When a patient is receiving cancer treatment, every part of that care is crucial. But despite the best efforts of clinicians around the country, patient care is lagging behind in an important area: nutrition.
In a new national survey of 215 outpatient cancer care centers, researchers found that for every one registered dietitian nutritionist, there are more than 2,300 cancer patients currently in treatment. The survey indicates a significant gap in access for oncology patients in need of nutritional care given that 80% of patients are malnourished at some point during treatment. We at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute believe this represents a significant barrier to quality care and treatment.
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The study was led by the Oncology Dietetic Practice Group of the Academy of Nutrition and Dietetics, which included authors from The Ohio State University, National Cancer Institute, University of Pennsylvania, Roswell Park Comprehensive Cancer Center, Dartmouth College and Cambia Health Solutions. Funding support was provided by ON DPG.
According to published studies, malnutrition is associated with a variety of poor health outcomes for cancer patients, including decreased quality of life, reduced tolerance to cancer therapy, greater treatment toxicities and increased mortality rates.
We believe these results prompt the need for urgent action to fully integrate medical nutrition therapy, delivered by RDNs, into standard-of-care guidelines for cancer patients.
For this national study, researchers evaluated RDN staffing patterns, nutritional services provided in ambulatory oncology settings, malnutrition screening patterns and referral and reimbursement practices specific to outpatient cancer centers.
Other results of the survey, which were reported in the Journal of Oncology, revealed significant gaps in RDN access for oncology patients. Highlights of the findings include:
— Only 53% of outpatient cancer centers screened for malnutrition among their patients.
— About 35% of outpatient cancer centers did not use a validated tool to facilitate malnutrition screenings.
— RDNs were able to counsel an average of seven to 11 patients per day.
— Nearly 77% of cancer centers did not bill for nutrition services because the services are not reimbursed through the Centers for Medicare and Medicaid Services or most private insurers in outpatient settings, limiting medical institutions’ financial ability to provide more extensive services.
It is critical that cancer patients at risk of malnutrition are identified early and receive adequate nutritional care. RDNs are uniquely trained to support the patient’s needs throughout the course of treatment, but they must be part of the care team from the very beginning.
RDNs have extensive training in the pathophysiology of carcinogenesis, medical nutrition therapy and behavioral counseling that can improve patient adherence to treatment regimens and promote optimal nutritional status both during and after treatment.
Research suggests that a staffing ratio of one RDN for every 120 oncology patients progressing through treatment may be an effective ratio for reducing malnutrition risk and treatment toxicities.
In addition to existing information, we are embarking on a new clinical trial this summer. The trial offers patients with lung cancer ongoing remote nutritional counseling with a dedicated oncology RDN.
When the RDN has determined the optimal dietary prescription for each patient, medically tailored meals will be delivered to the patients’ homes. This trial begins recruiting in August.
If this study is successful, it could change the paradigm of care and provide more patients with access to this critical resource. We believe this proactive approach will keep patients well-nourished throughout the course of treatment, better enabling them to fight their disease and improve quality of life.
A food-first approach can help reduce malnutrition, maintain a healthy immune system and improve health outcomes as well as quality of life throughout treatment and well into survivorship.
As we conduct more studies and obtain more information on the importance of RDNs, we hope the rest of the medical community will follow the lead of the OSUCCC — James and prioritize the nutritional status of their patients, improving outcomes and providing more comprehensive nutrition-related care.
Immediate action is warranted to improve oncology care in the United States. Oncology providers and stakeholders should advocate for more RDNs and reach out to colleagues, administrators, legislators, advocates and patients to make them aware of this gap in adequate cancer care. Every cancer patient should have access to medical nutrition therapy as part of their standard of care.
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Why Oncology Centers Need More Dietitians to Help Patients Battle Cancer originally appeared on usnews.com