Methods
This was a single-institution quality improvement project conducted at a tertiary pediatric cancer center. The study team, consisting of a pediatric hematology/oncology fellow and attending, partnered with an eating disorder specialist in the adolescent medicine department for guidance on an appropriate screening process. This allowed the team to create a pipeline to the adolescent medicine team for patients with a positive screening for further management.
Participants
Participants included patients with an oncology diagnosis aged 13-39 years and older who were treated with chemotherapy. Participants were excluded if they were receiving cytotoxic chemotherapy, those receiving targeted therapy post-active treatment were allowed. Patients on active therapy were excluded to eliminate confounding factors that could iatrogenically alter weight or appetite (ex: chemotherapy-induced nausea or vomiting, change to taste perception, and weight- altering medications). Similarly, patients on maintenance therapy that included steroids due to the known side-effects of increased appetite and weight, making it difficult to truly assess for an eating disorder.
Procedures
There are several questionnaires that are utilized in primary care offices that are validated screening devises for eating disorders. The SCOFF questionnaire (Table 1) is an easy-to-use tool that can be implemented in outpatient settings.3,5 The self-administered questionnaire consists of 5 yes/no questions designed to screen for both restrictive and binge-eating habits. Patients receive a point for each question answered “yes.” A score of 2 or greater is considered a positive screening.3,5
At check-in for their scheduled oncology appointments, participants were given a one-time SCOFF questionnaire by the clinic medical assistant (MAs) to complete prior to their appointments. Patients were identified prior to their appointments and the study team entered a note to indicate to the MAs which patients were eligible for screening. An informational sheet was provided to participants regarding the questionnaire. Questionnaires were then scored by a member of the research team. If a participant scored 2 or above, they were referred to the Adolescent Medicine clinic for further resources and discussion and their oncology providers were notified. All screenings were destroyed and not made part of the permanent medical record. Participants were aware that they would be referred to adolescent medicine should they screen positive. Screenings were collected from September 2022 to June 2023. Participants were only screened one time each during this time frame.