Nutrition
The COVID-19 pandemic has changed the clinical nutrition field drastically. Interactions between the dietitian and oncology patients that use to occur predominately in person are now mostly occurring over the phone. Patients can still be seen in person during treatment or clinic visits but on a much more limited basis. For the safety of both patients and staff, dietitians have moved into a mostly remote work routine temporarily. A normal nutrition assessment starts with diet interview on appetite, intake, gastrointestinal (GI) symptoms, weight history, and diet history. Depending on the answers to these areas, the dietitian can then determine appropriate interventions to help increase calorie intake, help with weight changes (usually with a goal of weight maintenance during treatment), and help relieve GI distress or treatment side effects. These interventions are then discussed and explained to patients, and handouts are typically given for the patient to take home. Dietitians can also recommend and manage tube feedings.
While diet interview questions can be asked over the phone, nutrition education can be more challenging. It can be difficult to assess the understanding of recommendations provided and the willingness to make changes. Handouts that are usually provided in person and reviewed during education are now mailed/emailed to patients following education sessions. Some HNC patients have a difficult time talking based on tumor location or medical/surgical interventions (i.e., laryngectomy). This can make telephone communication extremely difficult, especially if the patient lives alone. Utilizing email and other family members can be helpful in these situations. Communication with the interdisciplinary team has also shifted to occur more over the phone/email instead of in person. While this communication is usually sufficient, in-person communication with the medical team tends to provide easier interventions and quicker results. Despite the challenges of remote patient care, utilizing phone communication allows for continued nutrition intervention during this time as well as continuity of care. This experience may lead dietitians to explore further other methods of nutrition counseling (i.e., video appointments); however, the value of in-person contact is always the best method for intervention.