Nutrition Screening and Counseling in Patients With Lung Cancer in an Outpatient Setting

J Adv Pract Oncol 2012;3:191–193 Malnutrition is evident in 30% to 90% of patients with cancer at some point during their disease course (Molina, Yang, Cassivi, Schild, & Adjei, 2008; Nitenberg & Raynard, 2000; Read et al., 2005). Significant weight loss (> 10% of body weight) increases the risk of morbidity and mortality in individuals with cancer (Bozzetti, 2009; Dewys et al., 1980; Nitenberg & Raynard, 2000; Ottery, 1996). At diagnosis, at least one third of patients exhibit weight loss of > 5%, but this number is significantly higher in those with advanced disease (Ottery, 1996). Along with this weight loss, there are also changes in protein and albumin status that indicate progressive deterioration of nutritional status and propensity for cachexia (Esper & Harb, 2005). Thus, it is important to recognize those patients who are at risk for malnutrition or who are already malnourished at diagnosis. In an outpatient private practice, a dietitian or nutritionist may not be available for nutrition counseling; thus, this important step becomes an essential component of the oncology advanced practitioner’s role. In this article, an intervention developed at a suburban outpatient practice to address the problem of malnutrition in lung cancer patients is described. A synopsis of the screening and counseling program is given. Initial Office Visit At the first office visit, newly diagnosed lung cancer patients were approached to participate in the pilot study. Seven patients (four males, three females) consented to participate. One participant had stage II disease, three had stage III disease, and three had stage IV disease. Participants ranged in age from 45 to 83 years and all were either current (six patients) or former (one patient) smokers. Six of the participants had a diagnosis of non–small cell lung cancer and one had small-cell lung cancer. During the first visit, baseline bloodwork was ordered: complete blood cell (CBC) count with differential, comprehensive metabolic panel, and C-reactive protein (CRP). The CRP was added because evidence shows that there is elevation of the acute proinflammatory humoral response in patients who are at risk for malnutrition and cachexia (J. Brown, personal communication, April 2, 2009; Esper & Harb, 2005; Nitenberg & Raynard, 2000; Slaviero, Read, Clarke, & Rivory, 2003). Each patient made an appointment for an individualized counseling session during the next week.