The Barwon Health Cancer Cachexia Clinic was established in 2007 and is the only multidisciplinary clinic of its type in Australia. Treating cachexia can improve overall quality of life and function for patients. “Patients with cancer cachexia have poor appetites and significant weight loss, leading to weakness and fatigue as well as potentially life-threatening metabolic disturbances. In addition, impaired nutritional status and protein deficiency can affect response to chemotherapy and increase toxicity to therapy, leading to increased morbidity and mortality.”(Granda-Cameron et al, 2010, p.72).
Acknowledging the impact of cancer cachexia on patients and carers, the clinic’s focus is on assessing symptoms and developing a customised nutritional, exercise and pharmacological regime. The specialist clinical team now includes a Palliative Care Physician, Nurse Practitioner Candidate, Physiotherapist and Dietitian.
Initially the clinic operated fortnightly with a combination of forty minute initial assessments and twenty minute reviews with each of the three clinicians. Assessment included anthropometry, PG-SGA nutritional self-assessment, upper and lower limb strength and relevant pathology.
It has now evolved to weekly clinics, one hour initial assessments and thirty minute reviews. The significant changes have been to introduce self-assessments of quality of life (EORCT QOL), and functional assessment of anorexia/cachexia (FAACT). There is now a streamlined multidisciplinary assessment for patients with advanced/refractory cachexia with deteriorating condition.
Including the Nurse Practitioner Candidate (NPC) in the clinic resulted in triaging referrals to assess suitability for standard or streamlined clinic and development of improved communication and information delivery.
With increased session length there is time for patients and clinicians to explore all symptoms and issues that may be impacting on their quality of life.
Dyar et al. (2012) acknowledged cancer patients frequently have unmet psychosocial needs including social, financial and spiritual needs. The new clinic questionnaires’ results have highlighted symptoms and concerns that may not have been expressed by patients and can trigger a referral to the extended Supportive Care Team.