Abstract
Purpose
Registered dietitians (RDs) have the potential in cancer cachexia management. We investigated RDs’ knowledge on cancer cachexia and assessed the effects of factors on RDs’ perception of playing an important role in cancer cachexia management.
Methods
This is a secondary analysis of a survey examining the perspectives of health care professionals on cancer cachexia management. We sent the questionnaire to 451 RDs. RDs were divided into two groups: RDs with and without the perception. Comparisons were made using the Mann–Whitney U test or chi-square test. To examine the effects of factors on the perception, estimated crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the logistic regression model were calculated.
Results
A total of 237 RDs were analyzed. Significant differences were observed in the number of cancer patients/month, the primary area of practice, the number of clinical guidelines used, the number of items used, the number of symptoms used, and training for cancer cachexia management (p values all < 0.05). After adjustments, the factors of cancer care experience ≥ 20 years (OR 8.32, 95% CI 1.22–56.70; p = 0.030), the number of patients/month ≥ 50 (OR 27.35, 95% CI 3.99–187.24; p = 0.001), using the clinical guidelines (OR 2.69, 95% CI 1.29–5.61; p = 0.008), the number of items ≥ 5 (OR 3.52, 95% CI 1.47–8.40; p = 0.005), and receiving training (OR 3.91, 95% CI 1.77–8.67; p = 0.001) significantly associated with the perception.
Conclusion
Specific knowledge and training as well as abundant experience were associated with the perception.
Keywords: Dietitian, Perspective, Burnout, Cancer cachexia, Nationwide survey
Introduction
Cancer cachexia is a multifactorial syndrome with ongoing body weight loss and reductions in muscle mass leading to impaired physical function that cannot be completely reversed by usual nutritional support [1, 2]. Cancer cachexia is characterized by negative protein and energy balances driven by the combination of a reduced dietary intake and abnormal metabolism due to systemic inflammation [1, 2].
Recent evidence-based clinical practice guidelines on the management of cancer cachexia, clinical nutrition in cancer, and end-of-life care for patients with cancer suggested the importance of multimodal interventions to meet the physiological and psychological needs of patients with cancer cachexia and family members [3–6]. The demand for nutritional counseling among patients receiving cancer treatments has been associated with quality of life and eating-related distress [7], which is representative of psychosocial distress experienced by patients and family members [8, 9]. Nutritional counseling is a good opportunity to alleviate patients’ psychological health during cancer treatments [7]. Therefore, registered dietitians (RDs) have the potential to provide patients and family members with supportive and palliative care in addition to their conventional roles, such as nutritional support and counseling [7–9]. Eating-related distress may be effectively alleviated by collaborations between RDs and other health care professionals [7–9]. However, limited information is currently available on whether RDs themselves are aware of their potential roles in the management of cancer cachexia even though they have a greater interest in nutritional care in cancer and the management of cancer cachexia than other health care professionals [10].
Health care professionals involved in oncology or supportive and palliative care are working in high-stress environments and, thus, are at an increased risk of burnout [11–19]. A recent nationwide survey conducted among RDs belonging to cancer treatment–designated hospitals across Japan revealed that the prevalence of burnout on personal accomplishment was high in palliative care settings and that unsuccessful experiences in nutritional counseling due to the negative impacts of cancer cachexia on patients and family members were risk factors for burnout among RDs [20]. However, limited information is currently available on the factors associated with the burnout of RDs and how to avoid their burnout in nutritional care for patients with advanced cancer and family members [20].
Therefore, we performed a preplanned secondary analysis of a nationwide survey to investigate the perspectives of health care professionals on the management of cancer cachexia [10]. The aims of the present study were (1) to investigate RDs’ knowledge on cancer cachexia and their clinical practice in the assessment of cancer cachexia and (2) to assess the effects of factors on RDs’ perception of playing an important role in the management of cancer cachexia.
