Get a Grip! Grip Strength and Post Hospital Discharge Weight Within an Oncology Service Line

Research Objectives: Nutrition interventions have been shown to decrease mortality in the oncology patient population throughout treatment. Weight and grip strength have been shown to be a marker of frailty and mortality. An interdisciplinary approach is pivotal in maintaining strength and recovery of function during oncology treatment.

Liu, M. A., DuMontier, C., Murillo, A., Hshieh, T. T., Bean, J. F., Soiffer, R. J., Stone, R. M., Abel, G. A., & Driver J. A. (2019). Gait speed, grip strength, and clinical outcomes in older patients with hematologic malignancies. Blood, 134 (4): 374–382. https://doi.org/10.1182/blood.2019000758

Design: Clinical Nutrition and Rehabilitation Services at Lehigh Valley Health Network implemented a process improvement study to determine if weight maintenance and hand grip strength leads to improved outcomes for oncology patients across the continuum of care.

Setting: The study population was comprised of inpatients status post specific gastrointestinal or head and neck surgeries. The team collected weight, grip strength, AMPAC 6 clicks score and noted participation in outpatient rehabilitation during outpatient nutrition visits at 7 days, 1-month and 3-month intervals.

Participants: 106 patients met criteria with thirty-three (31%) females and average BMI upon admission of 26.26. Their average length of stay (LOS) was ten days. Of the 106 patients, 74.5% received PT and 62.3% received OT during their hospitalization. Of the eighty-six patients with reported discharge locations: seventy-three returned home, two discharged to a facility and eleven went to inpatient rehabilitation.

Interventions: A focused data set analyzed fifty-nine patients who attended outpatient Registered Dietitian follow-up appointments from 7-days post discharge to at least 3-months. Of these fifty-nine patients, 74.6% received PT services while hospitalized and 28.8% had re-admissions within 30-days.

Main Outcome Measures: Average hand grip, weight trend, and readmission.

Results: Average left- and right-hand grip strength for patients who were readmitted in 30 days decreased 15.4% from inpatient visit to 3-month visit. Average hand grip strength for those patients not readmitted in 30 days increased 24.4% from inpatient visit to 3-month visit. At one month, patients readmitted within 30 days experienced a 6.4% decrease in weight; patients not readmitted had a 5.4% decrease.

Conclusions: The results of this interdisciplinary collaboration demonstrate implementing an integrative care model for oncology patients may improve outcomes during their cancer treatment. Future studies to better understand the link between hand grip strength, weight maintenance and risk of readmission are necessary.

Author(s) Disclosures: No disclosures.