OnCo
ideasIdea

A dietitian in every gastrointestinal and head and neck tumour board

Malnutrition is the commonest untreated complication in cancers of the gut, throat and pancreas. Putting a dietitian in the meeting where treatment is decided means it is seen and treated before chemotherapy starts, not after weight has been lost.

Guidelines require malnutrition screening at diagnosis, and trials show dietitian counselling improves treatment completion in head and neck and gastrointestinal cancers, yet audits find fewer than half of patients are screened and dietitian referral typically follows, rather than precedes, treatment. Embedding a dietitian in the multidisciplinary team meeting for upper GI, pancreatic, colorectal and head and neck cancer, with authority to initiate nutrition therapy, prehabilitation and enzyme replacement, is a service-design change with a plausible effect on dose intensity and surgical complications.

Hypothesis
Dietitian participation in tumour boards with a nutrition plan for every patient increases the proportion of malnourished patients treated before first therapy from under 30% to over 80% and raises completion of planned chemotherapy or chemoradiation by at least 10 percentage points.
Rationale
The intervention is cheap relative to the cost of treatment interruptions and readmissions, the workforce (one dietitian per team) is realistic, and the geriatric assessment literature shows that structured assessment attached to the treatment decision changes outcomes.
What would test it
Stepped-wedge cluster trial across 20 hospitals with screening rate, time to nutrition intervention, relative dose intensity, unplanned admissions and 1-year survival as endpoints, plus cost analysis; then guideline and commissioning change.
Maturity
early clinical
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks

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