Methods
This was a secondary analysis of a nationwide survey to examine the perspectives of health care professionals on multimodal interventions for cancer cachexia. The methods used were previously reported [10]. In brief, we conducted a nationwide multicenter anonymized self-report questionnaire among 451 cancer treatment–designated hospitals across Japan between February and March 2022. Eligibility requirements for participation were (1) health care professionals with at least 3 years of practicing experience and (2) those involved in cancer care as their major specialties. The subjects analyzed in the present study were exclusively RDs. Only a subset of the questionnaire was used in this study.
Questionnaire
A questionnaire for RDs written in Japanese was developed by the authors based on previous global surveys [21] and discussions by the authors as previously reported [10].
We obtained data on participant demographics, such as age, sex, clinical experience, and the primary area of practice, and information on participating institutes, including the hospital location and number of beds. We then asked about knowledge on and the clinical use of the international definition of cancer cachexia in 2011 [1] and three evidence-based clinical guidelines, i.e., the American Society of Clinical Oncology (ASCO) guidelines in 2020 [3], the European Society for Medical Oncology (ESMO) clinical practice guidelines in 2021 [4], and the European Society for Clinical Nutrition and Metabolism (ESPEN) practical guidelines in 2021 [5].
We also asked subjects to select all items that were considered to be important in assessments of cancer cachexia from the following nine items: the amount of food intake, body mass index (BMI), blood test, physical function, triceps skinfold thickness or arm circumference (TSF/AC), bioelectrical impedance analysis (BIA), computed tomography or magnetic resonance imaging (CT/MRI), dual X-ray absorptiometry (DXA), and none. We also asked them to select all items that they actually use in daily clinical practice from these nine items. In the same manner, we asked about the importance and utilization of the following symptoms: weight loss, reduced food intake, lack of appetite, impaired physical function, nausea and vomiting, fatigue, pain, taste and smell changes, fever, early satiety, cognitive impairment, depression, sleep disorder, anxiety, drowsiness, and none.
We asked subjects to evaluate questions about whether they had received training for cancer cachexia management and if they played an important role in cancer cachexia management using the following seven-point Likert scale: (1) absolutely disagree, (2) disagree, (3) somewhat disagree, (4) neither agree nor disagree, (5) somewhat agree, (6) agree, and (7) absolutely agree.
Statistical analysis
Participant characteristics were presented as numbers (%) for categorical variables or medians [interquartile range (IQR)] for continuous variables where appropriate. Subjects were divided into the following two groups using the answer to the last question: (1) RDs without the perception of playing an important role (absolutely disagree, disagree, somewhat disagree, and neither agree nor disagree) and (2) RDs with the perception of playing an important role (somewhat agree, agree, and absolutely agree) in cancer cachexia management. Two-group comparisons were made using the Mann–Whitney U test or chi-square test where appropriate.
We also calculated the prevalence of each variable in knowledge on and the utilization of the international definition and clinical practice guidelines and the importance and utilization of items and symptoms in the assessment of cancer cachexia.
To examine the effects of factors on the perception of playing an important role in cancer cachexia management, estimated crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the logistic regression model were calculated through the forced entry method. The perception of playing an important role in cancer cachexia management was dichotomized as described above for multivariate logistic regression analyses (absolutely disagree, disagree, somewhat disagree, neither agree nor disagree vs. somewhat agree, agree, and absolutely agree). A multivariate model adjusted for practicing experience of cancer care, the number of patients with advanced cancer/month, the primary area of practice, the number of definitions and clinical guidelines used in clinical practice (0 vs. 1–4), the number of items used in the assessment of cancer cachexia (0–4 vs. 5–8), the number of symptoms used in the assessment of cancer cachexia (0–5 vs. 6–10 vs. 11–15), and training for cancer cachexia management (absolutely disagree, disagree, somewhat disagree, neither agree nor disagree vs. somewhat agree, agree, and absolutely agree).
All statistical analyses were performed using SPSS software version 28 (IBM). All results were considered to be significant if the p value was < 0.05.
Ethics
Approval by the Institutional Review Board of the National Cancer Center was not required under national policies because this study (Institute Study No. 6000–050) was a minimal-risk study involving health care professionals and was beyond the scope of the “Ethical Guidelines for Medical and Health Research Involving Human Subjects” in Japan.
