NutriCare:

Intervention on Optimizing Nutritional Status, Reducing Treatment-Related Toxicities, and Improving Quality of Life Among Vulnerable Patients with Lung Cancer

NutriCare randomized 280 participants into two groups at a 1:1 ratio: an intervention group and an enhanced control group. Participants assigned to the enhanced control group, called NutriTool, received printed educational nutrition materials and monthly emails. Participants assigned to the intervention group, received the full NutriCare intervention, which included a nutrition prescription, referral to registered dietitians (RDs) for remotely delivered medical nutrition therapy counseling, and home delivery of medically tailored meals along with the printed materials and monthly emails. This project addressed critical gaps in improving the nutritional status of vulnerable patients with lung cancer at the system level by achieving the following specific aims.

Aim One

The study evaluated the implementation of integrating NutriCare into oncology care by measuring: (a) participation; (b) retention; (c) patient compliance with the intervention components; and (d) compliance of the oncology healthcare team in delivering the intervention in outpatient oncology clinics.

Aim Two

It also assessed the efficacy of the intervention in optimizing nutritional intake, reducing food insecurity, minimizing unintentional weight loss, improving treatment compliance, reducing treatment-related toxicities, reducing hospitalizations, readmissions, and emergency department (ED) visits, and improving the gut microbiome among vulnerable patients with lung cancer. The team examined:
(a) changes in diet quality and intake of key food groups and nutrients as assessed by the National Cancer Institute Diet History Questionnaire (DHQ III);
(b) changes in food insecurity measured by the U.S. Department of Agriculture (USDA) Household Food Security Survey;
(c) changes in weight and percent weight loss as measured in the clinic;
(d) treatment completion (dose reductions and treatment delays) as assessed by the treating medical oncologist;
(e) treatment-related toxicities as assessed by the treating medical oncologist using the National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Events (CTCAE);
(f) hospitalizations and ED visits as assessed by medical record review and linkage with discharge data; and
(g) changes in the gut microbiome via metagenomic whole shotgun sequencing (mWGS).

Aim Three

Finally, the study evaluated the efficacy of the intervention in improving patient-reported outcomes among vulnerable patients with lung cancer. The team assessed:
(a) changes in patient-reported symptoms (fatigue, pain, nausea, vomiting, appetite loss, and sleep disturbance) as measured by the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE);
(b) changes in quality of life as measured by the EORTC-QLQ-30 and EORTC-QLQ-LC13;
(c) changes in anxiety as assessed by the GAD-7; and
(d) changes in depressive symptoms as assessed by the PHQ-9.