A dietitian in every gastrointestinal and head and neck tumour board
Malnutrition is the commonest untreated complication in cancers of the gut, throat and pancreas. Putting a dietitian in the meeting where treatment is decided means it is seen and treated before chemotherapy starts, not after weight has been lost.
Guidelines require malnutrition screening at diagnosis, and trials show dietitian counselling improves treatment completion in head and neck and gastrointestinal cancers, yet audits find fewer than half of patients are screened and dietitian referral typically follows, rather than precedes, treatment. Embedding a dietitian in the multidisciplinary team meeting for upper GI, pancreatic, colorectal and head and neck cancer, with authority to initiate nutrition therapy, prehabilitation and enzyme replacement, is a service-design change with a plausible effect on dose intensity and surgical complications.
- Cachexia, toxicity and the limits of the patient · Patients often die of wasting or cannot tolerate the doses that would work. Treating the patient, not just the tumour, lags far behind.
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.