Potential participants were informed that the study would use an anonymized questionnaire and that the results obtained would be analyzed in a confidential environment in the invitation letter. The completion and return of the questionnaire were taken as consent to participate in the study. If participants did not want to participate, we requested the return of the questionnaire with “no participation” indicated. If participants were not eligible to participate in this survey, we also requested the return of the questionnaire with “not eligible” indicated.
Results
Among 451 RDs, 264 responded (response rate, 59%). Of these, the number of questionnaires with “no participation” was 8, while that with “not eligible” was 19. No participant was excluded due to missing data. Therefore, 237 participants were included in the analysis.
Table 1 shows participant characteristics. Median age was 42 (IQR 36.0–49.8) years, and 214 (92%) were female. A comparison between RDs with and without the perception of playing an important role yielded the following results. Significant differences were observed in the number of patients with advanced cancer/month (p < 0.001), the primary area of practice (p = 0.012), the number of clinical guidelines used in clinical practice (p < 0.001), the number of items used in the assessment of cancer cachexia (p < 0.001), the number of symptoms used in the assessment of cancer cachexia (p < 0.001), and training for cancer cachexia management (p < 0.001).
Table 1.
Participant characteristics
| Items | Total (n = 237) |
Dietitians with the perception of playing an important role in cancer cachexia management (n = 89) |
Dietitians without the perception of playing an important role in cancer cachexia management (n = 142) |
P value | |||
|---|---|---|---|---|---|---|---|
| Age | |||||||
| Years | 42.0 | 36.0–49.8 | 42.0 | (37.0–50.0) | 41.0 | (35.0–49.0) | 0.591 |
| Sex | |||||||
| Male | 21 | (8.9) | 11 | (12.4) | 10 | (7.1) | 0.240 |
| Female | 214 | (91.1) | 78 | (87.6) | 130 | (92.9) | |
| Practicing experience as a dietitian | |||||||
| 1–2 years | 0 | (0.0) | 0 | (0.0) | 0 | (0.0) | 0.441 |
| 3–4 years | 10 | (4.2) | 2 | (2.2) | 8 | (5.7) | |
| 5–9 years | 38 | (16.0) | 17 | (19.1) | 20 | (14.2) | |
| 10–19 years | 90 | (38.0) | 32 | (36.0) | 57 | (40.4) | |
| 20 years or more | 98 | (41.4) | 38 | (42.7) | 56 | (39.7) | |
| Practicing experience of cancer care | |||||||
| 1–2 years | 24 | (10.1) | 4 | (4.5) | 19 | (13.7) | 0.062 |
| 3–4 years | 24 | (10.1) | 6 | (6.8) | 16 | (11.5) | |
| 5–9 years | 85 | (35.9) | 35 | (39.8) | 50 | (36.0) | |
| 10–19 years | 82 | (34.6) | 34 | (38.6) | 48 | (34.5) | |
| 20 years or more | 18 | (7.6) | 9 | (10.2) | 6 | (4.3) | |
| Number of patients with advanced cancer/month | |||||||
| 1–9 | 68 | (28.7) | 12 | (13.5) | 53 | (37.6) | < 0.001 |
| 10–19 | 89 | (37.6) | 38 | (42.7) | 49 | (34.8) | |
| 20–49 | 60 | (25.3) | 25 | (28.1) | 35 | (24.8) | |
| 50–99 | 14 | (5.9) | 9 | (10.1) | 4 | (2.8) | |
| 100 or more | 5 | (2.1) | 5 | (5.6) | 0 | (0.0) | |
| Primary area of practice | |||||||
| Palliative care | 67 | (28.3) | 26 | (30.2) | 37 | (26.6) | 0.012 |
| Cancer treatment | 82 | (34.6) | 39 | (45.3) | 42 | (30.2) | |
| Other | 82 | (34.6) | 21 | (24.4) | 60 | (43.2) | |
| Hospital location | |||||||
| Metropolitan city | 17 | (7.2) | 9 | (10.1) | 7 | (4.9) | 0.476 |
