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

Ben.Britton@hnehealth.nsw.gov.au Kristen.McCarter@newcastle.edu.au

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