Malnutrition in upper gastrointestinal (UGI) oncology patients has been reported to range from 42 to 87%. There is increasing evidence that an improvement in dietary intake can improve these outcomes. This evidence has led to the development of evidence-based guidelines to assist translation of research findings into clinical practice. Care pathways are a complex intervention for the mutual decision making and organisation of care processes for a well defined group of patients during a well defined period. Care pathways have been developed by the Nutrition Department at Peter MacCallum Cancer Centre in each of the high nutrition risk tumour streams.

The objectives of this project were to develop and implement nutrition evidence-based care pathways, in collaboration with the UGI multidisciplinary team, to guide nutritional management of UGI cancer patients.

A comprehensive literature review was completed and two evidence based care pathways were developed (chemoradiation and surgical) to guide practice for screening, timing and frequency of review and nutritional interventions. Audits comparing usual care and care post pathway implementation were utilised to assess clinician adherence to the evidence-based nutrition care pathways

Compliance with the care pathway components were: screening (100% surgical, 100% chemoradiation), timing of first contact (90% surgical, 100% chemoradiation), frequency of review (90% surgical seen during admission, 75% seen weekly during chemoradiation), interventions (90% surgical, 100% chemoradiation) and follow up (90% surgical, 100% chemoradiation). Reasons for non compliance included patients missing scheduled appointments, dietitian discretion for well nourished patients, and Patient Generated Subjective Global Assessment (PG-SGA) not being completed due to ICU admission.

Evidence based nutrition care pathways for UGI patients can provide standardisation of care, reduction of variation in practice and facilitate the translation of national evidence-based guidelines into local protocols. Further research to determine if these care pathways improve patient outcomes should be investigated