| Ordinance-designated city | 58 | (24.5) | 22 | (24.7) | 35 | (24.6) | |
| Core city | 75 | (31.6) | 28 | (31.5) | 45 | (31.7) | |
| Other | 87 | (36.7) | 30 | (33.7) | 55 | (38.7) | |
| Number of hospital beds | |||||||
| 200 or less | 5 | (2.1) | 1 | (1.1) | 4 | (2.8) | 0.122 |
| 200–300 | 25 | (10.5) | 5 | (5.6) | 20 | (14.1) | |
| 300–500 | 77 | (32.5) | 28 | (31.5) | 47 | (33.1) | |
| 500 or more | 130 | (54.9) | 55 | (61.8) | 71 | (50.0) | |
| Number of clinical guidelines used in clinical practice | |||||||
| 0 | 101 | (47.3) | 20 | (22.5) | 81 | (57.0) | < 0.001 |
| 1–4 | 130 | (56.3) | 69 | (77.5) | 61 | (43.0) | |
| Number of items used in the assessment of cancer cachexia | |||||||
| 0–4 | 180 | (78.3) | 56 | (63.6) | 124 | (87.3) | < 0.001 |
| 5–8 | 50 | (21.7) | 32 | (36.4) | 18 | (12.7) | |
| Number of symptoms used in the assessment of cancer cachexia | |||||||
| 0–5 | 81 | (36.2) | 25 | (28.4) | 56 | (41.2) | < 0.001 |
| 6–10 | 101 | (54.1) | 36 | (40.9) | 65 | (47.8) | |
| 11–15 | 42 | (18.8) | 27 | (30.7) | 15 | (11.0) | |
| Training for cancer cachexia management | |||||||
| Yes | 58 | (25.2) | 38 | (42.7) | 20 | (14.2) | < 0.001 |
| No | 172 | (74.8) | 51 | (57.3) | 121 | (85.8) | |
Values are n (%) or medians (IQR). Comparisons between groups were made using the Mann–Whitney U test or chi-square test, where appropriate. The sums of some percentages were not 100% due to missing values
IQR interquartile range
Figure 1 shows the prevalence of knowledge on and the utilization of the international definition of cancer cachexia and clinical practice guidelines on the management of cancer cachexia. A total of 138 (58%) RDs knew the international consensus [1], 111 (47%) the ESPEN guidelines [5], 31 (13%) the ASCO guidelines [3], and 19 (8%) the ESMO guidelines [4]. Furthermore, not all RDs who knew the definition and guidelines used them in daily clinical practice.
Fig. 1.
Knowledge on and the utilization of the international definition of cancer cachexia and clinical practice guidelines on the management of cancer cachexia (n = 237)
Figure 2 shows perceptions of the importance of the items and the prevalence of the utilization of these items in the assessment of cancer cachexia. The majority of participants recognized food intake, BMI, blood test, and physical function as essential items and actually used these items in their clinical practice; however, TSF/AC, BIA, CT/MRI, and DXA were considered less important and were less frequently used in clinical practice.
Fig. 2.
Importance and utilization of items in the assessment of cancer cachexia (n = 237). BMI, body mass index; TSF/AC, triceps skinfold thickness/arm circumference; BIA, bioelectrical impedance analysis; CT/MRI, computerized tomography/magnetic resonance imaging; DXA, dual X-ray absorptiometry
Figure 3 shows perceptions of the importance of the symptoms and the prevalence of the utilization of symptoms in the assessment of cancer cachexia. Weight loss, reduced food intake, and lack of appetite were considered to be vital and were clinically utilized by most participants, while psychological symptoms, i.e., cognitive impairment, depression, sleep disorder, anxiety, and drowsiness, were regarded as less important and, thus, were clinically utilized less frequently in the assessment of cancer cachexia.
Fig. 3.
