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Hello, my name is Dr. Anne Katz and I'm a clinical nurse specialist at Cancer Care Manitoba, in Winnipeg Canada. I'm also the editor of the Oncology Nursing Forum. At ONS Congress this year, I did a pre congress session on obesity and cancer.
We know that obese patients are less likely to seek medical care, they're less likely to participate in screening programs, and when we do imaging studies of them, X-rays, CT scans, MRI's, they tend to be of poorer quality. We also know that because of their larger mass, blood tests and tumor markers often are inaccurate because of hemodilution. There can be technical problems with radiation and surgery, making radiation and surgery more difficult. Patients who've had radiation and surgery are also more likely to have complications from those treatments.
Another area of great importance is the area of chemotherapy. When we calculate doses, we calculate them according to body mass and surface area. Because their body mass and surface area is much larger than healthy weight people, we have to give them greater doses of chemotherapy, risking greater toxicities as well as a greater risk of thromboembolism. However, if we give them doses that are below the levels that are required, we are at risk of under dosing them.
This is a sensitive topic and many of us struggle with being overweight or obese ourselves, and so are reluctant to talk to our patients about this. But the evidence is clear overweight and obesity is actually overtaking tobacco as a preventable cause of cancer. So we absolutely have to talk to our patients about this.
Cancer is a teachable moment. Many of our patients and their family members want to do something when someone is diagnosed with cancer. So they are often ripe and ready to make the kind of lifestyle changes that are required to eat more healthily, and as a result lose weight. They're also more likely to listen to messages about increasing physical activity, which will also aid in weight loss in a safe way.
My aim is to help oncology care providers, nurses in particular, be able to have the conversation with their patients about the fact that they're overweight or obese, and really do need to do something about it for the sake of their help. There's also an added benefit for their family members who very often can also stand to lose some weight and lead a healthier lifestyle.
So there are a number of ways that we can communicate with patients. There's motivational interviewing, mindfulness, the 5A model that I'm going to describe in more detail in a moment, the nurse model, and the brief negotiation model. These models help us structure the conversation, encourage patients to make lifestyle changes and lead more healthy lives. I'm going to focus on the 5A model for a number of reasons. It comes out of the tobaccos' cessation model, and so is familiar to many healthcare providers. It's also required by the Centers for Medicate and Medicare when counseling patients who are overweight or obese.
The first “A” stands for Assist. Weigh the patient and calculate their BMI. Tell the patient that they are overweight or obese, but be kind about it. And then ask them what they think about their weight. Whether they are happy being the way they are. Whether they recognize that this is a health risk for them. The third “A” stands for Advise. Share links about weight and cancer. Encourage them to get more physical activity, to eat more healthily, and then fourthly, assist them to get help. Referral to a registered dietician or nutritionist, a referral to websites that provide good information, and arrange for referral as necessary. These 5 steps are easy to remember and will help you to have that conversation with patients.
So how do we talk about this? It's very important to avoid the perception of judgment. When you feel judged, you are less likely to do what is being asked of you. There is a huge stigma related to being overweight or obese in western society. If you, yourself are overweight or obese or have struggled with this issue, I believe that it is actually a way of building a bridge of empathy with your patient, because you can say to them, I know how difficult this is because I have really been in your shoes.
As oncology care providers, we do not need to provide them with specific information about specific diets or what to do, or what not to do. We need to tell them about the links between obesity and their cancer, and then refer them to appropriate resources. I feel so strongly about this issue that I have written a book published by the Oncology Nursing Society called “A Healthcare Providers Guide to Cancer Obesity”. This book talks in detail about reaching out to our patients. Encourages us and enables us to have these difficult conversations so that we can help our patients avoid recurrence, avoid poor outcomes, and lead a healthier and better life.
My name is Dr. Anne Katz. Thank you for watching this, and I really hope that I have provided encouragement for you to talk to your patients about overweight obesity and cancer.