- Advanced Practice Nursing (APRN) (https://voice.ons.org/topic/advanced-practice-nursing-aprn)
- Treatment side effects (https://voice.ons.org/topic/treatment-side-effects)
- Patient quality of life (https://voice.ons.org/topic/patient-quality-life)
- Putting evidence into practice (PEP) (https://voice.ons.org/topic/putting-evidence-practice-pep)
Managing Weight Loss in Patients With Cancer
Patients’ weight and nutrition status will often vary throughout the cancer care continuum. Weight loss might occur before the diagnosis, be one of the presenting cancer symptoms, be related to the tumor itself, or be secondary to side effects of their treatment (e.g., anorexia from chemotherapy or radiation).
Severe weight loss not only has a major impact on a patient’s quality of life but is directly responsible for up to one-fifth of all cancer deaths (https://doi.org/10.1080/01635581.2016.1180412). Weight loss in the patient with cancer can lead to negative outcomes (https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq#section/_5), including an increased incidence and severity of treatment-related side effects, increased risk of infection, and ultimately an overall poorer prognosis leading to decreased survival rates. Advanced practice nurses (APNs) must take an active role in assessment and management of weight loss.
Identifying Patients at Risk
Nutrition screening is used to quickly identify patients who are at risk for developing malnutrition and promptly refer to a specialist such as a registered dietitian (RD) who can then perform a complete nutrition assessment (https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq#section/_5) and implement a nutrition care plan. Historically, weight loss, low albumin, and low body mass index were used to identify patients with malnutrition; however, these results alone can have other explanations.
Ultimately, the recommendation from numerous organizations, including the Academy of Nutrition and Dietetics, ONS, Association of Community Cancer Centers, and Joint Commission, is that nutrition screening with a validated tool should be performed at regular intervals (https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq#section/_5) over the cancer trajectory. Initial screening should occur before treatment begins, and additional evaluations can coincide with a patient’s treatment schedule (e.g., every two to four weeks with their chemotherapy cycles or weekly with radiation).
APNs are paramount in assessing and performing screening and then knowing what to do with the results. Several validated nutrition screening tools are available, but the Patient-Generated Subjective Global Assessment is the most commonly accepted tool in cancer, validated for use in both inpatient and outpatient oncology settings. It divides patients into four nutrition categories (http://www.oncologynutrition.org/store/product/oncology-nutrition-for-clinical-practice-165): no intervention needed, education by RD or other clinician, intervention by RD, and critical need for improved symptom management. Based on screening, APNs must provide prompt intervention for referral to a formal RD nutrition assessment (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679054/).
Anorexia or a loss of appetite is one of the more common reasons that patients with cancer lose weight. The ONS Putting Evidence Into Practice resources for anorexia (https://www.ons.org/practice-resources/pep/anorexia) have two interventions that are recommended for practice: (a) oral nutritional intervention that “involves the provision of dietary advice or education with or without dietary modification or nutritional supplements,” and (b) progestins. Systemic corticosteroids are considered “likely to be effective.”
APNs need to recognize weight loss in patients with cancer early and start interventions immediately to prevent it from becoming a more complicated and serious concern like cancer cachexia.