Debra Gibson

The role of computed tomography in evaluating body composition and the influence of reduced muscle mass on clinical outcome in abdominal malignancy: a systematic review

It is estimated that there were 3.45 million new cases and 1.75 million deaths from cancer in Europe in 2012. Colorectal cancer was one of the most common cancers, accounting for 13% of new cases and 12.2% of all deaths. Conditions causing reduced muscle mass, such as sarcopenia, can increase the morbidity and mortality of people with cancer. Computed tomography (CT) scans can provide accurate, high-quality information on body composition, including muscle mass. To date, there has been no systematic review on the role of CT scans in identifying sarcopenia in abdominal cancer. This review aimed to examine the role of CT scans in determining the influence of reduced muscle mass on clinical outcome in abdominal cancer. A systematic review of English-language articles published in 2000 or later was conducted. Articles included cohort, randomised controlled trials and validation studies. Participants were people diagnosed with abdominal cancer who had undergone a CT scan. Data extraction and critical appraisal were undertaken. Ten cohort studies met the inclusion criteria. Seven studies demonstrated that low muscle mass was significantly associated with poor clinical outcome, with six specifically demonstrating reduced survival rates. Eight studies demonstrated that a greater number of patients (27.3–66.7%) were identified as sarcopenic using CT scans compared with numbers identified as malnourished using body mass index. CT scans can identify reduced muscle mass and predict negative cancer outcomes in people with abdominal malignancies, where traditional methods of assessment are less effective.

Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial

Pre‐operative weight loss has been consistently associated with increased post‐operative morbidity. The study aims to determine if pre‐operative oral nutritional supplements (ONSs) with dietary advice reduce post‐operative complications.

Computed tomography compared with standard clinical measurements to assess body composition, facilitating the identification of sarcopenia and cachexia in colorectal malignancy

Our sample consisted of 128 older adults (95 women, 33 men), aged 65-97 years, independent and living in Loures municipality, Portugal. Functional physical fitness was assessed with Senior Fitness Test Battery. Predicted distance was calculated with Troosters et al (1999) equation. Grip strength was assessed with hydraulic dynamometer Jamar® and functional capacity with the Composite Physical Function (CPF) Scale. A basic descriptive analysis was conducted (statistical package SPSS IBM for Windows, v22) and the sample was stratified by age. BACKGROUND AND AIMSBackground: Cancer cachexia has a negative impact on the quality of life of both patients and their informal caregivers but there are few psychoeducational interventions to address this. This study is the first step in the development of a workshop to support patients with cancer cachexia and their carers. Methods: Interviews were carried out with 5 patients, 5 carers and 5 health care professionals (HCPs) to create two logic models, one to identify the antecedents (root causes) of why unintentional weight loss is difficult for people with cancer and one for why it is difficult for their informal caregivers. The maps were supplemented with data from previously conducted semi-structured interviews with 39 patients and 12 HCPs and from systematic reviews of the patient and carer literature. Members of the project advisory panel rated the importance and changeability of each antecedent in the context of a workshop. The highest scoring antecedents were grouped to form intervention targets. Results: A total of 54 antecedents were identified for patients and 65 for carers, with 15 patient antecedents and 14 for carers scoring above the mean for both importance and changeability. Not knowing what to do for the best, conflict with each other and negative emo- tions were high scoring patient and carer antecedents. Forcing self to eat rated highly for patients. Food provision and managing patient’ s dependency rated highly for carers. The high scoring antecedents were grouped together to form three intervention targets: providing information about eating well with cancer, resolving conflict and dealing with negative emotions. Conclusion: Interviews and literature reviews have guided the inter- vention targets for a workshop on cancer cachexia aimed at both pa- tients and their carers. Three areas, important and amenable to change, were identified. The workshop will educate, aid coping and provide relationship support.

Enabling successful hospital discharge to home at end of life: can a carer support needs assessment tool (CSNAT) help improve support for family carers?

