Examining Access to Nutrition Care in Outpatient Cancer Centers Proceedings of a Workshop (2016) / Chapter Skim
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2 Current Knowledge and Status of Nutrition Practices in Oncology Outpatient Care
2 Current Knowledge and Status of Nutrition Practices in Oncology Outpatient Care
Pages 13-34
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From page 13... ...
Early oncology care includes patients undergoing active treatment and patients recovering from treatment. Platek highlighted challenges created by nonstandardized screening for cancer patients at nutritional risk and the lack of available nutrition services in outpatient settings; provided an overview of the effects of cancer on nutritional status, the effects of treatment on nutritional status, and the effects of nutritional status on treatment and clinical outcomes; and discussed her search of the scientific literature for evidence of nutritional intervention in early oncology care.
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From page 14... ...
Then she became involved with conducting studies on outpatients at a comprehensive cancer center but still with a focus on early oncology care and, specifically, nutritional status of the outpatient. She noted that while much of what she would talk about relates to pediatric oncology, the focus would be on adult oncology patients, including adult patients undergoing radiation or chemotherapy; patients who have had surgery; patients who have been sent home and are being followed up in the clinic; and any combination of these situations.
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From page 15... ...
It is t difficult to screen and identify something for which there is no consensus. Today, operational definitions exist for inadequate nutritional status in cancer patients, cancer-related malnutrition, and cancer cachexia.
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. Effect of Treatment on Nutritional Status Now that improved definitive treatments are available and more people are surviving cancer, in addition to considering the effects of cancer itself on nutritional status, Platek considered the effects of cancer treatment on nutritional status.
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. In a survey of 1,200 outpatients at seven comprehensive cancer centers, with patients having been diagnosed with all types of different cancers at an average of about 9 months before the survey, Platek and colleagues found that most patients experienced some sort of symptomology and that fatigue was at the top of the list of symptoms (Coa et al., 2015)
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From page 18... ...
18 NUTRITION CARE IN OUTPATIENT CANCER CENTERS Symptoms are most likely to occur among those … q Losing weight unintentionally q Consuming less food and beverages since beginning treatment q Avoiding foods during treatment FIGURE 2-1 Symptoms experienced by cancer patients during early treatment, based on a study of 1,200 outpatients at 7 comprehensive cancer centers. SOURCES: Presented by Mary Platek on March 14, 2016; Coa et al., 2015.
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From page 19... ...
Of these 38 papers, 4 RCTs and 1 prospective study related to systematic individualized nutrition counseling. Overall, systematic individualized nutrition counseling was associated with improved weight, improved quality of life, improved nutritional intake, improved nutritional status and, with radiation therapy in particular, decreased toxicity (both reports and intensity of toxicity)
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From page 20... ...
Her review of these studies showed improved body weight and lean body mass, as well as improved performance tatus, with use of IEN support. s These same studies also showed decreased inflammation, decreased length of hospital stay, decreased postoperative complications, and decreased incidence of infections.
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From page 21... ...
. That the largest percentage of cancer survivors are women who have survived breast cancer explains, Rock said, why so much of the evidence for the cancer survivor population is based on breast cancer patients.
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From page 22... ...
SOURCE: Cheryl Rock, March 14, 2016 (modified from Parry et al., 2011)
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From page 23... ...
Again, of those 14.5 million, a large percentage are over the age of 65 years, with breast cancer survivors being the largest group, followed by prostate cancer survivors and colorectal cancer survivors. Among all survivors, over 4.7 million received their diagnosis 10 or more years earlier.
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From page 24... ...
Obesity and overweight have been associated with increased mortality from cancers of the esophagus, colon and rectum, liver, gallbladder, pancreas, kidney, and stomach, as well as non-Hodgkin's lymphoma and multiple myeloma. In addition to its effects on survival after diagnosis, being lean and physically active appears to also be associated with fewer treatment- related problems during the initial treatment period (e.g., lymphedema with breast cancer, incontinence with prostate cancer, physical function with all cancers)
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From page 25... ...
Rock recalled studies she has been involved with where women who had diabetes when they were diagnosed with breast cancer were more likely to have an early death during the course of the study regardless of treatment. Also worth pointing out, Rock noted, post- enopausal breast m cancer patients are far more likely to die from cardiovascular disease than from the effects of breast cancer.
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From page 26... ...
Finally, arthralgias and myalgias, that is, joint and muscle pain, occur in more than 40 percent of women with breast cancer who are treated with chemotherapy and in up to 50 percent of women who are treated with aromatase inhibitors. According to Rock, these problems are more common in obese women and can contribute to reduced physical activity.
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From page 27... ...
GI and head and neck cancer patients represent another special population for whom nutrition intervention likely has potential benefit, given the enduring effects of surgery among these patients on dietary intake and nutrient absorption. Finally, cancer patients undergoing palliative care represent yet another special group for whom nutritional support and counseling may help patients to live as actively as possible and improve quality of life.
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From page 28... ...
The study enrolled both premenopausal and postmenopausal women who had been diagnosed and treated for early-stage breast cancer and followed the women for about 7 years. The dietary intervention was not a weight loss intervention.
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From page 29... ...
on breast cancer outcomes: the SUCCESS C trial in Germany and the D IANA-5 study in Italy. Numerous other studies, at least more numerous than in other areas of research in nutrition and cancer, have examined the effect of weight loss interventions on weight and selected biomarkers in overweight and obese breast cancer survivors.
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From page 30... ...
. Rock found only one dietary intervention weight loss study among childhood cancer survivors (Huang et al., 2014)
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From page 31... ...
Finally, m she remarked that studies conducted to date suggest that cancer survivors are an appropriate target for interventions because they are able to make behavioral changes. PANEL DISCUSSION WITH SPEAKERS: DATA GAPS IN CURRENT NUTRITION PRACTICE IN ONCOLOGY OUTPATIENT CARE Following Rock's presentation, she, Platek, and Clinton answered questions from the audience on a wide range of topics related to the current knowledge and status of nutrition practices in oncology outpatient care (see Chapter 1 for a summary of Clinton's keynote presentation)
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From page 32... ...
She noted that the next batch of ACS guidelines for survivors would be addressing soy to a greater extent than in the past. Educating the Public About Cancer-Related Nutrition Issues An audience member who identified herself as an oncology dietitian working "in the trenches" has been trying to encourage women who are diagnosed with breast cancer to meet with her before surgery.
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From page 33... ...
Additionally, Fonfa suggested that, in the begin ing, rather than one-on-one education, the focus should be on group n discussions. Rock agreed that the message should be "healthy lifestyle," not "weight loss." However, in response to Fonfa's suggestion that initial education efforts be group discussions, Rock said she finds the one-on-one visits with patients very empowering.
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From page 34... ...
Risk needs to be modeled and nutrition care paths developed and compared. Immune-Enhancing Nutrition Support Also during her presentation, Platek had reviewed evidence on the effects of immune-enhancing nutrition (IEN)
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