February 2017 Blog Post

Introduction:

Registered Dietitians can play an integral part in the collaborative efforts of physicians, nurses, and oncology specialists. Care for a patient with cancer is multifactorial, regardless of whether they are seen in the hospital or in an outpatient setting. The oncology dietitian must take into consideration whether the patient is having surgery, their nutritional status at baseline, as well as the many different side effects of anticancer treatment. Social-environmental considerations also come into play, especially in regards to the support system of the patient as well as their financial situation.

Overview of Topic:

Dietitians are the nutrition experts in healthcare profession, and oncology is no exception. Often, patients will present with gastrointestinal symptoms such as nausea, vomiting, and diarrhea. It is important to take into consideration the quality of life they are experiences, which relates to food preferences and taste changes as well as changes in self-esteem from negative side effects such as hair loss, weight loss, and depression. The provision of Medical Nutrition Therapy (MNT) can help prevent or delay the loss of lean body mass, provide ways to manage side effects such as taste changes or food preferences, as well as manage nutrition support as appropriate.

Brief Summary of Articles:

The Academy of Nutrition and Dietetics (AND) has released their updated evidence-based oncology guidelines for dietetics professionals. These updated guidelines are based upon the AND Evidence Analysis Library oncology workgroup, which was led by the authors of the article. The overall recommendations focused on validated nutrition screening tools to determine if oncology patients are at risk for malnutrition as well as overarching recommendations for each step of the Nutrition Care Process (ADIME). As part of the recommendations for nutrition assessments and interventions, the consensus highlighted the use of Nutrition Focused Physical Assessments and inflammatory laboratory markers (ie. C-Reactive Protein).

MNT has a strong recommendation as a beneficial component of oncology care. Nutrition professionals should work as part of an interdisciplinary team in order to focus on best patient outcomes. The research featured as supportive evidence highlighted the effectiveness of “early and intensive” MNT, such as improved quality of life, weight maintenance, preservation of lean body mass, decreased hospital readmissions, better appetite, and better tolerance of anticancer treatments. Other recommendations of varying strength include the efficacy of fish oil supplementation, glutamine supplementation (both orally and parenterally), as well as the research on neutropenia and oncology patients.

Based upon previous research and professional consensus, the guideline highlights the necessity of referral to a Registered Dietitian if patients exhibit any signs of malnutrition, including pre-cachexia and cancer cachexia. The article emphasizes the importance of the identification and documentation of signs of muscle wasting, unintentional weight loss, poor oral intake, as well as decreased appetite and presence of inflammatory markers.

Cancer is considered an inflammatory process, in which the patient experiences chronic catabolism that directly results in increased nutrient needs and unintentional losses in weight and muscle mass. In the supplemental article the Academy of Nutrition and Dietetics and the American Society for Enteral and Parenteral Nutrition (ASPEN) published, the markers of malnutrition—also referred to as undernutrition—are highlighted as part of general guidelines for any patient at risk for malnutrition. These guidelines are in agreeance with the use of food recalls, biochemical markers, anthropometrics, findings from Nutrition-Focused Physical Assessments, and functional changes. Specifically, these guidelines are important as part of the dietitian’s assessment and intervention of oncology patients in order to promote best patient outcomes and increase chances for survival.

Continuing Education Article:

Thompson, K. L., Elliott, L., Fuchs-Tarlovsky, V., Levin, R. M., Voss, A. C., & Piemonte, T. (2017). From the Academy: Oncology evidence-based nutrition practice guideline for adults. Journal Of The Academy Of Nutrition And Dietetics, (11)7, 297-310.e47. doi:10.1016/j.jand.2016.05.010

Supplemental Article:

White, J. V., Guenter, P., Jensen, G., Malone, A., & Schofield, M. (2012). From the academy: Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). Journal Of The Academy Of Nutrition And Dietetics, 112730-738. doi:10.1016/j.jand.2012.03.012

Additional Resource:

The Academy of Nutrition and Dietetics Evidence Analysis Library: ONC Executive Summary of Recommendations (http://www.andeal.org/topic.cfm?menu=5291&cat=5067)