Examining Access to Nutrition Care in Outpatient Cancer Centers Proceedings of a Workshop (2016) / Chapter Skim
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Amidst growing concern about access to oncology nutrition services, combined with growing recognition of the importance of providing nutritional care to optimize oncology treatment outcomes and maximize quality of life among both patients and survivors of cancer, an ad hoc planning committee of the National Academies of Sciences, Engineering, and Medicine's Food and Nutrition Board1 convened a 1-day public workshop in Washington, DC, on March 14, 2016, titled "Examining Access to Nutrition Care in Outpatient Cancer Centers," to explore evolving interactions between nutritional care, cancer, and health outcomes. Specifically, as per the statement of task (see Box 1-1)
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The workshop will also explore nutritional interventions and cost of outpatient care. The workshop discussants will take into account a range of analytical approaches, including use of aggregate data from electronic medical records, to assess cost– benefit relationships between oncology nutrition services and health outcomes and survival.
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Finally, Chapter 6 "Evidence on Nutrition Care in Outpatient Oncology: Closing Discussion" summarizes the closing facilitated discussion. KEYNOTE PRESENTATION2 Pulling together different interests relating to nutrition care access in outpatient cancer centers was "a long time coming," Steven Clinton began.
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, and other organizations have supplied evidence-based reports that make these data not only useful for researchers but also applicable to public health policy and to governmental food, nutrition, and agricultural programs around the world. Data have emerged showing how dietary and nutritional strategies integrated into patient care plans not only enhance therapeutic efficacy and reduce complications of therapy but also promote healthy survivorship in terms of both reducing risk of recurrence and improving overall health (i.e., with regard to other chronic disease outcomes)
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Clinton called for more people to be trained as dietitians and nutritionists. Additionally, he called for more grants to be awarded to institutions with the infrastructure to offer combined degree training programs, particularly RDs/Ph.D.s, which he predicted will be at the forefront of bringing nutrition expertise to the bedside.
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Perhaps it is time to revisit the integration of nutritional services into specific components of the NCCN guidelines. With both head and neck and oral cancers, where surgical procedures coupled with chemotherapy and radiation make it difficult for patients to consume an adequate diet, there is very clear and strong evidence that nutritional support can greatly improve the ability to receive a full complement of effective therapy on time and at the most impactful dose.
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So learn today, speak up, and act." SPONSOR PANEL Representatives from the six sponsors who contributed more than $10,000 to support this workshop described their institutions' interests in the workshop topic. First, Deirdre McGinley-Gieser, Senior Vice President for Programs at AICR, described AICR as a national nonprofit organization based in W ashington, DC, with a focus on the link between nutrition, physical activity, and weight management to the risk of cancer.
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Yet there are very few weight loss treatment opportunities available for cancer patients and survivors, although she noted a 2014 report issued by the American Society of Clinical Oncology emphasizing the oncology community's commitment to look for ways to implement nutrition weight loss programs for cancer survivors. A group at particularly high nutritional risk and one often missed as being at high risk is patients with sarcopenic obesity.
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Another was lack of resources, that is, that there were not enough staff to help manage patients on enteral nutrition. Yet another answer, which Clayton found the most troubling, was that many patients with pancreatic cancer are incurable and that placing a feeding tube confuses end-of-life issues.
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of the AND. She echoed other remarks about the lead-up to this workshop, calling it a "historic day." Outpatient oncology nutrition has evolved into its own field of practice over the past 20 years, especially with the shift to outpatient care, with 90 percent of cancer care now being provided in the outpatient clinic (see Box 1-3)
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Claghorn remarked that many workshop attendees had likely witnessed how, among cancer patients, medical nutrition therapy delivered by dietitians can help to prevent delays in treatment, prevent unplanned hospitalizations, avoid reactionary nutrition support, improve outcomes in patient satisfaction, and reduce the cost of care. Addiionally, t registered dietitians serve an important role in helping cancer survivors with the long-term side effects of treatment, one of the most challenging being obesity.
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