title: Establishing a cancer nutrition rehabilitation program (CNRP) for ambulatory patients attending an Australian cancer center.
abstract: OBJECTIVE
  To establish a multidisciplinary Cancer Nutrition Rehabilitation Program (CNRP) for the management of the anorexia-cachexia syndrome (ACS) in an Australian cancer center and to evaluate outcomes of 2 months participation in the CNRP METHOD: Patients were eligible if they had significant anorexia/weight loss, identified by their oncologist or the Malnutrition Screening Tool. In the 9 months that funding was available, 54 participants (37 males, 17 females; median age, 62 years) enrolled. They had mainly lung or gastrointestinal cancers, with 67% receiving chemotherapy concomitantly. Baseline assessments of nutrition and physical status were: median weight 62.7 kg, median weight loss 10.2%, median BMI 21.2 kg/m(2), and 78% malnourished according to PG-SGA. Median baseline Karnofsky performance score (KPS) was 70%, with reduced right-hand grip strength (RGHS; median, 27 kg) and endurance (median, 6 min walk test 6MWT 442 m). Patients received individualized nutritional interventions, exercise programs, and symptom management and were followed prospectively for up to 6 months.
  
  
  RESULTS
  Twenty-five (58%) of 41 evaluable CNRP participants attended the 2-month follow-up. Median weight (63.4 kg), KPS (80%), endurance (6MWT 570 m), and strength (RGHS 28 kg) were all improved. Edmonton symptom assessment scores (36 vs 27) and C-reactive protein levels (39 vs 22) fell. Participants were significantly more likely to return for re-evaluation if at baseline they were having anticancer therapy (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.3-16.2) or could walk >420 m in 6 min (OR 21, 95% CI 1.9-227).
  
  
  CONCLUSIONS
  A CNRP may be beneficial for patients with advanced cancer and the ACS, but identification of patients who are likely to stay on the program is needed.
authors.affiliation: MSKCC, New York, NY, USA. glarep@mskcc.org
authors.forename: Paul
authors.initials: P
authors.lastname: Glare
authors.forename: Wendy
authors.initials: W
authors.lastname: Jongs
authors.forename: Bill
authors.initials: B
authors.lastname: Zafiropoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000855:Anorexia / Q000209:etiology / Q000534:rehabilitation*; D001315:Australia; D002097:C-Reactive Protein / Q000378:metabolism; D002100:Cachexia / Q000209:etiology / Q000534:rehabilitation*; D002173:Cancer Care Facilities; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein