Madison Gartman
Outcome Measures Project
Final Outcome Measures Project:
Comparison Study of Chemotherapy Outpatients Receiving Nutritional Care and Education
Provided by a RD
Madison Gartman
Dietetic Intern
G.V. (Sonny) Montgomery VA Medical Center
Madison Gartman
Outcome Measures Project
Introduction:
Nutrition status of patients undergoing chemotherapy is a concern in a variety of healthcare
facilities. Chemotherapy involves taking strong drugs, orally or by injection, which kill cancer
cells; however, healthy cells, such as bone marrow, lining of the digestive tract, and hair, may be
killed during the treatment (American Cancer Society, 2006). During cancer treatment, nutrition
plays a vital role in maintaining adequate protein stores and weight management.
High protein intake is needed during chemotherapy due to increased energy needs needed
during the high intensity treatment. Recent studies have shown serum albumin to drop during the
course of chemotherapy, which indicates protein depletion (Inversen et al, 2008; Inversen et al,
2010). Improving patient intake of protein would improve albumin status and nutritional status.
Consumption of high protein foods is recommended during chemotherapy while experiencing
common side effects, such as low white blood count, nausea, vomiting, poor appetite,
constipation, diarrhea, mouth sores, fatigue, and weight loss (American Cancer Society, 2006).
Several patients undergoing chemotherapy experience weight loss. Researchers (Inversen
et al, 2008; Inversen et al, 2010) have noted muscle mass decreased in patients during cancer
treatment, indicating body composition was affected by treatment. Body mass index (BMI) did
not decrease as expected (Inversen et al, 2008); however, patients had a median baseline BMI of
25 kg/m2, which is considered overweight by height. A decrease in weight management may be
associated with poor appetite, nausea, vomiting, and swallowing difficulty, which are all
common side effects of chemotherapy.
Patients undergoing chemotherapy would benefit from receiving a nutritional assessment
by a Registered Dietitian (RD). An RD provides individualized nutritional care and education for
each patient. The Clinical staff within the Department of Nutrition and Food Services at G.V.
Madison Gartman
Outcome Measures Project
(Sonny) Montgomery VA Medical Center will conduct a comparison study on nutritional status
of chemotherapy patients since current protocol does not require nutritional screenings or
assessments on chemotherapy patients, unless consulted by a Medical Doctor (MD). The purpose
of this study is to determine the need for a full-time RD in the chemotherapy department to
screen and assess all patients needing nutritional assessments, which will result in improved
serum albumin levels and weight management.
Madison Gartman
Outcome Measures Project
Objectives:

To determine if nutritional care and education by RDs are an effective form of care in
patients undergoing chemotherapy.

To determine if medical nutrition therapy initiated by RDs improve serum albumin levels
and weight management for patients undergoing chemotherapy.
Study Sample:

A total of 100 chemotherapy patients will be screened and assessed; 50 patients will
be in the intervention group receiving nutritional care and education by an RD, and
50 patients will be in the control group receiving nutritional care and education as
needed.

Inclusion Criteria:
 Chemotherapy outpatients at G.V. (Sonny) Montgomery VA Medical Center,
Jackson, MS.
 Chemotherapy outpatients aging 45 years and older, which is due to the
current population at G.V. (Sonny) Montgomery VA Medical Center.

Exclusion Criteria:
 Outpatients undergoing dialysis will not be included in the study.
 Chemotherapy inpatients at G.V. (Sonny) Montgomery VA Medical Center,
Jackson, MS, will not be included in the study. Inpatients will not be included
because inpatients are followed by RDs while in the hospital.
Methodology and Procedures:

All data collection will occur at G.V. (Sonny) Montgomery VA Medical Center in
Jackson, MS.
Madison Gartman
Outcome Measures Project

The time frame for the data collection is 2 months.

The data will be collected by the clinical outpatient RD over the Green Clinic, which is
the RD who recieves consults involving chemotherapy outpatients.

The unit which will be included in the study is the G.V. (Sonny) Montgomery VA
Medical Center chemotherapy clinic. This clinic is also easily accessible for the Green
Clinic RD, who will be conducting the data collection.

The Green Clinic RD must screen each chemotherapy outpatient for nutritional risks, and
assess as needed; however, for the intervention group, the RD must assess and provide
individualized nutritional care and education for each patient.
Data Collection Methodology (Control Group):

A total of 50 chemotherapy outpatients in the control group will be screened using the
G.V. (Sonny) Montgomery VA Medical Center nutritional screening tool to determine
the nutritional status of patients, as well as perform an assessment as needed.

