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Introduction:Oncology clinicians support the nutritional management of cancer patients thus improving their nutritional status, quality of life and reducing morbidity. The aim of this study was to investigate the attitudes, practices and behaviours of the MASCC Nutrition and Cachexia Study Group as well as clinicians from other health professional organisations. Methods:An online survey was disseminated through the mailing lists of MASCC and multiple healthcare organisations over 3 months. The survey consisted of 46 questions with a mixture of Likert scale and open-ended questions, and respondents could select common issues from a supplied list as well as providing u201cotheru201d options.Results:We received 232 responses from 22 countries; the majority of clinicians being: Dietitians (34%), Physicians (16%) and Nurses (12%). The greatest challenges were health services barriers (37%), health literacy of patients (34%) and inconsistent patient followup (40%). Qualitative data indicated inconsistent health messaging between the professions, a need for better interdisciplinary action and common interdisciplinary resources. Most (95%) clinicians had nutrition screening in their facilities and half felt confident in its use (major nutrition screening tools being: MST (45%); PG-SGA SF (12%); and MUST (9%). The most common nutrition assessment tools were PGSGA (35%) and SGA (23%). Body composition (BIA (12%) and CT scans (6%)) and hand grip strength (16%) were less frequently used.Conclusions:This survey provides a baseline summary of the knowledge, behaviour and needs of a cohort of international and multidisciplinary oncology clinicians which can be used to target the development of interdisciplinary guidelines and oncology nutrition education.

IntroductionDespite the rapid growth in palliative care (PC) services, regions remain without access to specialty palliative care. Community-based telemedicine may offer solutions to underserved populations from rural areas within the United States.1,2MethodsRetrospective review of 22 patients managed in a rural oncology clinic from a University hospital via telemedicine. Consecutive patients over 9 months, with active, advanced cancer referred for symptom management, transitions of care, or both. Care coordinated by the University PC service and oncology clinic, included nurses, nurse practitioner, and oncologist. Regulatory, legal, information technology (IT), and systems logistics were developed in partnership for 6 months prior to pilot. Edmonton Symptom Assessment Scale (ESAS) recorded at each visit.ResultsAverage age 66, predominately female with metastatic solid tumors. Patients had 1-3 telemedicine visits. Most common symptom was pain, median score 6. Morphine equivalent daily dose averaged 65. Most common opioids were oxycodone, transdermal fentanyl, and extended release morphine. Three visits required physical exam support from onsite providers (one for dermatological, 2 for neurologic exams). Six visits required immediate controlled substance prescriptions (other prescriptions were mailed; non controlled prescriptions sent electronically). Goals of care discussion in 45% (n=10) and advance care planning documents reviewed when applicable. Technological issues occurred in 2 visits and resolved without IT involvement.ConclusionsOur pilot program integrated specialist palliative care into a rural oncology clinic providing supportive care via telemedicine, including symptom management and goals of care discussions. Further research should define optimal integration of PC telemedicine into rural oncology clinics.Sources: 1) Menon PR, Stapleton RD, et al. Telemedicine as a tool to provide family conferences and palliative care consultations in critically ill patients at rural health care institutions: a pilot study. Am J HospPalliatCare. 2015 Jun;32(4):448-53.2)Watanabe SM, Fairchild A, PituskinE, et al. Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project. Support Care Cancer. 2013 Apr;21(4):1201-7.