Lack of access to nutrition care in outpatient cancer centers is a critical issue
in the US health care system. It is well documented that malnutrition adversely affects
key outcomes, including morbidity and mortality, as well as hospitalizations, readmissions,
and other variables that may increase cost of oncology care.
1
,
2
,
3
,
4
Based upon this evidence, the Oncology Nutrition Dietetic Practice Group (ON DPG),
a practice group of the Academy of Nutrition and Dietetics (Academy), formulated a
strategic plan to address nutrition-related gaps in cancer care. The ultimate goal
of the strategic plan is to improve patient access to oncology nutrition care from
the time of diagnoses, through treatment and into cancer survivorship, for whatever
period of time survivorship may encompass.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer-associated malnutrition, cachexia and sarcopenia: The skeleton in the hospital closet 40 years later.Proc Nutr Soc. 2016; 75: 199-211
- ESPEN expert group recommendations for action against cancer-related malnutrition.Clin Nutr. 2017; 36: 1187-1196
- Prevalence of malnutrition in hospitalized patients: A multicenter cross-sectional study.J Korean Med Sci. 2018; 33: e10
- Pre-therapeutic nutritional assessment for predicting severe adverse events in patients with head and neck cancer treated by radiotherapy.Clin Nutr. 2017; 36: 1681-1685
- Examining Access to Nutrition Care in Outpatient Cancer Centers: Proceedings of a Workshop.The National Academies Press, Washington, DC2016
- Prevalence of outpatient cancer treatment in the United States: Estimates from the Medical Panel Expenditures Survey (MEPS).Cancer Invest. 2008; 26: 647-651
- The Joint Commission: Nutritional, Functional, and Pain Assessments and Screens. Vol 2014. The Joint Commission, Oakbrook Terrace, IL2008
- Defining and developing an oncology nutrition program in a cancer center.in: Leser M. Ledesma N. Bergerson S. Trujillo E. Oncology Nutrition for Clinical Practice. Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics, Chicago, IL2013: 47-51
American College of Surgeons Commission on Cancer. Cancer Program Standards 2012: Ensuring Patient-Centered Care. Chicago, IL: American College of Surgeons Commission on Cancer.
- The Association of Community Cancer Centers.Cancer Nutrition Services: A Practical Guide for Cancer Programs. The Association of Community Cancer Centers, Rockville, MD2012
- A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation.JPEN J Parenter Enteral Nutr. 2009; 33: 472-500
National Institute for Health and Care Excellence. http://www.nice.org.uk/Guidance/Topic. Accessed December 18, 2017.
- Patient management framework. Head and neck tumour stream: larynx, pharynx and oral cancer.Metropolitan Health and Aged Care Services Division, Victorian Government Department of Human Services, State of Victoria2006 (Accessed December 18, 2017)
- About.COSA, Sydney NSW2016 (Accessed January 4, 2018)
- Blueprint for Growth II: Evaluating Staffing Models. The Advisory Board Company, Washington DC2009
- Board certification: specialist in oncology nutrition “CSO.”.Oncol Nut Connect. 2008; 16: 5-10
- Availability of outpatient clinical nutrition services for patients with cancer undergoing treatment at comprehensive cancer centers.J Oncol Pract. 2015; 11: 1-5
- Cachexia as a major underestimated and unmet medical need: Facts and numbers.J Cachexia Sarcopenia Muscle. 2010; 1: 1-5
- Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study.Oncotarget. 2017; 8: 79884-79896
- Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review.Clin Nutr. 2017; 36: 1473-1482
- Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group.Am J Med. 1980; 69: 491-497
- Cachexia in cancer patients.Nat Rev Cancer. 2002; 2: 862-871
- Evidence Analysis Library: Oncology evidence-Based Nutrition Practice Guidelines.(Accessed December 18, 2017)
- Preoperative prognostic nutritional index is a significant predictor of survival in patients with localized upper tract urothelial carcinoma after radical nephroureterectomy.Urol Oncol. 2017; 35: 671.e671-671.e679
- Prognostic nutritional index predicts initial response to treatment and prognosis in metastatic castration-resistant prostate cancer patients treated with abiraterone.Prostate. 2017; 77: 1233-1241
- Preoperative prognostic nutritional index is a powerful predictor of prognosis in patients with stage III ovarian cancer.Sci Rep. 2017; 7: 9548
- Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index.J Clin Oncol. 2013; 31: 1539-1547
- Association of systemic inflammation and sarcopenia with survival in nonmetastatic colorectal cancer: results from the C SCANS Study.JAMA Oncol. 2017; 3: e172319
- Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact.Proc Nutr Soc. 2016; 75: 188-198
- Predictors of early death risk in older patients treated with first-line chemotherapy for cancer.J Clin Oncol. 2012; 30: 1829-1834
- Predictors of 1-year mortality in a prospective cohort of elderly patients with cancer.J Gerontol A Biol Sci Med Sci. 2015; 70: 1148-1155
- Underweight status at diagnosis is associated with poorer outcomes in adult patients with acute myeloid leukemia: A retrospective study of JALSG AML 201.Ann Hematol. 2018; 97: 73-81
- Individualized nutrition intervention is of major benefit to colorectal cancer patients: Long-term follow-up of a randomized controlled trial of nutritional therapy.Am J Clin Nutr. 2012; 96: 1346-1353
- Does dietary counseling improve quality of life in cancer patients? A systematic review and meta-analysis.J Support Oncol. 2008; 6: 234-237
- Forcing the vicious circle: sarcopenia increases toxicity, decreases response to chemotherapy and worsens with chemotherapy.Ann Oncol. 2017; 28: 2107-2118
- Nutritional status is a predictor of outcome in cancer patients, irrespective of stage.Intern Emerg Med. 2017; 12: 135-136
- Effect of nutritional risk at admission on the length of hospital stay and mortality in gastrointestinal cancer patients.Clin Nutr Res. 2013; 2: 12-18
- Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies?.Eur J Cancer. 1998; 34: 503-509
- Role of nutritional status in predicting quality of life outcomes in cancer—A systematic review of the epidemiological literature.Nutr J. 2012; 11: 27
- Functional decline in older patients with cancer receiving first-line chemotherapy.J Clin Oncol. 2013; 31: 3877-3882
- Clinical value of nutritional status in cancer: what is its impact and how it affects disease progression and prognosis?.Nutr Cancer. 2017; 69: 1151-1176
- Nutritional status in the era of target therapy: poor nutrition is a prognostic factor in non-small cell lung cancer with activating epidermal growth factor receptor mutations.Korean J Intern Med. 2016; 31: 1140-1149
- Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score.Cancer. 2012; 118: 3377-3386
- Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment.Clin Cancer Res. 2009; 15: 2920-2926
- Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer.Clin Nutr. 2005; 24: 998-1004
- Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer.Clin Oncol (R Coll Radiol). 2005; 17: 639-645
- Dietary counseling improves patient outcomes: A prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy.J Clin Oncol. 2005; 23: 1431-1438
- Cancer wasting and quality of life react to early individualized nutritional counselling!.Clin Nutr. 2007; 26: 7-15
- Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area.Br J Cancer. 2004; 91: 447-452
- Nutritional counseling and nutritional supplements: a cornerstone of multidisciplinary cancer care for cachectic patients.Curr Opin Support Palliat Care. 2013; 7: 390-395
- Dietary counseling is beneficial for the patient with cancer.J Clin Oncol. 2005; 23: 1348-1349
- Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy.Support Care Cancer. 2010; 18: 837-845
- Nutritional intervention and quality of life in adult oncology patients.Clin Nutr. 2007; 26: 289-301
- Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery.Br J Surg. 2013; 100: 1108-1114
- Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: A systematic review.Clin Nutr. 2013; 32: 671-678
- Prevalence of malnutrition and current use of nutrition support in patients with cancer.JPEN J Parenter Enteral Nutr. 2014; 38: 196-204
- Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer.Br J Cancer. 2017; 117: 15-24
- Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: A randomized controlled trial.Nutrition. 2013; 29: 1342-1349
- Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: A two-year randomized controlled trial.PLoS One. 2014; 9: e108687
- Intensive nutritional care for patients treated with radiotherapy in head and neck cancer: A randomized study and meta-analysis.Eur Arch Otorhinolaryngol. 2017; 274: 977-987
- Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: A systematic review and meta-analysis of randomised controlled trials.J Hum Nutr Diet. 2012; 25: 411-426
- NUTRISCORE: A new nutritional screening tool for oncological outpatients.Nutrition. 2017; 33: 297-303
- The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis.Eur J Surg Oncol. 2016; 42: 1176-1182
- Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: A systematic review.JBI Database System Rev Implement Rep. 2015; 13: 141-187
- Validation of nutritional risk index method against patient-generated subjective global assessment in screening malnutrition in colorectal cancer patients.Chin J Cancer Res. 2013; 25: 544-548
- Energy balance and metabolism after cancer treatment.Semin Oncol. 2013; 40: 745-756
- Evidence suggesting that obesity prevention measures may improve prostate cancer outcomes using data from a prospective randomized trial.Prostate Cancer. 2014; 2014: 478983
- Obesity in adult lymphoma survivors.Leuk Lymphoma. 2012; 53: 569-574
- A cross-sectional study of overweight in pediatric survivors of acute lymphoblastic leukemia (ALL).Pediatr Blood Cancer. 2011; 57: 1204-1209
- Weight gain in breast cancer survivors: Prevalence, pattern and health consequences.Obes Rev. 2011; 12: 282-294
- Postdiagnosis change in bodyweight and survival after breast cancer diagnosis.Epidemiology. 2012; 23: 320-327
- Preoperative weight change and risk of adverse outcome following radical prostatectomy: Results from the Shared Equal Access Regional Cancer Hospital database.Prostate Cancer Prostatic Dis. 2011; 14: 361-366
- Weight gain after breast cancer diagnosis and all-cause mortality: Systematic review and meta-analysis.J Natl Cancer Inst. 2015; 107: djv275
- Obesity and survival in the neoadjuvant breast cancer setting: role of tumor subtype in an ethnically diverse population.Breast Cancer Res Treat. 2018; 167: 277-288
- Associations of alcohol intake, smoking, physical activity and obesity with survival following colorectal cancer diagnosis by stage, anatomic site and tumor molecular subtype.Int J Cancer. 2018; 142: 238-250
- Obesity, physical activity, and breast cancer survival among older breast cancer survivors in the Cancer Prevention Study-II Nutrition Cohort.Breast Cancer Res Treat. 2018; 167: 133-145
- Pre-diagnostic anthropometry and survival after colorectal cancer diagnosis in Western European populations.Int J Cancer. 2014; 135: 1949-1960
- Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer.Clin Cancer Res. 2009; 15: 6973-6979
- Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.Lancet Oncol. 2008; 9: 629-635
- The obesity paradox in cancer: A review.Curr Oncol Rep. 2016; 18: 56
- Life style prevention of cancer recurrence: The yin and the yang.Cancer Treat Res. 2014; 159: 341-351
- Weight management and its role in breast cancer rehabilitation.Cancer. 2012; 118: 2277-2287
- Improvement of metabolism among obese breast cancer survivors in differing weight loss regimens.Obes Res. 2004; 12: 306-312
- Effectiveness of dietetic consultations in primary health care: A systematic review of randomized controlled trials.J Acad Nutr Diet. 2017; 117: 1941-1962
- Weight loss intervention for breast cancer survivors: A systematic review.Curr Breast Cancer Rep. 2013; 5: 222-246
- The Role of Obesity in Cancer Survival and Recurrence—Workshop Summary.The National Academies Press, Washington, DC2012
- Questions and Answers on Dietary Supplements.(Accessed February 1, 2018)
- The use of dietary supplements in oncology.Curr Oncol Rep. 2014; 16: 411
- Vitamin and mineral supplement use among US adults after cancer diagnosis: A systematic review.J Clin Oncol. 2008; 26: 665-673
Li C, Hansen RA, Chou C, Calderon AI, Qian J. Trends in botanical dietary supplement use among US adults by cancer status: The National Health and Nutrition Examination Survey, 1999 to 2014 [published online ahead of print December 6, 2017]. Cancer. https://doi.org/10.1002/cncr.31183.
- Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive services Task Force recommendation statement.Ann Intern Med. 2014; 160: 558-564
- Undernutrition screening survey in 564,063 patients: patients with a positive undernutrition screening score stay in hospital 1.4 d longer.Am J Clin Nutr. 2016; 103: 1026-1032
- Relationship between nutritional status and the clinical outcomes of patients with and without neoplasms according to multiple correspondence analysis.Arq Gastroenterol. 2017; 54: 148-155
- Evaluation of nutritional status as an independent predictor of post-operative complications and morbidity after gastro-intestinal surgery.Clin Nutr ESPEN. 2015; 10: e129-e133
- Comparison of nutritional diagnosis methods and prediction of clinical outcomes in patients with neoplasms and digestive tract diseases.Clin Nutr. 2015; 34: 647-651
- An interdisciplinary nutrition support team improves clinical and hospitalized outcomes of esophageal cancer patients with concurrent chemoradiotherapy.Chin Med J (Engl). 2015; 128: 3003-3007
- Outcomes of undernutrition in patients in the community with cancer or cardiovascular disease.Proc Nutr Soc. 1999; 58: 655-661
- The medical care costs of obesity: An instrumental variables approach.J Health Econ. 2012; 31: 219-230
- The impact of Medicare coverage for anti-obesity interventions.(IHS Markit. Accessed January 4, 2018)
- The clinical and economic consequences of obesity.Am J Manag Care. 2013; 19: s219-s228
- Academy of Nutrition and Dietetics: Revised 2017 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in oncology nutrition.J Acad Nutr Diet. 2018; 118: 736-748e.42
Cancer Guidelines Wiki. Evidence-Based Practice Guidelines for the Nutritional Management of Adult Patients with Head and Neck Cancer. https://wiki.cancer.org.au/australia/COSA: Head_and_neck_cancer_nutrition_guidelines. Sydney: Cancer Council Australia: Head and Neck Guideline Steering Committee. Accessed February 1, 2018.
- The role of dietary counseling and nutrition support in head and neck cancer patients.Curr Opin Support Palliat Care. 2012; 6: 438-445
- Nutritional considerations for head and neck cancer patients: A review of the literature.J Oral Maxillofac Surg. 2013; 71: 1853-1860
- Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.J Laryngol Otol. 2016; 130: S32-s40
- Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.J Acad Nutr Diet. 2018; 118: 141-165
- American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity.CA Cancer J Clin. 2012; 62: 30-67
- Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. AICR, Washington, DC2007
- Definition of standardized nutritional assessment and interventional pathways in oncology.Nutrition. 1996; 12: S15-S19
- Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer.Eur J Clin Nutr. 2002; 56: 779-785
- Validation of a malnutrition screening tool for patients receiving radiotherapy.Australas Radiol. 1999; 43: 325-327
- Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.Nutrition. 1999; 15: 458-464
- Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease.N Engl J Med. 1996; 334: 1150-1155
- Effect of selenium and vitamin E on risk of prostate cancer and other cancers: The Selenium and Vitamin E Cancer Prevention Trial (SELECT).JAMA. 2009; 301: 39-51
- Nutrigenomics in cancer: Revisiting the effects of natural compounds.Semin Cancer Biol. 2017; 46: 84-106
- Telehealth.(Accessed February 1, 2018)
- Propelling the profession with outcomes and evidence: Building a robust research agenda at the Academy.J Acad Nutr Diet. 2017; 117: S62-s78
- Research and the dietetics profession: Making a bigger impact.J Am Diet Assoc. 2003; 103: 108-112
- Data mining in healthcare and biomedicine: A survey of the literature.J Med Syst. 2012; 36: 2431-2448
- Data mining applications in healthcare.J Healthc Inf Manag. 2005; 19: 64-72
- Toward international best outcomes: The shared path of the nutrition care process, informatics, and research translation.J Acad Nutr Diet. 2017; 117: 1727-1730
- National Comprehensive Cancer Network.(Accessed February 8, 2018)
- (Accessed December 19, 2017)
- National Institutes of Health. Provocative questions: identifying perplexing problems to drive progress against cancer.(Accessed December 18, 2017)
Biography
E. B. Trujillo is a nutritionist, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD.
Biography
S. W. Dixon is a senior content writer, The Mesothelioma Center, Orlando, FL.
Biography
K. Claghorn is an advanced practice clinical dietitian specialist, Abramson Cancer Center, University of Pennsylvania, Philadelphia.
Biography
R. M. Levin is an oncology dietitian nutritionist, Dell Children’s Blood and Cancer Center, Austin, TX.
Biography
J. B. Mills is a certified specialist in oncology nutrition, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Biography
C. K. Spees is an assistant professor, Medical Dietetics & Health Sciences, School of Health and Rehabilitation Sciences, James Cancer Hospital & Solove Research Institute Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus.
Article info
Publication history
Published online: March 22, 2018
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There was no funding or support for this work.
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
