外来化学療法室での栄養指導の取り組み

Abstract

2020 年度の診療報報酬改定では，外来でのがん化学療法の質向上のための総合的な取り組みの一環として，外来化学療法患 者に対して専門的な知識を有する管理栄養士が患者の状態に合わせて継続的な栄養指導を行うことが評価された．診療報酬改 定を機会に，外来化学療法室での継続した栄養指導を開始するために準備を進め2020 年4 月から実施した．継続的な栄養指導 により食事内容の改善がみられ，食事に関する不安の軽減につながった症例もあった．一方で指導件数は伸びず，がん患者を 十分に支援できたとは言えない．管理栄養士の人員の増加や業務調整により対象症例を増やすこと，栄養状態の変化やQOL の 向上などの栄養指導介入効果の検証を行うこと等の課題がみえた．

The 2020 medical fee revision included the evaluation of continuous nutritional guidance provided by a registered dietician with professional knowledge concerning patients receiving chemotherapy as an out-patient according to each individual patient’s symptoms, as part of the comprehensive effort for improvement of the quality of chemotherapy for cancer in the outpatient clinic. Taking this medical fee revision as an opportunity, we have been preparing to provide continuous nutritional guidance in the outpatient chemotherapy room, and started providing the guidance in April 2020. Each patient’s diet was improved by the continuous nutritional guidance and there were cases in which the anxiety towards eating was mitigated. On the other hand, the number of patients who received the guidance was limited, and the cancer patients were not provided with sufficient support. The issues that became clear were the need to increase the number of registered dieticians, increase the number of patients receiving guidance by adjusting the shift, and evaluate the outcome of nutritional intervention on the nutritional condition and on the quality of life of the patient.