition screening was mostly undertaken by dietitians and nurses (63% each), followed by surgeons (26%) and allied health assistants (17%). Very few oncologists (5%) and physicians (2%) performed screening in inpatients. Only 2% of participants reported that patients were rarely screened for malnutrition.

Prescription of nutritional support was most commonly undertaken by dietitians and surgeons in inpatient and outpatient settings. Encouragingly, use of nutritional support was common with only 11% in outpatients and 1% in inpatients reporting that nutritional support was rarely prescribed. 

Most participants (98%) reported that their health service had dietetics support available overall, although only 41% reported having an outpatient dietetic service. 

Participants (>90%) demonstrated very high awareness of the impact of malnutrition and the importance of early nutrition support and mostly perceived that dietitians, nurses and surgeons were responsible for malnutrition screening, whilst prescription of nutritional support was the responsibility of dietitians and surgeons. 

Key barriers to providing adequate nutrition support were:

    • variation in practices between surgeons and/or oncologists for insertion of feeding tubes or escalation of nutrition support
    • lack of standard procedures or clinical pathways
    • lack of funding and availability of dietitians.

Key enablers were adequate knowledge of staff, who to refer to, and adequate referral procedures.