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
Terry Haines1,4, Kate Huggins5, Lauren Hanna1, Kate Furness6, Maryanne Silvers3, June Savva3, Helena Frawley1, DaniEl Croagh3, Paul Cashin3, Liang Low3, Judy Bauer1, Helen Truby21Monash University, Clayton, Victoria, Australia2University of Queensland, St Lucia, Victoria, Australia3Monash Health, Clayton, Victoria, Australia4National Centre for Healthy Ageing, Frankston, Victoria, Australia5Deakin University, Burwood, Victoria, Australia6LaTrobe University, Bundoora, Victoria, Australia
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), p = 0.998; App: −0.08 (−0.18, 0.02), p = 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.
Biography
Professor Terry Haines has the role of Head of School, School of Primary and Allied Health Care at Monash University. This school has 5 departments, the Rehabilitation and Independent Living Research Centre, over 150 staff, over 100 research higher degree students, and is a key member in the National Centre for Healthy Aging.
He has a professional background in physiotherapy and health economics, and has worked in research roles embedded within health services for over 15 years before commencing as the Head of School in 2017.