The assessments of the patients within the control group will not be initiated. It is
important to obtain nutritional measurements on the control group for comparison
purposes.

The 50 chemotherapy outpatients will be followed on an as needed basis. The RD will
document serum albumin lab data and weights.
Data Collection Methodology (Intervention Group):

A total of 50 chemotherapy outpatients in the intervention group will be assessed using
the G.V. (Sonny) Montgomery VA Medical Center nutritional screening tool to
determine the nutritional status of patients, as well as perform assessments on each
patient.
Madison Gartman
Outcome Measures Project

Nutritional assessments completed for the 50 outpatients in the intervention group will be
done on an individual basis and the American Dietetic Association and American Cancer
Society guidelines for nutritional needs of patients undergoing chemotherapy will be
used.

Nutritional recommendations for the intervention group will be initiated.

The Green Clinic RD will follow-up on each patient in the intervention group every every
5-7 days to determine nutritional status, monitor lab values and weight, and make
additional nutrition recommendations as needed.

Once all of the data has been collected, the intervention and control groups will be
compared to determine if an RD is needed full-time in the chemotherapy department to
improve the nutritional status of the outpatients and if outpatients improved their serum
albumin levels and weight maintenance after having nutritional care and education from
an RD.
Data Collection Tools:

Tools to be used to collect data from outpatients include the G.V. (Sonny) Montgomery
VA Medical Center patient computer programs CPRS and Vista.
o CPRS is a computer program that entails all patient records. These individual
records include appointments, medications, diagnoses, assessments, notes,
weights, and lab data. This program will be used to examine and determine the
nutritional status and needs of each patient.
o Vista is a computer program that entails all patient information, which provides
current information pertaining to patients’ diet orders, and allows RDs to perform
edit and create nutritional assessments. Vista allows patient information to be
Madison Gartman
Outcome Measures Project
updated and transferred to CPRS to finalize and record nutritional assessments.
Data Analysis:

All data collected will be organized into a Microsoft Excel Spreadsheet by the Green
Clinic RD.

Once data is organized, SPSS statistical software will be used to conduct data analysis.
The Green Clinic RD will be responsible for utilizing the statistical software.

Descriptive statistics will be done on the mean albumin levels and weight changes of
patients within the control and intervention groups. This data will be presented in the
form of a table for the comparison of each group to determine significant differences.
Summary and Production of Reports:

Once the study has concluded and the statistical analysis is complete, the Green Clinic
RD and the Clinical Nutrition Manager will be responsible for writing the final report
within six months from the date the study was complete.

The final report will include characteristics of the sample used, results from the data
analysis in the form of charts and tables, and a comparison of outcomes between the
control and intervention group. Also, the report will discuss the implications from the
study that can be incorporated into clinical practice at G.V. (Sonny) Montgomery VA
Medical Center, which may entail hiring a full-time RD to oversee the chemotherapy
clinic to improve the nutritional status of chemotherapy outpatients.
Madison Gartman
Outcome Measures Project
Appendix:
Mean Values
Control
Intervention
Albumin levels
Weight changes
5
4.5
Albumin Levels
4
3.5
3
2.5
Nutrition
2
Control
1.5
1
0.5
0
2
4
6
8
# of Persons w/ Weight Changes
Weeks of Chemotherapy
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Nutrition
Control
2
4
6
Weeks of Chemotherapy
8
Madison Gartman
Outcome Measures Project
References:
American Cancer Society. (2006). Nutrition for the person with cancer during treatment: a guide
for patients and families. www.cancer.org
Iversen, P.O., Ukrainchenko, E., Afanasyev, B., Hulbekkmo, K., Choukah, A., Gulbrandsen, N.,
Wisloff, F., & Tangen, J. (2008). Impaired nutritional status during intensive
chemotherapy in Russian and Norwegian cohorts with acute myeloid leukemia. Leukemia
& Lymphoma, 49(10), 1916-1924. doi: 10.1080/10428190802339723
Inversen, P.O., Wisloff, F., & Gulbrandsen, N. (2010). Reduced nutritional status among
multiple myeloma patients during treatment with high-dose chemotherapy and
autologous stem cell support. Clinical Nutrition, 29, 488-491.
doi:10.1016/j.clnu.2009.12.002