Management of nutrition in individuals with pancreatic cancer

Enrolled participants will have the choice to attend an in-person dietetics consultation at their nearest Epworth HealthCare facility. However, if attending in-person is not convenient or feasible, telehealth consultations will be available. These virtual sessions can be conducted either over the phone or through Microsoft Teams. The frequency of follow-up consultations will be tailored based on the patient’s prognosis, treatment plan, and the health status as per ESPEN practical guidelines. Dietetic assessment and review: • BMI, PG-SGA (malnutrition) questionnaire, SARC-F (sarcopenia) questionnaire • Clinical symptoms and situation: Including nausea, vomiting, bowel function, treatment plan and side effects (if applicable), operative plan (if applicable) • Dietary intake: - Review current dietary intake, changes/impacts from clinical situation, implementation of previous dietetic strategies (if applicable) using a food diary template designed specifically for this study. - Assess whether meeting estimated energy and protein requirements in line with ESPEN guidelines for preventing/treating malnutrition pre-operatively. Dietetic intervention: • Strategies to maintain weight prior to systemic therapy and to enhance oral intake if currently suboptimal i.e., high calorie high protein meal fortification, oral nutrition supplements such as Fortisip®/Resource® will be measured via weight chart designed specifically for this study. • Consideration of escalated nutrition support via artificial feeding if oral intake severely suboptimal or patient severely malnourished (liaise with treating team). • Participants will be provided written handouts of the nutrition counselling session, as needed. • They will also receive nutrition pamphlets to further highlight common side-effects of treatment, such as loss of appetite and weight loss. These are readily available resources located on the Jreissati Pancreatic Centre website: https://www.epworth.org.au/-/media/project/epworth/epworthweb/documents/services/jreissati-family-pancreatic-centre/pi2429-jpc-nutrition-guide-a5-v6-web.pdf Frequency of follow-up Follow-up appointments will be scheduled according to nutrition risk stratification at diagnosis/planning and pre/post therapy. For instance, participants with a PG-SGA assessment of ‘B’ or ‘C’ (i.e., malnourished) may require additional dietetic review to optimise their nutrition, compared to a participant with a PG-SGA 'A' assessment whose dietary intake is likely adequate. Individuals who are considered low risk (A assessment) will be followed-up every month. Those in moderate risk (B assessment) will be followed up via telehealth or clinic review every 1-2 weeks. Individuals at severe risk (C assessment) will require 1-2 telehealth/clinic reviews per week or inpatient admission. The frequency of these follow-ups will occur over a maximum duration of a year.