When patients with high-risk cancer have limited access to registered dieticians, it may be difficult for them to follow through on a nutrition plan set by their healthcare team. However, a recent study of a program launched by the Levine Cancer Institute (LCI) found that telenutrition services can offer a beneficial alternative.
“As we started adding the regional sites, we knew that we weren’t going to be able to physically place a dietician out there because we didn’t have a large enough patient population, but we knew that they had a need,” said Michele Szafranski, MS, RD, CSO, LDN, clinical nutrition manager at LCI said in an interview with Oncology Nursing News
. Every other Tuesday, Szafranski conducts video conferences with patients who are being treated in one of the Carolinas HealthCare System’s satellite locations.
The telenutrition video conferences are conducted while the patient is at their own doctor’s office and are completely HIPPA-compliant.
“Since we’re doing it doctor’s office to doctor’s office, if I need the doctor to write orders, I could do that immediately,” Szafranski said. “It brings the professionalism up a notch and allows us to do what we haven’t done before.”
Connecting electronically allows oncology-certified dieticians like Szafranski to communicate with patients who may not otherwise be able to receive such services close to home. Conducting the conferences using video may prove to be more useful than phone calls because it allows Szafranski to conduct nutrition-focused physical exams—observing things such as fat pads under patients’ eyes and temporal wasting—that she would not have been able to do otherwise.
Overall, patients and their healthcare providers reported that they were satisfied with the services and were particularly happy with the quick access to oncology-certified nutrition specialists via virtual conference. The video conference allowed dieticians to assess muscle or fat wasting, the skin, mouth and nails on their patients. In addition, dieticians were able to better coach patients through tube feeding techniques and share screens of written information.
“The patients have been very open to telenutrition because I think they’d rather do that than drive an hour or two to see me in real life,” Szafranski said.
For many of these patients, the only other options besides a long car ride include seeing and paying for a local dietician who may not be oncology certified, or patients may go without the service altogether. The telenutrition conferences are included in the price of being treated at the Carolinas HealthCare System.
“We’re trying to target the highest risk in the cancer population,” said Szafranski, “the people who we could help the most.”
Patients who participated in the study had to have experienced 10% or more involuntary weight loss prior to the start of cancer treatment or were on tube feeding or intravenous nutrition. They also needed to have shown the following for more than 5 days: poor appetite or intake; difficulty chewing or swallowing; nausea or vomiting; mucositis/esophagitis; unresolved chronic constipation or diarrhea, or had progressive weight loss.
Szafranski said that programs like these have potential to be used in centers across the United States. The only consideration, though, is that registered dieticians must be registered in the state where they are seeing patients.
“I absolutely want to grow the program,” Szafranski said. “It does have national potential.”
Szafranski ML, York B, Eaton T, et al. Telenutrition in oncology: a novel model of care in a geographically diverse network. J Clin Oncol
. 2017;35 (suppl 5S; abstr 43).