Semantic Convergence with LLMs for Head and Neck Cancer Quality Indicators.

We developed a novel method for leveraging large language models (LLM) to systematically filter and categorize large numbers of clinical quality indicators (CQI) for head and neck cancer. This was used to transform a tedious, human-resource intensive review process into a more efficient, knowledge-driven approach. Although we have successfully demonstrated the successful application of this approach to reduce manual effort overall, it is not possible to rely entirely on language models for such a task, and human oversight remains essential.

Critical actions for embedding research evidence into practice: how to get the most out of your implementation scientist.

Abstract: Implementation science has been gaining traction over the last decade to support health care systems in adopting and sustaining evidence-based interventions, programs, and policies. Given the inherent complexity of implementation research and practice, and their associated methodologies, implementation scientists play a central role in translating research into practice. However, many health care system stakeholders often struggle to understand how best to collaborate with implementation scientists.

Navigating pain and appetite challenges in palliative care for pancreatic cancer: insights from a national, longitudinal consecutive cohort study.

Purpose: Pancreatic cancer poses significant challenges in symptom management. Many people have intractable pain and anorexia which is often not amenable to current available options for palliation. This study aims to outline the longitudinal patterns and assess the burden of distress related to pain and appetite experienced by individuals with pancreatic cancer in people referred to Australian palliative care services.

Current Challenges in Digital Representation of Variation in Cancer Care.

Advances in cancer treatment have improved patient outcomes and survival in recent decades. Increased complexity, duration, and individualisation of treatment protocols present an important challenge for care teams monitoring adherence to best-practice care. A rigid rules-based system for flagging outliers is not fit for purpose, as there are sound reasons for deviating from baseline protocols, such as the management of treatment side effects to a tolerable degree, however the methods for determining the bounds of appropriateness for variation are not well studied or understood.

Poor nutrition status associated with low patient satisfaction six months into treatment for head and neck/esophageal cancer treatment: A prospective multicenter cohort study.

Background: Patient-reported outcome measures have been associated with survival in oncology patients. Altered intake and malnutrition are common symptoms for patients treated for head and neck cancer and esophageal cancer (HNC/EC). The purpose of this study was to examine the relationship between patient-reported satisfaction with medical care and nutrition status.

Quantifying the severity of sarcopenia in patients with cancer of the head and neck.

Background & Aims: Existing skeletal muscle index (SMI) thresholds for sarcopenia are inconsistent, and do not reflect severity of depletion. In this study we aimed to define criterion values for moderate and severe skeletal muscle depletion based on the risk of mortality in a population of patients with head and neck cancer (HNC). Additionally, we aimed to identify clinical and demographic predictors of skeletal muscle depletion, evaluate the survival impact of skeletal muscle depletion in patients with minimal nutritional risk or good performance status, and finally, benchmarking SMI values of patients with HNC against healthy young adults.

A Multi-Site, International Audit of Malnutrition Risk and Energy and Protein Intakes in Patients Undergoing Treatment for Head Neck and Esophageal Cancer: Results from INFORM.

Patients with foregut tumors are at high risk of malnutrition. Nutrition care focuses on identifying individuals at risk of malnutrition and optimizing nutrient intake to promote the maintenance of body weight and lean body mass. This multi-center prospective, longitudinal study audited nutrition care practices related to screening for risk of malnutrition (Patient-Generated Subjective Global Assessment Short Form; PG-SGA SF), and nutrition interventions prescribed (route; adequacy of energy and protein intakes).

Mapping ongoing nutrition intervention trials in muscle, sarcopenia, and cachexia: a scoping review of future research.

Muscle loss alone, or in the context of sarcopenia or cachexia, is a prevalent condition and a predictor of negative outcomes in aging and disease. As adequate nutrition is essential for muscle maintenance, a growing number of studies has been conducted to explore the role of specific nutrients on muscle mass or function. Nonetheless, more research is needed to guide evidence-based recommendations.

Comparison of prophylactic percutaneous endoscopic gastrostomy with reactive enteral nutrition in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy: A systematic review.

Background & Aims: Nutrition support is frequently indicated in patients with head and neck cancer (HNC). However, the optimal timing of enteral tube placement and feeding commencement is unknown. This review aims to compare the outcomes for patients with HNC undergoing curative intent radiotherapy (RT) or chemoradiotherapy (CRT) receiving either prophylactic percutaneous endoscopic gastrostomy (pPEG) tube placement/feeding or reactive enteral nutrition (rEN).

Nutritional outcomes in patients undergoing transoral robotic surgery for head and neck cancers compared to conventional open surgery. Systematic review.

This systematic review examined nutritional outcomes in patients undergoing transoral robotic surgery (TORS), compared to open surgery (OS) for head and neck cancer. PUBMED, CINAHL, and Web of Science were systematically reviewed. Target nutritional outcomes included: weight, nutritional status, use of enteral feeding, swallowing function/ability, and time to oral diet.

Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes.

