Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Development of a novel NET-nutrition screening tool to identify patients requiring nutrition-related intervention and support (#474)

Erin Laing 1 , Nicole Kiss 1 2 , Jenelle Loeliger 1 2 , Belinda Steer 1 2 , Michael Michael 3 4 , Nick Pavlakis 5 , Meredith Cummins 6 , Simone Leyden 6 , David Chan 5 , Megan Rogers 3 , Grace Kong 3 7 , Lara Edbrooke 8 9 , Lynda Dunstone 6 , Meinir Krishnasamy 10 11
  1. Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. School of Exercise & Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
  3. Upper Gastrointestinal & NET Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  4. Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  5. Medical Oncology Department & NET Unit, Royal North Shore Hospital, Sydney, VIC, Australia
  6. NeuroEndocrine Cancer Australia, Australia
  7. Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  8. Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  9. Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
  10. Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  11. Department of Nursing, University of Melbourne, Melbourne, VIC, Australia

Aim

Patients with neuroendocrine tumours (NET) are at risk of malnutrition, malabsorption and dietary change, but existing validated nutrition screening tools are not designed to capture complex NET symptoms and nutrition issues. This study aimed to develop a novel nutrition risk screening tool to improve early identification of patients with NETs requiring nutrition intervention.

Methods

Virtual focus groups and a two-round, online modified Delphi survey, involving international multidisciplinary NET health professionals (HP), informed the tool content and structure. The Delphi survey established consensus on the importance, wording and response options for proposed tool items. Acceptance criteria for inclusion of items between rounds was set at 75% (of rating > 7 on the 9-point Likert scales). Patients with NETs attending clinics at an ENETS Centre of Excellence in Melbourne were recruited to test the tool utility against key domains (ease of use, format, acceptability), assessed using a 5-item survey (with 7-point Likert scales), and test-retest study of item reliability.

Results

Twenty-two multidisciplinary HPs, from 5 countries/regions, participated in focus groups developing essential content for the initial 7-item tool (NET-NS). In Delphi round one, 46 HPs (including Medical Oncologist n=14, Surgeon n=8, Nurse n=7, Dietitian n=6) from across 6 countries/regions (Aus=21, Canada=6, Europe=11, NZ=5, US=3) revised the tool. After round one, all questions were retained (100% rated >4, 60% rated >7) with wording changes. Twenty-four (52%) participants completed Delphi round two, after which 6/7 questions (relating to NET-symptoms and diet change) met acceptance criteria, resulting in a 6-item tool. Consumer testing results were positive, with mean survey responses of 6.3-6.9 (SD 0.3-0.7, n=15), and 9/11 sub-items scoring >0.833 on the test-retest study (n=24).

Conclusions

Using NET HP expertise and consumer-informed utility testing, a novel NET-nutrition risk screening tool has been developed. Planning for a multi-site validation study and international implementation is underway.