Yiyuan Zhao¹ （RN，MSN，NP）, Jingjing Wang¹  （RN，BN）, Yanli Wang²（RD）, Yening Zhang³（MD）, Ying Zhang¹（RN，BN）, Bin Zhang¹（MD，Professor）, Yuhan Lu⁴（RN，MSN，NP, Professor）

1. The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck, Peking University Cancer Hospital & Institute, Beijing, China

2. The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Nutrition, Peking University Cancer Hospital & Institute, Beijing, China

3. The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-oncology, Peking University Cancer Hospital & Institute, Beijing, China

4．The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Nursing Department, Peking University Cancer Hospital & Institute, Beijing, China

Rehabilitation management is crucial for postoperative inpatients with head and neck cancer (HNC) to reduce treatment related complications such as excessive salivary flow, anastomotic fistula and poor nutritional status. Recently, we conducted a study that aimed to establish a Nutrition-Rehabilitation Multidisciplinary Team (NRMDT) led by nurses and evaluate the effects of adopting this model in rehabilitation management on improving clinical outcomes among patients with HNC.

The NRMDT consists of a group of experts--surgeons, oncology nurse specialists, registered nurses, dietitians, palliative care physicians (Figure). The oncology nurse specialist in this department is also a certified Dysphagia Specified Nurse. The NRMDT is led by the oncology nurses who play essential roles in nutritional and symptom assessment, coordination of and monitoring multidisciplinary perioperative care (Table). They also provide a food-intaking-transition training to patients who have postoperative dysphagia (Picture).

Quasi-experimental design with a sequential sampling method was used in this study. The study was carried out from January 2017 to August 2021. A total of 49 HNC patients recruited were divided into the NRMDT group (n=38) and the control group (n=11). Patients in the control group received usual care from January 2017 to April 2018, whereas those in the NRMDT group were offered nutrition and rehabilitation management during the period of May 2018 to August 2021.Clinical outcomes including rates of weight loss, gastric tube dwelling time, the positive ratio of secretion, the occurrence rates of anatomic fistula, rates of hypoproteinemia, and length of stay were collected. SPSS software V.22.0 was used for data input and statistical analysis. Chi-square and independent-sample t-test were used to evaluate the clinical outcomes between these two groups.  

The positive ratio of secretion in the NRMDT group was significantly lowerthan that in the control group（13.16% versus 45.45%, P=0.02).  Furthermore, 2.63% of patients underwent anastomotic fistula in the NRMDT group, which was significantly lower than that in the control group (36.36%, P=0.01). The participants in the NRMDT group reported the proportion of weight loss and hypoproteinemia was 43.75% and 15.79% respectively, versus 54.54%(p=0.47) and 36.36% (p=0.29) in the control group. The days of gastric dwelling time and hospital length of stay were 16.87±7.91 and 19.89±6.31 in the NRMDT group compared with 21.18±9.87 (p=0.14) and 23.73±10.53 (p=0.27) in the control group.

This study demonstrated that the model of NRMDT may reduce the positive ratio of secretion and occurrence of anastomotic fistula among patients undergone surgery with HNC. A full‑scale study is warranted to examine its effects on improving other clinical outcomes for these patients.

Appendix

Figure                  The team members of NRMDT

 

Picture         Assessment of dysphagia

Table    Roles of nurses in the NRMDT model

	Oncology nurse specialist	Registered nurse
Preoperative stage	Quality control and management of perioperative and multidisciplinary care	Assessment of symptoms and food/fluid intake and output, coordination of multidisciplinary care, and timely respond to patients’ needs
Early stage of postoperative	Quality control and management of perioperative and multidisciplinary care	Coordination of multidisciplinary care, provide post-operative care, timely respond to patients’ needs
Rehabilitation stage	Assessment of dysphagia, nutritional status, provide food-intaking-transition training to HNC patients	Implementation of oral intake/ nutrition plan designed by oncology nurse specialist / dietitian
Stage of discharge and home-nursing	Follow-up all the discharged cases in the online or face-to-face nursing clinic	Provision of general health education and evaluation (with other team members if needed)

This study was presented at ICCN2022 virtual conference.

Registration for ICCN2022 virtual library now open. For more information, please access https://www.iccn2022.com/registration/

Authors: Yongyi Chen, Yang Liu, Junchen Guo

Affiliations: the Palliative Care Committee of China Anti Cancer Association (CACA)

On April 23, Parallel session of Palliative Care for 2021 Chinese Conference on Oncology (CCO) was held online. A total of nearly70,000 experts and representatives have attended this conference.

Those who share the same aspirations are not far away

Daiming Fan, the chairman of China Anti Cancer Association (CACA), attended the opening ceremony and delivered a speech. He pointed out that palliative care is at a flourishing stage. As the first palliative care conference for annual CCO, more and more health care workers would benefit from this influential conference. The integrated perspective and multi-dimensional strategies would be applied to improve the whole life cycle health.

