Friday 30th September 2016
Mac Voice, the magazine for Macmillan professionals: Autumn 2016
Patient satisfaction data suggests 98% of patients see the benefit of Ruth Boyce’s specialist services
Imagine battling with a new diagnosis of pancreatic cancer, alongside the weight loss, bloating, increased flatulence, belching, foul smelling and pale stools, to name but a few debilitating symptoms associated with the disease.
Pancreatic cancer is widely recognised as being associated with weight loss and malabsorption, secondary to pancreatic exocrine insufficiency (PEI). This is the disturbance of the exocrine pancreatic function. Ominously, 85% of patients will suffer with malnutrition as a consequence of PEI, which can adversely affect their response to and tolerance of cancer treatment. Interestingly, the main symptom of weight loss has been specifically linked to a decreased survival time in cancer and patients, not to mention lower rates of response to chemotherapy. It is therefore reasonable to suggest that weight stabilisation and optimising nutrition from the point of diagnosis is crucial to overall survival. 
Following a successful application to Macmillan in 2014, the University Hospitals of Leicester (UHL) Nutrition Dietetic Service secured funding for a Senior Specialist Pancreas Cancer Dietitian. The aim was to nutritionally treat all patients that present to UHL with a diagnosis of pancreatic cancer and monitor their nutrition plan throughout their cancer journey.
Since starting in the role, I have successfully developed and implemented a brand new service for pancreatic cancer patients, utilising a range of nutritional interventions. These include:
- Recommending a range of therapeutic diets.
- Appropriately using nutritional supplements.
- Advocating tube feeding to optimise nutrition for our surgical candidates.
Commencing Pancreatic Enzyme Replacement Therapy for all pancreatic cancer patients, to minimise the catastrophic consequence of PEI. This involves teaching patients how to take enzymes with food and drinks and ensuring they take correct amounts.
Patient satisfaction and audit data from 2015 suggested 98% of patients were either ‘satisfied’ or ‘very satisfied’ with the dietetic service they received. 74% gained or maintained their weight, while 64% reported considerable improvement in their bowel habits. Patients were posed with the question ‘Is there anything the dietitian did well for you and/or your family?’ Responses included:
‘After speaking to the dietitian my overall outlook improved significantly (outstanding). She made me feel I was going to survive.’
‘Her continuing support and encouragement has been invaluable, from initially explaining the benefits of correct nutrition on healing and health, to the supply of nutritional supplements and booklets then discussion with family regarding pancreatic enzymes.’
I continue to promote the important role of nutrition in pancreatic cancer at a range of events. In November 2015, I presented nationally alongside my Specialist Nurse Colleague at the Pancreatic Society of Great Britain and Ireland. I also represented UHL in April 2016 at a pancreatic disease workshop in Santiago de Compostela to augment my working knowledge further in the area of PEI. I actively support Pancreatic Cancer UK wherever possible, answering diet-related questions should the nurse specialist on the support line require advice, attending their excellent study days and signposting patients to their services, alongside Macmillan support to ensure a holistic patient approach.
I am very fortunate to work with a phenomenally experienced and passionate team and consider it an absolute privilege to work with such a stoic group of patients. I will be forever thankful to Macmillan for giving me the opportunity to make a difference to people’s lives.
1. Argiles JM. Cancer-associated malnutrition. European Journal of Oncology Nursing. 2005. 9(2):39-50.
2. Ferrucci LM et al. Nutritional status of patients with locally advanced pancreatic cancer. Support Care Cancer. 2011. 19(11): 1729-34.
3. Pancreatic Cancer UK. Time to change: : A plan of action for pancreatic cancer. 2013.
Macmillan Senior Specialist Dietitian
Leicester General Hospital