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.