Early Supportive and Nutritional Care For Adults With Pancreatic Cancer: A Pilot Study

Abstract

Context

Individuals diagnosed with advanced pancreatic cancer face a poor prognosis, heightening the importance of interventions aimed at improving quality of life. Quality of life for individuals with pancreatic cancer is highly influenced by symptom burden and nutritional status. Programs are needed that coordinate palliative and nutrition care for this population.

Objectives

To address this gap, we conducted a single-arm feasibility trial of Support Through Remote Observation and Nutrition Guidance Plus Supportive Care (STRONG+), a 12-week team-based digital intervention to reduce malnutrition and improve quality of life for individuals with advanced pancreatic cancer.

Methods

Participants initiating palliative chemotherapy were referred for early and ongoing dietitian-led nutrition counseling and supportive care visits led by a palliative care specialist during the first three months of chemotherapy. Participants also logged food intake daily and completed patient-reported outcome assessments monthly, data that was shared with the dietitian and palliative care specialist through a web-based dashboard. Feasibility and acceptability outcomes were compared against prespecified benchmarks. Preliminary effectiveness was evaluated based on change in patient outcomes between baseline and last follow-up at 16 weeks using linear and ordered logistic regression models. Outcomes included malnutrition risk assessed using the Patient-Generated Subjective Global Assessment Short Form and health-related quality of life measured using the FACT-G. Qualitative data obtained through interviews with participants, their caregivers, and clinicians was analyzed for themes.

Results

Among the 83 eligible patients who were invited to participate in the study, 50 patients consented to participate. A total of 12 individuals withdrew or died prior to study conclusion. Participants who completed the study (N = 38) had a mean age of 65. Feasibility benchmarks were achieved for participant recruitment (60% vs. benchmark: 50%), attrition (24% vs. benchmark: 30%), study assessment completion (84% vs. benchmark: 70%), and adherence to nutritional counseling (68% vs. benchmark: 60%) and supportive care visits (61% vs. benchmark: 60%). Participants found the overall intervention to be highly acceptable (94% vs. benchmark: 70%). Caregivers also rated the intervention as highly satisfactory (87%). Compared to baseline, participants saw decreased malnutrition risk (P < .001) and improved general health-related quality of life (P = .009) at the end of the study (16 weeks). Participants cited benefits of the intervention including increased knowledge about self-managing nutrition and improved symptom management. Participants provided recommendations for intervention refinement, such as providing recipes and more hands-on nutrition instruction.

Conclusion

Study findings suggest the intervention may be feasible and acceptable. Future research is needed to refine the intervention and test the intervention in a fully powered trial. Because the study focused on patients initiating palliative chemotherapy who may benefit from nutrition counseling, findings may be limited in generalizability to all individuals with pancreatic cancer.