Nutrition Education for Cancer Care N.E.C.C

1. Nutrition Education for Cancer Care N.E.C.C

2. Nutrition Education for Cancer Care (NECC) • Total Funding Requested: • $100,000.00 • Project Duration: • 8 Months • Project Director’s Name: • Michelle Eastman, CNS, CPT • Nutritionist, Health Education Department • PULSE Health and Counseling Services • Submitted To: • Conquer Cancer Foundation

3. Goal • To improve overall treatment outcomes for patients 65 years of age and older with cancer, specifically, nutritional outcome, morbidity, and quality of life (QoL) through the use of additional dietary counseling, from a registered dietician, during and three months after radiotherapy in Trinity County.

4. Project Design • The duration is eight months. • First two months- Trinity Hospital will be acquiring two fulltime registered dieticians, who will initially assess and then council patients undergoing cancer treatment. • Two months prior to implementation of dietary council provided by the dieticians, patients being treated for cancer will be assessed for nutritional status and quality of life to provide comparison evaluation data. • Patients will be assigned to one of the two dieticians and will receive personalized dietary counseling once weekly for three months while undergoing radiotherapy and once every two weeks after radiotherapy treatment for three additional months. • Outcome measured will be nutritional status, determined by the participant’s personal dietician or participant’s doctor, using Ottery's Subjective Global Assessment. The participant’s quality of life (QoL), will be also be assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.

5. Participants • Trinity Hospital- total of forty-six cancer patients • Aged 65 and older referred for radiotherapy from their primary care physician. • Will be asked to participate in NECC project. • All patients will give their written informed consent to participate in the pilot program.

6. Activities • 1. Initial assessment of nutrition status and quality of life -two months prior • 2. Basal energy requirements will be calculated - metabolic cart • 3. Malnutrition and initial dietary behavior, screening. • 4. Dietary counseling • 5. Adherence to diet and reevaluation of dietary plan • The outlined activities of NECC will provide additional screening of patients to determine their nutritional status by closely monitoring changes in weight, food intake, and symptoms such as nausea and vomiting, which will assist in the goal of improving patient quality as well as patient adherence to cancer treatment.

7. Evaluation • ESHA will be used to analyze nutrient contents of regular foods and meals. • Nutritional assessment will be performed by use of the Ottery's Patient Generated Subjective Global Assessment. • Nutritional status will be categorized in three degrees: normal, moderate, and severe malnutrition and assessment will be done at initial baseline, three months and at the end of the project at six months. • Quality of life will be assessed at the four time points, two months prior to participation in the project, baseline, three months and six months. • EORTC Quality of Life Questionnaire will be used for assessment. Data will then be used to analyze the effectiveness of dietary council and outcomes for cancer patients by comparing preprogram data with post program data.

8. Sustainability • Once NECC is implemented at Trinity Hospital, in Trinity County, CA, the program director’s role will be reassumed by one of the registered dieticians, paid for by Trinity Hospital. Both dieticians will be required to interview for the program director position which will be reevaluated as fulltime hospital employees. The decision to hire and appoint a program director will be done by the Trinity Hospital’s onsite Oncologist, Dr. White. Trinity Hospital will continue to offer the availability of dietary council, provided by both dieticians, to cancer patients if the outcome of the implementation of NECC reveals the goals are being met.

9. Partners • Partnering with Trinity Hospital, • Dr. White, Trinity Hospital’s onsite practicing Osteologist.

10. Position Details • Program Director: Contact and coordinate with Trinity Hospital regarding the provision of their food and services. Work with onsite Osteologist to conduct interviews of dieticians and hire two. Train dieticians in the use of outcome measure assessment tools, specifically EORTC Quality of Life Questionnaire. Provide dieticians with background knowledge about elderly care and screening for malnourishment while undergoing radiotherapy. Collect and analyses patient outcome data. • Registered Dieticians: Provide information about the health benefits of adherence to the diet assigned. Consult with patients regarding their struggle to adhere to the diet while undergoing cancer treatment and share helpful solutions to help motivate the patients to continue their efforts. • Dr. White: Trinity Hospital’s onsite practicing Osteologist who will help coordinate NECC details and tailor the plans to fit the hospital’s needs. He will also oversee all dietary advice and be the main source of initial contact for the program’s implementation.