Importance and utilization of symptoms in the assessment of cancer cachexia (n = 237)
Table 2 shows the results of the multiple logistic regression analysis performed to examine the effects of factors on the perception of playing an important role in cancer cachexia management. After adjustments, the factors of practicing experience of cancer care for 20 years or more (OR = 8.32, 95% CI 1.22–56.70; p = 0.030), caring for 50 or more patients with advanced cancer/month (OR = 27.35, 95% CI 3.99–187.24; p = 0.001), using the international definition and clinical guidelines of cancer cachexia (OR = 2.69, 95% CI 1.29–5.61; p = 0.008), using five or more items in the assessment of cancer cachexia (OR = 3.52, 95% CI 1.47–8.40; p = 0.005), and receiving training on cancer cachexia management (OR = 3.91, 95% CI 1.77–8.67; p = 0.001) were associated with the perception of playing an important role in cancer cachexia management.
Table 2.
Estimated crude and adjusted odds ratios for a logistic regression model assessing effects of factors on the perception of playing an important role in cancer cachexia management (n = 237)
| Independent variables | Crude OR (95% CI) | P value | Adjusted OR (95% CI) | P value |
|---|---|---|---|---|
| Practicing experience of cancer care | ||||
| 1–2 years | 1.00 (reference) | 1.00 (reference) | ||
| 3–4 years | 1.78 (0.43–7.44) | 0.429 | 0.85 (0.16–4.64) | 0.853 |
| 5–9 years | 3.32 (1.04–10.62) | 0.043 | 1.25 (0.30–5.22) | 0.757 |
| 10–19 years | 3.36 (1.05–10.78) | 0.041 | 1.42 (0.34–5.91) | 0.633 |
| 20 years or more | 7.12 (1.60–31.72) | 0.010 | 8.32 (1.22–56.70) | 0.030 |
| Number of patients with advanced cancer/month | ||||
| 1–9 | 1.00 (reference) | 1.00 (reference) | ||
| 10–19 | 3.43 (1.61–7.30) | 0.001 | 2.88 (1.12–7.43) | 0.029 |
| 20–49 | 3.15 (1.40–7.09) | 0.005 | 1.53 (0.53–4.37) | 0.430 |
| 50 or more | 15.46 (4.32–55.36) | < 0.001 | 27.35 (3.99–187.24) | 0.001 |
| Primary area of practice | ||||
| Other | 1.00 (reference) | 1.00 (reference) | ||
| Cancer treatment | 2.01 (0.99–4.07) | 0.053 | 1.83 (0.76–4.40) | 0.177 |
| Palliative care | 2.65 (1.37–5.14) | 0.004 | 1.32 (0.55–3.14) | 0.536 |
| Number of clinical guidelines used in clinical practice | ||||
| 0 | 1.00 (reference) | 1.00 (reference) | ||
| 1–4 | 4.58 (2.52–8.33) | < 0.001 | 2.69 (1.29–5.61) | 0.008 |
| Number of items used in the assessment of cancer cachexia | ||||
| 0–4 | 1.00 (reference) | 1.00 (reference) | ||
| 5–8 | 3.94 (2.04–7.60) | < 0.001 | 3.52 (1.47–8.40) | 0.005 |
| Number of symptoms used in the assessment of cancer cachexia | ||||
| 0–5 | 1.00 (reference) | 1.00 (reference) | ||
| 6–10 | 1.24 (0.67–2.31) | 0.498 | 0.69 (0.30–1.57) | 0.379 |
| 11–15 | 4.03 (1.83–8.86) | 0.001 | 2.06 (0.73–5.85) | 0.174 |
| Training for cancer cachexia management | ||||
| No | 1.00 (reference) | 1.00 (reference) | ||
| Yes | 4.51 (2.39–8.49) | < 0.001 | 3.91 (1.77–8.67) | 0.001 |
A multivariate model adjusted for practicing experience of cancer care, the number of patients with advanced cancer/month, the primary area of practice, the number of clinical guidelines used in clinical practice, the number of items used in the assessment of cancer cachexia, the number of symptoms used in the assessment of cancer cachexia, and training for cancer cachexia management
OR odds ratio, CI confidence interval
Discussion
This is the first study to investigate Japanese RDs’ knowledge on cancer cachexia and their clinical practice in the assessment of cancer cachexia and to assess the effects of factors on RDs’ perception of playing an important role in management of cancer cachexia.