Introduction Successful hospital discharge and prevention of readmission often depend on carers’ ability to support patients. Aim To investigate how carers are supported during patient discharge from acute care towards end of life (EOL) and suitability of using a Carer Support Needs Assessment Tool (CSNAT) to improve this support. Methods Qualitative design: focus groups (FGs) with 40 practitioners supporting patient discharge from three English acute hospital trusts; interviews with 22 carers of patients discharged. 14 practitioners and 5 carers joined two final workshops. FGs/interviews/workshops explored current discharge processes and potential value of using CSNAT. Thematic framework analysis was conducted. Results Both practitioners and carers viewed CSNAT as highly relevant in supporting carers at discharge. Discharge processes were heavily focussed on patients: carers were consulted but about patients’ needs; there was no systematic approach to supporting carers. CSNAT was identified as a means of facilitating much needed EOL conversations which often were absent, enabling carers to articulate concerns, and managing carers’ expectations of their caregiving role at EOL and support available (or not) in the community. However, palliative care discharges were complex: from many different wards involving different practitioners. No single professional group was identified as best placed to support carers. Feasibility issues included skills, confidence and time for carer assessment and support. A two stage process using CSNAT earlier in hospital admission, then as a carer-held record to manage transition to home were seen as ways forward. Conclusion CSNAT shows good potential to enhance carer support at hospital discharge and play a role in preventing readmissions towards EOL. References Ewing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study. J Pain Symptom Manage 2013;46:395–405 Ewing G, Grande GE. Development of a Carer Support Needs Assessment Tool (CSNAT) for end of life care practice at home: a qualitative study. Palliat Med 2013;27:244–256

O-4 Enabling successful hospital discharge to home at end-of-life: how can we support family carers?

Background Successful hospital discharge and prevention of readmission often depend on carers’ ability to support patients. Aim To investigate how carers are supported during patient discharge from acute care towards end-of-life (EOL) and suitability of using the Carer Support Needs Assessment Tool (CSNAT) to improve carer support at discharge. Methods Qualitative design: focus groups (FGs) with 40 practitioners supporting patient discharge from three English acute hospital trusts; interviews with 22 carers of patients discharged. 14 practitioners and five carers joined two final workshops. FGs/interviews/workshops explored current discharge processes and potential value of using CSNAT. Thematic framework analysis conducted. Results Discharge processes were heavily focussed on patients’ needs: there was no systematic approach to supporting carers. Practitioners and carers viewed CSNAT as highly relevant and could be used to facilitate much needed EOL conversations which often were absent and to manage carers’ expectations of their caregiving role at EOL, including support available (or not) in the community. They also provided advice on feasibility of using the five stage CSNAT approach at discharge. Stage 1. CSNAT introduction was seen as crucial, to overcome carer reluctance for support for themselves and to avoid it being viewed as ‘another leaflet’ Stage 2. Carers’ consideration of needs: useful to help manage expectations of caregiving, but carers need to be given time to reflect Stage 3. Assessment conversation: CSNAT questions seen as a useful trigger, but a separate space and a separate focus from patents needed. Stage 4. Action planning: an essential part of the process – giving out the CSNAT was not ‘job done’ Stage 5. Review: challenge in this context is the transition to home, but CSNAT as a carer-held record was a possible solution. Conclusion CSNAT shows good potential to enhance carer support at hospital discharge and play a role in preventing readmissions towards EOL. Funder: Marie Curie.

LB031-SUN: Concurrent Validity of Fat Free Mass Using Computed Tomography and Bioelectrical Impedance Analysis in People with Colorectal Cancer (CRC) and Weight Loss

Malnutrition can lead to poor outcome in patientswith colorectal cancer (CRC). Body composition, particularlysarcopenia, may be directly pertinent to clinical outcome [1].However, there are minimal data on the roles of computedtomography (CT) and bioelectrical impedance analysis (BIA)in determining body composition in this group.