Quality statement 4: Dietetic support

Quality statement

Adults with oesophago-gastric cancer have tailored specialist dietetic support before and after radical treatment.

Rationale

Nutrition plays an important role in the management of oesophago-gastric cancer because of the physical changes associated with this type of cancer such as difficulty swallowing, loss of weight and malnutrition. Specialist dietetic support, tailored to the person's clinical situation, can help manage specific difficulties associated with the complex nutritional needs of adults with oesophago-gastric cancer. This support would be ideally provided by a dietitian. People with better nutrition are more likely to have an improved quality of life.

Quality measures

Structure

Evidence of the availability of tailored, specialist dietetic support for adults with oesophago-gastric cancer before and after radical treatment.

Data source: Local data collection, for example, local protocols, staff rotas.

Process

a) Proportion of adults with oesophago-gastric cancer with radical treatment planned who have tailored, specialist dietetic support.

Numerator – the number in the denominator who have tailored, specialist dietetic support before radical treatment.

Denominator – the number of adults with oesophago-gastric cancer who have radical treatment planned.

Data source: Local data collection, for example, from patient records (such as a documented discussion with a dietitian or individualised care plan).

b) Proportion of adults with oesophago-gastric cancer who have tailored specialist dietetic support after radical treatment.

Numerator – the number in the denominator who have tailored specialist dietetic support after radical treatment.

Denominator – the number of adults with oesophago-gastric cancer who have radical treatment.

Data source: Local data collection, for example, from patient records (such as a documented discussion with a dietitian or individualised care plan).

Outcome

Health-related quality of life for adults who have radical treatment for oesophago-gastric cancer.

Data source: Local data collection. Health-related quality of life scores for adults with oesophago-gastric cancer, for example, ECOG (Eastern Cooperative Oncology Group) performance status scores from a survey of quality of life questionnaires.

What the quality statement means for different audiences

Service providers (specialist oesophago-gastric cancer centres/tertiary care centres) ensure that they have the expertise and capacity to support delivery of tailored specialist dietetic support before and after radical treatment for oesophago-gastric cancer in adults.

Healthcare professionals (such as dietitians and clinical nurse specialists) provide specialist tailored dietetic support to adults with oesophago-gastric cancer before and after radical treatment. The support should be tailored to individual needs, depending on the stage of disease and its effects. An optimal nutritional status helps people to complete a treatment that aims to remove or destroy the cancer completely.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services with capacity and expertise to enable adults with oesophago-gastric cancer to access tailored, specialist dietetic support before and after radical treatment. They should monitor contracts and seek evidence of support being provided.

Adults with oesophago-gastric cancer are helped with any problems they have eating or drinking both before and after treatment to remove the cancer (radical treatment). This should enable them to get the most from their diet so they are in the best possible health to start and recover from the treatment.

Source guidance

Oesophago-gastric cancer: assessment and management in adults (2018) NICE guideline NG83, recommendation 1.6.1

Definitions of terms used in this quality statement

Tailored specialist dietetic support

Specialist dietetic support could consist of:

  • advice about routes for delivering nutrition (including oral supplements, tube feeding, surgical jejunostomy, total parenteral nutrition) and their management in hospital and community settings (including support from home enteral feeding teams)

  • support (counselling, advice) to help adults with oesophago-gastric cancer adjust their diet to maximise their nutritional input after radical treatment. Examples include supporting them to choose suitable food and change the size of portions and frequency of meals in response to changes in tolerance of food after treatment.

The support should be tailored to the dietary requirements of the individual adult with oesophago-gastric cancer. It is important before, during and after radical treatment.

[Adapted from NICE's guideline on oesophago-gastric cancer: full guideline, sections 5.1.7.2, 10.1.1, 10.1.7.6; expert opinion].

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health and social care services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.