Examining Access to Nutrition Care in Outpatient Cancer Centers Proceedings of a Workshop (2016) / Chapter Skim
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5 Dissemination and Implementation: Reaching the Ideal
5 Dissemination and Implementation: Reaching the Ideal
Pages 69-86
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From page 69... ...
She emphasized the need to increase awareness of and access to nutrition services and issued a call to action to everyone in attendance to "use your voice" and described the effort reflected in this workshop as the beginning of a national movement to bring dietitians not just into cancer centers and hospitals to help cancer patients, but also into community-based settings to help support survivors. Lastly, Joan McClure discussed the National Comprehensive Cancer Network (NCCN)
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From page 70... ...
But it was not until 2006 that ONDPG brought forth what Grant described as a "crazy idea," which was that the CDR ought to credential RDs/RDNs working in oncology nutrition, given the "certified world" of cancer centers, with oncology nurses, therapists, and doctors all being board-certified. In addition to feeling it was important to have that credential, Grant and her colleagues also wanted to establish minimum competency for taking care of 1 This section summarizes information and opinions presented by Barbara Grant, M.S., RDN, CSO, FAND, Saint Alphonsus Cancer Care Center, Boise and Caldwell, Idaho.
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From page 71... ...
. Dissemination of Oncology Nutrition RDNs and CSOs in Cancer Centers Across America Grant attributed the dissemination of oncology nutrition RDNs and CSOs in cancer centers across the United States to four key factors: 1.
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From page 72... ...
When K athryn called to tell her, Grant said, "this actually brought tears to my Hamilton." Effective in January 2016, all CoC-accredited cancer programs must have policies and procedures in place to ensure that patients have access to an RDN and that nutrition services are available either on-site or by referral. Additionally, rather than stating simply that "nutrition services" must be available, the eligibility requirements spells out the spectrum of services that must be available (screening and referral for nutrition-related problems, comprehensive nutrition assessment, nutrition counseling, and education)
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From page 73... ...
These are available on the ACCC website.2 In Grant's opinion, probably the greatest opportunity for fostering a relationship to help disseminate and implement oncology nutrition services is via the NCCN, given that most of the NCCN Guidelines for Treatment of Cancer by Site do not even mention nutrition. The only ones that do are for esophageal and gastric cancers and head and neck cancers.
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From page 74... ...
Again, Grant, said, "We are a very committed group," with 27 percent of respondents working more than 40 hours per week providing oncology nutrition services. Based on a 2015 national benchmarking study conducted by the Advisory Board Company's Oncology Roundtable, 76 percent of the 140 institutions surveyed reported having a dedicated dietitian working with cancer patients.
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From page 75... ...
The joy expressed by the husband and wife illustrated for Hamilton how valuable and helpful this type of resource is. Community-Based Settings for Supporting Cancer Survivors in Healthy Behavior Change Through her work with the ACS, Doyle has been fortunate to visit many different hospitals, cancer centers, and other entities that have survivorship wellness programs.
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From page 76... ...
The second project, Moving Forward, a weight loss intervention trial for African-American breast cancer survivors, showed positive results after an Illinois pilot test (i.e., significant decreases in weight, daily calories, and dietary fat; significant increases in daily vegetables, fiber, daily vigorous activity; and a trend toward increased moderate activity)
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From page 77... ...
Doyle noted that a 2017 Food and Nutrition Board workshop, Incorporating Weight Management and Physical Activity into Cancer Treatment: Overcoming Barriers in the Delivery of Care, was being planned and that some of the questions likely to be addressed include: What are the criteria for effective programs? What programs are out there?
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From page 78... ...
She referred workshop participants to the ACS's 2012 recommendation for community action. Without community involvement, Doyle said, "we can't sustain lifelong healthy eating [and]
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From page 79... ...
Doyle viewed the effort reflected in this workshop as the beginning of a national movement to bring dietitians into cancer centers and hospitals and into community-based settings where they can help support survivors. She said, "I hope that when you leave here today, you will be able to think of at least two or three things you could do in addition to what you are doing now to really help support cancer patients." DEVELOPING GUIDELINES FOR NUTRITION IN CANCER PATIENTS4 NCCN is an alliance of leading U.S.
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From page 80... ...
"It is that it doesn't exist." Much of oncology care is based on phase II studies or on historic practices. In many cases, clinical trials of current standards of care would probably be unethical (e.g., colectomies for colon cancer)
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From page 81... ...
Each guideline is based on what the NCCN calls a "category of evidence" and consensus. Category 1 evidence, McClure explained, is what NCCN defines as "high-level" evidence, which means there are randomized controlled clinical trials or meta-analyses addressing that particular issue and the panel considers the evidence to be persuasive, with at least 85 percent of member institutions agreeing this is the case.
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From page 82... ...
The more filled in the blocks, "the better," McClure said.6 NCCN Guidelines for Nutrition in Cancer Patients NCCN has made three separate attempts to develop guidelines for nutrition in cancer patients. The first attempt was 15 years ago.
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From page 83... ...
First and foremost, develop a more extensive evidence base. She suggested integrating correlative nutrition studies and nutrition status studies into large treatment clinical trials and seeing who responds versus who does not respond and what survivorship is for people with good nutrition status versus poor nutrition status.
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From page 84... ...
McClure encouraged submissions from the nutrition community, particularly if a professional organization "mentored" the submission so that, to help manage time constraints, panels are receiving only single collated submissions rather than multiple separate submissions. The Challenge of Testing Nutrition Interventions in Clinical Trials Dixon wondered how to reconcile the need to collect and analyze nutrition intervention data with the knowledge that nutrition interventions do not fit the Western medical model of placebo-controlled, double-blinded clinical trials.
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From page 85... ...
. Grant repeated that just having the RD/RDN credential in the CoC eligibility requirements is huge.
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