Regarding knowledge on and the utilization of the international definition of cancer cachexia and clinical practice guidelines on the management of cancer cachexia, the present results revealed that approximately 60% of subjects knew the international consensus and approximately 50% knew the ESPEN guidelines. This may be because Japanese RDs are generally encouraged to attend lectures in Japanese held at annual nutrition-related conferences, such as the Japanese Society for Clinical Nutrition and Metabolism (JSPEN). Since nutritional care in cancer has been one of the most important topics, this lecture topic has been promoted in these conferences in Japan. However, there have been no clinical practice guidelines that specifically focus on the management of cancer cachexia and nutritional care for patients with advanced cancer edited by Japanese academic societies. On the other hand, only approximately 10% of subjects knew the ASCO and ESMO guidelines. This may be because these guidelines have not yet been sufficiently lectured in nutrition-related conferences in Japan and RDs have difficulty in reading cancer cachexia guidelines written in English by themselves due to the language barrier. In addition, not all of the RDs who knew the definition and guidelines used them in daily clinical practice, which may be attributed to a poor collaboration between health care professionals and may be one of the reasons for RDs’ burnout on personal accomplishment [20].
Regarding the importance and utilization of the items in the assessment of cancer cachexia, approximately 90% of subjects considered food intake, BMI, blood test, and physical function to be essential; however, only 60% actually used physical function in their clinical practice. Moreover, subjects considered CT/MRI, which are routinely performed in cancer treatments, to be less important and, thus, they did not use them frequently in clinical practice. Regarding the importance and utilization of symptoms in the assessment of cancer cachexia, psychological symptoms were regarded as less important and, thus, were clinically utilized at a lower frequency. However, measurements of skeletal muscle mass, fat mass, and fluid retention by CT/MRI need to be incorporated into nutritional assessments [5]. Therefore, it is important to know if RDs consider body composition and physical function as essential factors that RDs should incorporate into their practice. In addition, it is important to know how many RDs have training to understand how to incorporate assessments of body composition and physical function into nutrition care. Furthermore, care for patients’ and family members’ concerns about dynamic and longitudinal changes in the nutritional status, body composition, and physical function need to be performed in nutritional counseling. It is also important to know what nutrition counseling involves, for example, assessment of patients’ and families’ concerns, providing them with feeding advice and nutritional supplements, assessment of nutrition impact symptoms, and consultation with other health care professionals to alleviate these concerns and symptoms [9].
A qualitative study conducted in Australia to examine the views and experiences of health care professionals working in a dedicated cancer cachexia clinic suggested the advantages of providing a structure for staff to gain knowledge about cancer cachexia and how this may contribute to feelings of a more detailed understanding and the confidence necessary to respond to the challenge of cancer cachexia [22]. Another qualitative study among health care professionals, such as radiation oncologists, nurses, dietitians, and speech pathologists, involved in head and neck cancer care in Australia and the USA examined the perspectives of health care professionals. The findings obtained showed that the subjects valued dietitians as a core member of the multi-disciplinary team. This study also reported that how the role of the dietitian is enacted in clinical practice was influenced by professional experience, input from doctors and nurses, clinic structures, culture, and the presence of evidence-based clinical practice guidelines [23].
A recent Japanese nationwide survey among RDs under similar conditions to the present study reported that burnout was associated with fewer years of clinical experience, the lack of a positive attitude to caring for dying patients, the difficulty of listening to patients and family members about distress and anxiety for imminent death, uneasiness interacting with patients and family members without an effective proposal, and the absence of feeling that a good contribution is made to patients and family members. The survey also reported that the prevalence of burnout on personal accomplishment was high and that RDs engaging in nutritional counseling for patients with cancer and family members may benefit from education to prevent burnout [20]. The present study revealed the associations between the RDs’ perception of playing an important role in the management of cancer cachexia, years of practicing experience of cancer care, the number of patients with advanced cancer per month, using the international definition and clinical guidelines of cancer cachexia, the number using the items in the assessment of cancer cachexia, and receiving training on cancer cachexia management.
