Examining Access to Nutrition Care in Outpatient Cancer Centers Proceedings of a Workshop (2016) / Chapter Skim
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6 Evidence on Nutrition Care in Outpatient Oncology: Closing Discussion
6 Evidence on Nutrition Care in Outpatient Oncology: Closing Discussion
Pages 87-96
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From page 87... ...
Rather than directly answering these questions in turn, the speakers and other workshop participants used them more as backdrop for the discussion. Three major overarching themes emerged during the course of this discussion.
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From page 88... ...
She agreed with McClure's suggestion to measure nutrition status as part of cancer drug clinical trials to help determine whether people with better nutrition status are more likely to stay on their treatments. But even doing that is looking through a very short window of time -- 10 or 12 or 16 weeks for most cancer survivors.
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From page 89... ...
These organizations could serve as models for moving forward and addressing the continuum of care. INCORPORATING NUTRITION STUDIES INTO DRUG CLINICAL TRIALS During her presentation on the NCCN guidelines, McClure had stated that, while the best nutrition evidence may be among breast cancer patients and survivors, for every one of those nutrition studies, there are probably some 3,000 drug studies.
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From page 90... ...
When those guidelines are operationalized and applied to data from prospective cohort studies, Robien said, "They are being confirmed." So while a randomized controlled trial provides a stronger level of evidence, there is so much observational data and so much consistency that when the guidelines are evaluated this data should count as well, in her opinion. With respect to which cancer and which area of the continuum of care has the strongest set of observational data, Clinton identified breast cancer survivors as having a very strong set of observational data in addition to a small amount of intervention data and lots of laboratory/mechanistic data.
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From page 91... ...
The Oncology Nursing Society Putting Evidence into Practice guidelines were added as well. In addition to building the evidence base for nutrition interventions among oncology outpatients, for Robien, another reason the nutrition community should become involved with clinical trials is to support standardization with respect to how body surface area is assessed and height and weight data are collected.
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From page 92... ...
"You can always go back to your clinical roots," she said. "I think that we need more methodologists." While there were several calls for adding nutritional components to phase III trials and the comparatively minimal cost of doing so, a couple of workshop participants cautioned that the current structure of the NCI funding and the "hoops to jump through" pose a challenge.
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From page 93... ...
Revisiting earlier comments about the need to empower dietitians, there was some additional discussion about the importance of dietitians developing relationships with advocates and other oncology professionals as a way to "get the word out" and build momentum for conducting nutrition studies. Fonfa encouraged dietitians to attend as many conferences as possible and submit abstracts to "get the word out." Another workshop participant emphasized grassroots efforts within dietitians' workplaces and the importance of developing relationships with not only physicians, but also physical therapists, speech therapists, and nurses, so these other professionals begin seeking out dietitians' expert opinions, much like physicians send their patients to physical therapists because they recognize the value of physical therapy.
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From page 94... ...
" Another workshop participant suggested that Vice President Joe Biden's cancer "moonshot" campaign and his apparent openness to engage multiple stakeholders from different fields creates a unique opportunity to engage a broader national dialogue about nutrition in cancer. Robien agreed.
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From page 95... ...
First, the objective of the first session of the workshop was to describe the current status of nutritional care for oncology outpatients. "We concluded," Rock said, "that there was a fair amount of evidence." While there is still not "enough" evidence, as Joan McClure discussed during her presentation on the NCCN guidelines, Rock said, "We are on the road." The second workshop objective was to describe the ideal care setting for nutritional care for oncology outpatients.
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From page 96... ...
96 NUTRITION CARE IN OUTPATIENT CANCER CENTERS the bulk of medical care for all long-term cancer survivors is provided by primary care providers. We often criticize oncologists for neglecting nutritional issues Rock said, "but after the oncologists are done with initial care of cancer patients, there is a much larger group of health care providers that are really the first-line caretakers of these patients."
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