The Missing Link: Improving Cancer Outcomes Through a Structured Nutritional Quality Improvement Program.

Background Malnutrition and weight instability are common but often under-recognized in patients receiving active cancer treatment. Treatment toxicities, altered metabolism, and psychological distress may reduce intake, promote muscle wasting, and cause unintentional weight loss, thereby worsening treatment tolerance, hospitalization risk, survival, and patient-reported outcomes. At the Armed Forces Hospital Southern Region (AFHSR) Oncology Center, improving nutritional care was identified as a patient safety and quality priority. Local problem A pre-intervention review of 50 patients receiving active oncologic therapy showed that nine (18.0%) experienced weight loss greater than 3%, three (6.0%) experienced weight gain greater than 3%, and 38 (76.0%) maintained stable body weight. These findings highlighted a significant care gap in systematic nutritional screening, timely referral, and proactive management of nutrition-related symptoms. Methods A structured quality improvement approach was used. Root cause analysis identified key contributors to unintentional weight loss, and Pareto analysis prioritized the most important and modifiable causes. A solution selection matrix was then applied to identify interventions that were feasible, cost-effective, and likely to yield meaningful clinical benefit. The selected strategies were implemented and refined through iterative FOCUS-PDSA cycles. Data analysis was conducted using the IBM SPSS Statistics for Windows, Version 27 (Released 2019; IBM Corp., Armonk, New York, United States). Interventions Three consecutive PDSA cycles were implemented in the Oncology and Radiation Departments at AFHSR. The first cycle focused on early nutritional screening and structured education for all eligible patients, with follow-up every two to three weeks. The second cycle targeted patients who did not maintain stable body weight despite education alone; these patients received individualized dietary counselling, oral nutritional supplementation, and practical guidance regarding meal size, content, and timing. The third cycle addressed refractory cases with persistent weight loss risk despite prior interventions and incorporated pharmacological management of chemotherapy-induced nausea and vomiting as well as psychological support to improve adherence and nutritional intake. Results A total of 141 patients were enrolled, of whom 117 (83%) received chemotherapy. Although all 141 patients received nutritional education, 82 (58%) required oral nutritional supplements, 106 (75%) maintained stable body weight, and 35 (25%) required pharmacologic intervention. Control charts showed improvement in weight stability from about 80% initially to a mean of 93.6%, within control limits and without rule violations. Moving range charts showed reduced variability over time. Process capability was high (Cp=2.809, Cpk=2.541). Analyses of >3% weight loss and gain also showed capable, well-centered processes. Patient satisfaction with nutritional education, oral supplementation, and the overall nutrition service was high. Conclusions A structured multidisciplinary nutritional support program significantly improved and sustained weight stability among patients receiving active cancer treatment. The intervention achieved statistical control, high process capability, and consistent adherence, supporting its value as a cost-effective and sustainable quality improvement strategy in oncology practice.