Therefore, having a sufficient knowledge, receiving proper training, and making good relationships with other health care professionals, as well as gaining clinical experience, may be necessary for RDs to accomplish what RDs themselves want to achieve in cancer care with confidence. These matters may be also vital for RDs to perform what other health care professionals expect from RDs in the multidisciplinary team. Moreover, specialized education and training programs on the management of cancer cachexia for RDs will fill knowledge gaps, lead to a high level of personal accomplishment, and decrease distress to avoid burnout in caring for patients with incurable cancer and family members. Furthermore, these programs need to include guidance on how to deal with patients and family members with severe distress for imminent death in holistic multimodal interventions for cancer cachexia [8, 9].
The present study has multiple strengths, including the large number of participants and moderate response rate despite the COVID-19 pandemic. However, there were also several limitations that need to be addressed. Since this study was conducted in one country, the results obtained may not be generalizable to other countries. In addition, this study was a cross-sectional analysis of a questionnaire; therefore, data on changes in the perception of RDs were not obtained. Furthermore, the questionnaire did not have any questions that directly address the issue of burnout of RDs. Specialized education and training programs on the management of cancer cachexia by RDs, such as seminars, formal classroom instruction, articles, and requirement for RD practice, need to be established and further studies to investigate the beneficial effects of these programs are warranted.
Conclusions
Specific knowledge on cancer cachexia and training for the management of cancer cachexia, as well as abundant experience of nutritional care in cancer, were associated with the RDs’ perception of playing an important role in the management of cancer cachexia. Specialized education and training programs on the management of cancer cachexia for RDs need to be urgently developed in order to promote their personal accomplishment and prevent burnout in their daily clinical practice.
Author contribution
Study concept and design: SK, KA. Collection and/or assembly of data: KA. Statistical analysis: SK, KA, SO. Data analysis and interpretation: SK, KA. Original draft preparation: SK, KA. Review and editing: NM, SA, HI, ES. Supervision: TM, TT. Final approval of the manuscript: all authors.
Funding
The present study was supported by JSPS KAKENHI Grant Number 21K10319 (KA) and the Institute for Food and Health Science, Yazuya Co., Ltd. (SK).
Data availability
The datasets generated and/or analyzed in the present study were not publicly available.
Code availability
N/A.
Declarations
Ethics approval
The authors of this manuscript certify that they comply with the ethical guidelines for editorship and publishing in the journal. Approval by the Institutional Review Board of the National Cancer Center was not required under national policies because this study (Institute Study No. 6000–050) was a minimal-risk study involving health care professionals and was beyond the scope of the “Ethical Guidelines for Medical and Health Research Involving Human Subjects” in Japan.
Consent to participate
Potential participants were informed that the study would use an anonymized questionnaire and that the results obtained would be analyzed in a confidential environment in the invitation letter. Completion and return of the questionnaire were taken as consent to participate in the study. If participants did not want to participate, we requested the return of the questionnaire with “no participation” indicated. If participants were not eligible to participate in this survey, we also requested the return of the questionnaire with “not eligible” indicated.
Conflict of interest
The authors declare no competing interests.
Footnotes
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Contributor Information
Saori Koshimoto, Email: skoshimoto-rd@umin.ac.jp.
Koji Amano, Email: kojiamano4813@gmail.com.
Naoharu Mori, Email: nmori@aichi-med-u.ac.jp.
Shunsuke Oyamada, Email: shunsuke.oyamada@jortc.jp.
Sayaka Arakawa, Email: sarakawa@ncc.go.jp.
Hiroto Ishiki, Email: hishiki@ncc.go.jp.
Eriko Satomi, Email: esatomi@ncc.go.jp.
Tatsuya Morita, Email: tmorita@sis.seirei.or.jp.
Takashi Takeuchi, Email: okaspsyc@tmd.ac.jp.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and/or analyzed in the present study were not publicly available.
N/A.