Background: Computed tomography (CT)-defined skeletal muscle depletion and malnutrition are demonstrated as poor prognostic factors in patients with head and neck cancer (HNC), however to date, have only been explored in isolation. We aimed to describe body composition profile and examine the impact of nutritional status as well as independently and concurrently occurring body composition features on overall survival, treatment completion, unplanned admissions and length of stay (LOS) in patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) of curative intent for HNC.

Methods: This work is a retrospective, observational study of patients who had completed treatment of curative intent for HNC.

Evaluation of the agreement, adoption, and adherence to the evidence-based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians.

Aim: Evidence-based guideline translation to practice can improve outcomes but is often impaired by poor implementation. This project aimed to evaluate the implementation of the Evidence-based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians providing clinical care to this population.

Methods: A questionnaire was developed, with face and content validity confirmed by an expert panel (n = 13), to gauge participant perceptions of the guidelines against an implementation evaluation framework.

The effect of timing of enteral nutrition support on feeding outcomes and dysphagia in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy: A systematic review.

Background & Aims: Patients with head and neck cancer (HNC) often require enteral nutrition (EN). This systematic review reports the effect of EN timing in patients with HNC undergoing curative-intent and definitive or adjuvant radiotherapy or chemoradiotherapy on tube feeding duration, tube-related complications and dysphagia.

Methods: Randomised controlled trials (RCTs) published between January 2015-April 2020 were obtained from Medline, CINAHL and Embase.

Optimal frequency of individualised nutrition counselling in patients with head and neck cancer receiving radiotherapy: A systematic review.

Background: Head and neck cancers (HNC) are strongly associated with malnutrition. This systematic review aimed to investigate the optimal frequency of individualised nutrition counselling (INC) pre-, peri- and post-treatment for patients with HNC.

Methods: Pubmed, EMBASE, Cinahl and Scopus were searched from inception through to April 2020 to identify randomised controlled trials (RCTs) that focused on the INC frequency for adult patients with HNC (Registration no.

Computed tomography (CT)-defined sarcopenia and myosteatosis are prevalent in patients with neuroendocrine neoplasms (NENs) treated with peptide receptor radionuclide therapy (PRRT).

Background/objectives: Neuroendocrine neoplasms (NEN) may predispose patients to malnutrition. CT-defined sarcopenia and myosteatosis are common in other tumour types and recognized adverse prognostic factors. However, the prevalence and prognostic impact of sarcopenia and myosteatosis remain undetermined in NEN patients to date.

"There's a lot of talent in the room but it's only really the medical talent that gets heard": a qualitative exploration of multidisciplinary clinicians' perspectives of optimal nutrition care of patients with head and neck cancer.

Background: The high prevalence of malnutrition in patients with head and neck cancer (HNC) negatively impacts outcomes. The best-available evidence has been published in clinical nutrition guidelines; however, translation into practice has lagged.

Aim: This project aimed to explore multidisciplinary team (MDT) clinicians' perspectives regarding barriers and enablers to best-practice nutrition care in order to inform the design of a new model of care.

Translating Evidence-Based Guidelines into Practice-Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM).

Malnutrition is highly prevalent in patients with foregut tumors comprising head and neck (HNC) and esophageal (EC) cancers, negatively impacting outcomes. International evidence-based guidelines (EBGs) for nutrition care exist; however, translation of research evidence into practice commonly presents considerable challenges and consequently lags. This study aimed to describe and evaluate current international nutrition care practices compared with the best-available evidence for patients with foregut tumors who are at high risk of malnutrition.

Is sarcopenia a predictor of prognosis for patients undergoing radiotherapy for head and neck cancer? A meta-analysis.

Introduction: Computed tomography (CT)-defined sarcopenia is a demonstrated poor prognostic factor for survival in patients with cancer, however, its impact in patients with head and neck cancer (HNC) has only recently been explored. This study aimed to determine the prognostic impact of CT-defined sarcopenia at the level of the third lumbar vertebra (L3) on overall survival in patients with HNC undergoing radiotherapy ± other treatment modality of curative intent.

Methods: A systematic review of the literature published between January 2004 and May 2020 was conducted in Medline, Embase, CINAHL, AMED and PubMed.

Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia.

This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer-related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence-based guidelines, systematic reviews and meta-analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members.

The Association Between Computed Tomography-Defined Sarcopenia and Outcomes in Adult Patients Undergoing Radiotherapy of Curative Intent for Head and Neck Cancer: A Systematic Review.

Background: Computed tomography (CT)-defined sarcopenia is a demonstrated poor prognostic factor in patients with cancer; however, its influence on outcomes for patients with head and neck cancer (HNC) has not been established.

Objective: This review synthesizes current knowledge regarding the association between CT-defined sarcopenia and outcomes for adult patients undergoing radiotherapy with or without other treatment modalities of curative intent for HNC.

Methods: A systematic review of the literature published between January 2004 and June 2019 was conducted in Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and PubMed.

Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes.

Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence-practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition.