Executive summary

From Cancer Guidelines Wiki

Executive summary

Malnutrition is common in patients with head and neck cancer, with the causes of malnutrition being multifactorial. Specialist dietitians from Australia, who were working with patients with head and neck cancer, had identified inconsistencies in dietetic practice and the need for a uniform model of nutritional care for this complex patient group. Hence, the Evidence Based Guidelines for the Nutritional Management of Patients with Head and Neck Cancer have been developed by a working party of dietitians in consultation with a multidisciplinary steering committee which included consumer representation. Members of the committees were invited to contribute to the project based on their clinical and research expertise in head and neck cancer and their experience in guideline development. The project was undertaken in partnership with the Clinical Oncological Society of Australia with a sponsorship grant received from the Cancer Institute NSW Oncology Group (Head and Neck).

The purpose of these guidelines is to provide the multidisciplinary team of health professionals with a summary of the best available evidence for nutrition interventions in patients with head and neck cancer. The guidelines are presented in the format of clinical questions with evidence-based answers related to the dietetic management of patients primarily undergoing treatment with curative intent for primary mucosal head and neck cancer, although patients undergoing palliative treatment are also considered.

Key clinical questions have been developed for the stages of the Nutrition Care Process [1] as described below and applied to the patient care pathway according to the relevant treatment stage:

  • Appropriate Access to Nutrition Care

(Nutrition Screening; Nutrition Assessment)

  • Quality Nutrition Care – Nutrition Diagnosis, Nutrition Intervention

(Establishing Goals; Nutrition Prescription; Implementation)

  • Nutrition Monitoring and Evaluation - Outcomes

(Measuring and Evaluating Outcomes)

The strength of the evidence was assessed using the level of evidence rating system recommended by the National Health and Medical Research Council (NHMRC) publication, NHMRC Levels of Evidence and Grades for Recommendations for Developers of Guidelines [2], and the quality of the evidence was assessed using the American Dietetic Association: Evidence Analysis Manual. Steps in the ADA Evidence Analysis Process [3]. This best available evidence is presented and used as a basis for providing recommendations about clinical practice and can be used as a framework to aid decision making within the multidisciplinary team.

These guidelines have undergone rigorous peer and expert review by the committee members and they have undergone wide stakeholder review through consultation with key organisations in Australia. They have been presented to multidisciplinary audiences, including oncologists, surgeons, nurses, pharmacists, radiation therapists and speech pathologists, attending the Australia and New Zealand Head and Neck Cancer Society and Clinical Oncological Society of Australia Annual Scientific Meetings throughout 2009 and 2010. These guidelines will be submitted for endorsement by: Clinical Oncological Society of Australia (COSA), Cancer Institute NSW Oncology Group (Head and Neck), Dietitians Association of Australia (DAA), Dietitians New Zealand (DNZ), British Dietetic Association (BDA) and the Australia and New Zealand Head and Neck Cancer Society (ANZHNCS).

The Evidence Based Guidelines for the Nutritional Management of Patients with Head and Neck Cancer will be maintained on the COSA website utilising wiki technology. This will enable the guidelines to be updated as new literature is published to ensure currency.

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References

  1. Lacey K, Pritchett E. Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management. J Am Diet Assoc 2003 Aug;103(8):1061-72 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12891159].
  2. National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for guideline developers. Canberra: National Health and Medical Research Council; 2009 Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf.
  3. American Dietetic Association. American Dietetic Association: Evidence Analysis Manual. Steps in the ADA Evidence Anaysis Process. 2008;Chicago: Scientific Affairs and Research [Abstract available at http://www.adaevidencelibrary.com/files/Docs/201001_ADA%20EA%20Manual.pdf].

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