February 2017 Discussion Summary

The February blog post generated much discussion on the topic on the updated oncology recommendations established by the Academy of Nutrition and Dietetics Evidence Analysis Library. Three questions were posed regarding nutrition education on pre- and post-surgical recommendations, considerations for nutrition-related side effects of anticancer treatments, and the supporting evidence for malnutrition documentation for oncology patients.

There were many new contributors for this blog post, which provided a variety of different viewpoints that made for well-rounded discussions. Overall, the contributors felt strongly that complete nutritional assessments (including Nutrition-Focused Physical Assessments) are necessary for oncology patients preparing for surgery. Several contributors brought up valid points about beneficial supplementation, including fish oil, multivitamins, and stool softeners (as appropriate). However, more holistic approaches to “natural” remedies such as herbal supplements and restrictive diets warranted caution, and unbiased approaches to nutrition counseling and presentation of factual information should be utilized by RDs.

A variety of different side effect management tips were shared by the contributors. Overall, the main concept addressed was to individualize the treatment and plan of care to match the client/patient’s specific needs.  On contributor mentioned the “miracle berry,” which generated a lot of discussion in its suggested use to alter or mask metallic taste as a side effect. In addition, adequate calories and protein were also highlighted to maintain weight or slow the progression of weight loss. The quality of life of the individual was addressed by almost all of the contributors, which is important to maintain during and after anticancer treatment.

As for malnutrition and considerations for oncology patients, all contributors highlighted the importance of evidence-based research. Discussion addressed the use of albumin as a negative acute stress responder as well as the financial implications of coding for malnutrition. Using accredited organizations like AND and ASPEN help to lend credibility to evidence-based practices—such as NFPAs—in the dietetics profession. The metabolic factors driving the progression of malnutrition and cancer cachexia were also briefly addressed. Overall, communication between physicians and the interdisciplinary team (including RDs) is extremely important in addressing and treating malnutrition, especially in oncology patients.