Eating As Treatment:
Eating as treatment (EAT): Improving treatment
outcomes for head and neck cancer patients
undergoing radiotherapy
Ben Britton, Amanda Baker, Alison Beck, Kristen
McCarter, Luke Wolfenden, Chris Wratten, Judy Bauer, Sean Halpin, Gregory Carter
BACKGROUND
• Common, relatively high mortality rate
• Malnutrition occurs in up to 80%
• Risk Factors – smoking, alcohol, HPV.
• Demographics – male, over 50
STUDY ORIGINS
Motivational Interviewing
+
CBT
METHOD: STUDY DESIGN
Initiation Step 1 Step 2 Step 3 Step 4 Step 5
Adelaide Control Intervention Intervention Intervention Intervention Intervention
Melbourne Control Control Intervention Intervention Intervention Intervention
Sydney Control Control Control Intervention Intervention Intervention
Perth Control Control Control Control Intervention Intervention
Brisbane Control Control Control Control Control
Intervention
Stepped Wedge
METHOD
Motivational Interviewing
+
CBT
Evidence-based practice guidelines
for the nutritional management of
adult patients with head and neck
cancer
METHOD: TRAINING
• Initial Learning:
• Workshop
• Integration into Practice
• Shadowing
• Ongoing Implementation
• Supervision and coaching
• Booster
• Practice Change Strategies
METHOD: PRACTICE CHANGE
Performance
audit &
feedback
Training
Executive support
Systems & prompts Academic detailing
Tools & resources
PROMPTS
MEASURES
Primary outcome:
• Nutrition - PG-SGA
Secondary outcomes:
• Intervention fidelity - Study specific checklist, BECCI.
• Best practice guideline adherence - % delivered
RESULTS 307 patients (July 2013 to Jan 2016)
Age 58, (18-81)
21% women
13% (40) smoked 34% (94) CO confirmed 31% hazardous drinking
RESULTS
RESULTS: Primary Outcome
0
2
4
6
8
10
12
14
16
18
Week 1 Last Week 1 Month 3 Months
PG-SGA
Control
p = .03
RESULTS: EAT to Live
0
10
20
30
40
50
60
70
80
90
100
Prop
ortio
n of
Tap
es:
'Yes
' to
'Eat
ing
as In
tegr
al t
o Ra
diot
hera
py'
Control
Intervention
0
10
20
30
40
50
60
70
80
90
100
Prop
ortio
n of
Tap
es:
'Yes
' to
'Elic
iting
Rea
sons
for R
adio
ther
apy'
Control
Intervention
Increased application of EAT to Live Conversation
RESULTS: Nutrition Planner
Increased use and review of written nutrition planner
0
10
20
30
40
50
60
70
80
90
100
Prop
ortio
n of
Tap
es:
'Yes
' to
Wri
tten
Nut
ritio
n Pl
anne
r
Control
Intervention
0
10
20
30
40
50
60
70
80
90
100
1
Prop
ortio
n of
tap
es"
'Yes
' to
Colla
bora
tivel
y Re
view
Nut
ritio
n Pl
anne
r
Control
Intervention
RESULTS: BECCI
Increased application of BCC From between ‘minimally’ and ‘to some extent’ to between ‘some extent’ and a ‘good deal’
0
0.5
1
1.5
2
2.5
3
1 2 3 4 5
Control
Intervention
0
0.5
1
1.5
2
2.5
3
Control
Intervention
Pro
po
rtio
n o
f Ta
pes
A
pp
licat
ion
of
BC
C
Pro
po
rtio
n o
f Ta
pes
B
ECC
I sc
ore
RESULTS: Guideline Adherence
Guideline recommendations
RESULTS: Guideline Adherence
Guideline recommendations
CONCLUSIONS
Improved nutrition
Sustained behaviour change in routine clinical
consultations
Improved adherence to best practice guidelines
THANKYOU
@MccarterKristen
[email protected] [email protected]
Britton B, McCarter K, Baker A, et al Eating As Treatment (EAT) study protocol:
a stepped-wedge, randomised controlled trial of a health behaviour change
intervention provided by dietitians to improve nutrition in patients with head and
neck cancer undergoing radiotherapy BMJ Open 2015;5:e008921. doi:
10.1136/bmjopen-2015-008921
ACKNOWLEDGEMENTS
Funding:
National Health and Medical Research Council
Institutions: Participating sites:
• University of Newcastle • Royal Adelaide Hospital
• Hunter New England Health • Peter MacCallum Cancer
Centre
• University of Queensland • Sir Charles Gairdner
Hospital
• TROG Cancer Research • Radiation Oncology Mater
Centre
• Princess Alexandra
Hospital
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