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.