The development of a nutrition care pathway for patients undergoing surgery for upper gastrointestinal cancer

Ms Irene Deftereos1,2, Ms Vanessa Carter1, Ms  Jasmine Everist1, Ms Kathryn Pierce1

1Western Health, Gordon St Footscray, Australia, 2The University of Melbourne, Melbourne, Australia


Malnutrition is a significant problem for Upper Gastrointestinal (UGI) cancer patients, and guidelines recommend perioperative nutritional intervention. In 2016, Western Health Dietetics Department established a UGI Nutrition Clinic alongside UGI surgical oncology clinics, with a Nutrition Care Pathway (NCP) aiming to address service gaps. Appointments link with pre-existing surgical appointments, minimising patient burden and providing multi-discplipinary care.

A retrospective audit of 12 months pre (group 1) and post (group 2) implementation was conducted.

Age, BMI, gender and tumour types were similar in Group 1 (n=32) versus Group 2 (n=30). 60% in Group 2 received nutrition assessment at time of diagnosis, compared to 25% in Group 1. Dietitian input in radiotherapy/chemotherapy increased from 78% to 100%. 78% of patients received review post neoadjuvant therapy, previously not provided. Average dietetic outpatient time pre surgery increased from 2 minutes pre implementation to 35 minutes. Average occasions of service (OOS) pre surgery increased from 1.7 to 4.5. 93% received nutrition follow up within 3 weeks post discharge, compared to 15% pre implementation. 4 hospital admissions for feeding tube issues were avoided. Percentage weight loss was not different, contributed to by low yield from missing data.

Significance to allied health:
Patients now have access to coordinated, consistent, timely, effective nutrition care reflecting best practice.  A process driven, pathway approach linking with pre-existing appointments can ensure a patient centred, multi disciplinary and sustainable model of care.


Irene is a Senior Dietitian at Western Health.  She specialises in Upper Gastrointestinal Surgical Oncology. Irene has worked as a Clinical Dietitian since 2009 in surgical, ICU and oncology settings. Irene is currently undertaking her PhD titled ‘The investigation of preoperative nutritional status and intervention in patients with Gastrointestinal Cancers.’ Irene is passionate about the role of the Dietitian for the nutritional optimisation of surgical patients in the pre and postoperative periods.