Introduction
Eating disorders are prevalent in the adolescent and young adult (AYA)
population. It is difficult to ascertain the true prevalence of eating
disorders in adolescents, as estimates vary greatly – ranging anywhere
from 1-22% in the literature depending on the source and specific
eating disorder diagnosis.1 According to the mental
health section of the National Institutes of Health (NIH), the overall
prevalence of eating disorders in adolescents is
2.7%.2 Risk factors for the development of an eating
disorder include underlying psychiatric conditions, stressful life
events, family history of eating disorders, and underlying chronic
illnesses (especially those with steroid-dependent
treatments).1,3,4 Eating disorders have a high rate of
morbidity and mortality, especially the longer they go undiagnosed, and
impact all aspects of patients’ mental and physical
well-being.1,3 When undiagnosed, eating disorders can
cause adverse and/or fatal electrolyte derangements, cardiac arrythmias,
and cardiomyopathy. Emotionally, eating disorders are associated with
depression, anxiety, and suicidal ideation.1,3,5 Early
identification and intervention are key in limiting the morbidity
associated with eating disorders.1,3 The American
Academy of Pediatrics (AAP), therefore, recommends yearly screening for
eating disorders in the general adolescent
population.3 Even with this recommendation, eating
disorders in the general population often go underdiagnosed and
undertreated.4
Adolescent and young adult (AYA) cancer survivors (those who have had or
had cancer ages 15-39 years per the National Cancers Institute (NCI)
definition) possess several of the general risk factors for eating
disorders – including coping with chronic underlying diseases and
stressful life events. During treatment, AYA patients are also exposed
to weight and appetite-altering therapies and often have their weight
and nutrition emphasized, all of which may impact body image. Currently,
however, there is a lack of data regarding the development or incidence
of eating disorders in the AYA patient population. Additionally, there
is no standard for routinely screening for eating disorders in oncology
clinics. Patients with cancer, even when off-therapy, often see their
oncology team monthly or every few months, typically more frequently
than their primary care providers, therefore, oncology clinic is an
opportune setting to screen patients and identify eating disorders
early.
The purpose of this quality-improvement project was to implement a
standardized process for screening AYA oncology survivors for eating
disorders in oncology clinics using a validated questionnaire. We
postulated that AYAs with cancer have an increased risk for eating
disorders compared to their healthy peers, as they are exposed to
weight-altering therapies, face consistent scrutiny over their weight
and nutrition, and may be at risk for maladaptive coping strategies,
such as disordered eating behaviors, in the face of a significant
life-altering disease.