Nutritional optimisation before surgery for complex cancer
The Perioperative Medicine Team at University Hospital Southampton are piloting a novel perioperative nutrition pathway for people with cancer undergoing neoadjuvant treatment and complex surgery for pelvic malignancy and if successful aim to implement for all patients with solid tumours, including those who do not proceed to operative intervention.
Covid has increased the risk of pre-treatment malnutrition for these patients as they are having less face-to-face contact with health professionals who may have previously identified evolving malnutrition. However, the pandemic has also provided the opportunity to trial more virtual methods of screening and assessment which have been found to be acceptable to patients and clinicians.
The pathway comprises a virtual cross-divisional perioperative nutrition service and re-structured perioperative pathway that identifies people who are at risk of malnutrition at the point of referral to the surgical team. All patients will undergo a virtual malnutrition screen and baseline assessment with ongoing assessment determined by the outcome of the screen.
Those screening as “not at risk” will be re-screened on a weekly basis. Those “at risk” will enter a bespoke management pathway involving oral nutritional supplementation, in-depth virtual Dietetic assessment and weekly virtual follow-up. Once assessed people will be categorised as low, moderate or high risk with subsequent management streamed to universal, targeted and specialist intervention, in line with the Universal Personalised Care Plan. Those determined to be at highest risk will be bought in for a face-to-face assessment and will be discussed in a specialist MDT meeting.
This pathway has been developed in partnership with the Southampton Complex Cancer and Exenteration team. If you would like further information please e-mail either PerioperativeDietitian@uhs.nhs.uk or Lewis.Matthews@uhs.nhs.uk.
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Pathway outline
Dietetic intervention streams
