Hospital cancer nutrition program highlighted nationally
Educating cancer patients on ways to improve their diet in order to support their recovery is a part of the oncology program at the Davenport-Mugar Cancer Center at Cape Cod Hospital (CCH) and the Clark Cancer Center at Falmouth Hospital (FH). Now, the clinical team is sharing their program with a wider audience.
Three members of the team who developed the nutrition program were asked to write an article for the national journal of the Association of Community Cancer Centers (ACCC). The article, “Improving Access to Oncology Nutrition Services,” was written by Katie Michaud, MPA, FACHE, executive director of oncology services for Cape Cod Healthcare; Shelley West, MSN, RN, OCN, MBA, director of oncology nursing and infusion services; and Abigail Usen Berner, MS, RD, LDN, an oncology dietitian at the hospital.
West was also invited to be a presenter at the ACCC conference in Minneapolis to share the details of the CCHC program with other community cancer centers. Berner was invited to be part of a national roundtable meeting at a separate conference.
The program’s success at keeping patients out of Cape Cod Hospital and Falmouth Hospital ERs through better nutritional support caught the attention of Cape Cod Healthcare’s Cancer Committee chairperson, Peter Hopewood, MD. He was so impressed with the program’s progress that he suggested submitting their work to the ACCC for its innovation award. Even though they didn’t win, the panel of judges invited them to speak at the annual conference and submit the article to the journal.
“The national recognition is nice, but more important to me is that we can help other programs by inspiring them and giving them practical advice and saying, ‘Here’s how we did it,’” Michaud said. “That’s what we’re aiming for in the article."
Seeds of the Program
Development of the program started partly because of how much difficulty oncology clinicians were having with patient tube feeding, said West.
“It’s only a minor part of the article, but it brought nursing and the dietitians together and also started to involve the speech and swallow folks,” she said. “So, it just kind of bloomed from working on how we determine a better process to identify who needs Abby’s services in the first place and how do we make that more seamless for the patient.”
Now, every oncology patient at CCH and FH is screened with a risk assessment questionnaire by medical assistants and nurses. If it is determined that they are at risk for malnutrition, the patients meet with Berner. People with head, neck and gastrointestinal cancers are automatically referred to Berner because those cancers are treated with both chemotherapy and radiation at the same time, which can have difficult side effects and fatigue.
Patient Empowerment
“We improved our process for getting them an appointment,” Michaud said. “One of the things that we did was we created an opportunity for patients to self-schedule, so we are better leveraging our Epic technology. So, as soon as we identify that someone is at risk for malnutrition, we put a referral through and that automatically sends the patient a notification through MyChart, and they can go ahead and self-schedule their appointment.”
Berner then meets with the patient for 60 minutes to assess their nutritional needs. She meets people in her office in Hyannis, or while they are getting chemotherapy. She also does virtual visits. With certain cancers, the speech and swallow therapists are also at the meetings, so instead of making the patient travel for an additional meeting with them, the care is brought to the patient. Follow-up meetings are 30 minutes long.
“What I tend to do is assess what’s going on with them at that moment, such as if they’re having any side effects, taste changes, swallowing or chewing difficulty. I learn what their eating habits are like now and make recommendations based on what they’re doing to improve their intake,” Berner said. “It’s not a one-size-fits-all situation. It is very tailored to what’s going to best meet that person’s needs.”
The other part of Berner’s job is helping people to access food if they can’t afford it or are too tired to prepare it. She connects patients to community resources like food pantries and the Barnstable Senior Meal Program. As part of a collaboration with the Cape Wellness Collaborative, once a month, Chris Shortall, the culinary director at The West End cooks medically-tailored meals for oncology patients. Berner also has grocery store gift cards she can give to patients.
Monitoring for Success
Once a month, West reviews the list of oncology patients that came through the Cape Cod Hospital Emergency Center to see why they came in.
“I look at the ones who were admitted for diarrhea, vomiting, nausea, dehydration, and I’m honestly not finding many because we’re doing such a good job of getting them in contact with Abby early, so that we ward off those types of visits,” West said. “That’s the goal. Good nutritional control is very key to keeping them out of the ER and it’s been certainly paying dividends.”
