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.