CASE STUDY: Early Intervention by a PCN Dietitian Improves Long Term Outcomes
Jenny Ward, Unity PCN Dietitian, Coventry
Case Study 1: Early Intervention by a PCN dietitian
1) Patient Background
A 57-year-old male was referred to the PCN dietitian by a GP. He was on a "2-week-wait" pathway for suspected oesophageal cancer and was awaiting biopsy and CT results. He had experienced a concerning 6% unintentional weight loss over a few weeks, with his weight dropping from 87-88 kg to 83 kg. His main symptoms included a significantly reduced appetite, severe reflux, and an inability to tolerate anything other than soft foods
2) Dietetic Intervention and Plan
The PCN dietitian provided crucial early intervention within one day of the referral, as he couldn't be seen by hospital oncology dietitians until his diagnosis was confirmed. The immediate advice included:
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Meal Pattern: Shifting to small, frequent meals to manage reflux and increase intake.
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Nutrient Density: Recommending food fortification and a high-calorie, high-protein diet to prevent further weight loss.
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Texture Modification: Guidance on prioritizing nutrient-dense soft foods.
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Oral Nutritional Supplements (ONS): Arranging for samples to be trialled.
A week later, his supplement trial was successful, leading to a specific plan: Altraplen Energy 5-6 times/day and Altraplen Compact Daily once/day, alongside a soft diet.
3) Outcome and Follow-up
Two weeks after the initial intervention, the patient's weight was stable. He was consistently taking the prescribed ONS. Once his diagnosis of metastatic gastric cancer was confirmed, his care was seamlessly transitioned to the hospital's oncology dietitians.
Benefit of PCN Dietitian: The early intervention prevented further weight loss and stabilised the patient's nutritional status during a period of high clinical uncertainty and stress. This bridged the gap between primary care referral and secondary care diagnosis.