Implementing an evidence-based model of pre-operative nutrition care in patients undergoing oral cavity reconstruction surgery for head and neck cancer: a feasibility study.

PURPOSE: Malnutrition is prevalent in patients undergoing reconstruction surgery for head and neck cancer (HNC), impacting negatively on outcomes. Despite the availability of evidence-based guidelines (EBGs), evidence-practice gaps persist. This study examined the feasibility of implementing a pre-operative, nutrition evidence-based care pathway (EBCP).

METHODS

This mixed-methods, pre-post study included a retrospective audit (Jan-Dec 2023) and prospective pilot implementation of a pre-operative, supportive care-led clinic (Oct 2024-Jan 2025). Nutrition care processes (referrals, malnutrition screening, and nutrition assessment with validated tools) were benchmarked against Clinical Oncology Society of Australia (COSA) EBGs. Secondary analysis examined associations with clinical outcomes (complications, length of stay (LOS), and readmissions). Multidisciplinary team (MDT) engagement informed the EBCP, guided by the Action, Actor, Context, Target, Time (AACTT) Implementation Framework.

RESULTS

Pre- (n = 115, 56% male, mean (SD) age 62 (15) years) and post-implementation (n = 41, 64% male, 62 (14) years) cohorts were included. Pre-operative nutrition care processes all improved following EBCP implementation, including referrals (64% vs. 95%, p < 0.001) and malnutrition screening (91% vs. 98%, p = 0.14). False negative screening reduced (22% vs. 10%, p = 0.13) and median time from screening to surgery increased (0 vs. 5 days, < 0.001). Nutrition assessment with a validated tool increased (13% vs. 80%, p < 0.001). Survey responses pre- (n = 11) and post- (n = 8) implementation indicated improved perception of the service and fewer barriers to screening and assessment following ECBP implementation.

CONCLUSION

Implementation of a pre-operative nutrition EBCP is feasible, improves adherence to evidence-based nutrition care for patients with HNC, and has the potential to improve patient outcomes. This model may be transferrable to other areas of cancer care.