Yazhou Xiao, the Director of the Palliative Care Committee of CACA, extended a welcome speech. He called on palliative care workers to work together for the better palliative care collaboration, the more refined quality improvement, and the higher level of science and technology innovation. The ultimate goal is to achieve the improvement of the quality of life for end-stage patients.

The video "Journey of Life, Love is always there" filmed by the Association was played at the conference. A book release ceremony for "Love in Peace: narrative stories from the palliative care ward" was held. Prof. Ruixian He, Xiaoxia Xu, Zhangyu Pan, Huiqing Yu, and Yongyi Chen were served as the hosts of the conference.

Those who are in harmony do not regard the region as the boundary

The conference comprised of three modules: The development of palliative care, the practice of palliative care, spiritual comfort and quality management of palliative care.

Concurrent Session 1: The development of palliative care

The topic of Prof. Yazhou Xiao was"Palliative Care: Protecting the dignity of the last mile of life", shared the review and reflections of understanding the development process of palliative care from various angles, the responsibility of promoting the steady development of palliative care from multiple dimensions, the practice of improving the service capacity of palliative care through multiple channels, and the countermeasures and prospects for the all-round development of palliative care with multilevel assistance. He emphasized that the "last mile" of life is a livelihood project and a system project that requires the joint efforts of all medical staff and even the whole society.

In "Palliative Care Development in China: Past, Present and Future", Prof. Jin Gu from Peking University Cancer Hospital elaborated on the development and practice of palliative care in four aspects: the unprecedented changes in a century, the changes in doctor-patient relationship, and the construction of palliative care centers, medical humanities and hospital culture. He introduced how to spread the concept of palliative care and led the behavior of medical care, so as to arouse more attention and investment in palliative care from the society.

Concurrent Session 2: The practice of palliative care

ProfGuijun Lufrom Tsinghua Changgeng Hospital in Beijing elaborated"Palliative Care Discipline Development and Professional Practice Outlook" in three aspects:re-examination of medical model, palliative care discipline development, and thepractice outlook. He reviewed the demand, current situation, and policy evolution of palliative care in China. He also put forward "four assessments": funeral assessment, burial assessment, grief assessment, and growth assessment, as well as the "five satisfaction": the deceased, bereaved families, teamwork, policy integration, and self-satisfaction.

Prof. Wenwu Cheng from Fudan University Cancer Hospital shared his in-depth analysis of the difficult issues of palliative care in clinical practice in "Difficult aspects of palliative care in clinical practice". He offered corresponding countermeasures and suggestions on how to promote the concept of palliative care, popularize knowledge and education, formulate corresponding norms to safeguard the rights and interests of all parties, improve the breadth of coverageand perfect the protection system, build a diversified model for quality services.

Concurrent Session 3:Spiritual comfort and quality management of palliative care

Prof. Yifang Wang shared his plenary address regarding "Spiritual Comfort at the End of Life in Chinese Cultural Perspective". His speech began with traditional Chinese folklore and expanded to physical, psychological, social, and spiritual palliative care, multiple and multidirectional transmission of holistic concepts, philosophical rhetoric and philosophical categories. He also shared the concept and historical of spirit development, the essence of spirit, and spiritual care from the perspective of care, analyzed the concept of death, near-death experience, and near-death image, and emphasized the importance of spiritual comfort at the end of life.

Prof. Yongyi Chen of Hunan Cancer Hospital shared the practice of quality management from the perspective of high-quality development of palliative care. She explained in detail the model, assessment tools and management exploration of palliative care quality management around three aspects: opportunity, practice and prospects. She believed that rigorous and scientific quality management will help to realize the systematization of the quality assessment of palliative care and the homogenization and standardization of the quality assessment of palliative care.

Those who know each other are not thousands of miles away.

The conference set up an "expert connection" session, three experts discussed online and explored the future development of palliative care.

Prof. Ping Zhao of the Cancer Foundation of China reviewed the development history of palliative care. He pointed out that although China moved up from the 71^st to 53^rd in the Death Quality Index released in 2021, there was still significant space for improvement in death quality.

Prof. Duanqi Liu analyzed the palliative home care model in the context of normalized COVID-19 pandemic. He believes that advanced cancer patients are a rather vulnerable group under the COVID-19. He emphasized it was necessary to realize the integration and coordinated development of needs, resources, and professions from the perspective of integration.

Prof. ShiyingYu from Tongji Hospital considered that how to transform the realization of palliative care wishes into concrete actions is a question worthy of in-depth consideration. We can refer to the international document, standards, and guidelines on the core elements of palliative care to retain the dignity of terminal patients,

Prof. Yongyi Chen made a summary of the conference. In the future, the committee will continue to take the responsibility to realize service optimization to get out of the "acceleration" of the high-quality development of palliative care, utilized the ability to press the "fast-forward key" of the high-quality development of palliative care, and carry out popular science education to drive into the "fast lane" of the high-quality development of palliative care.