Recommendations Summary
ONC: Hematological: Chemotherapy and Medical Nutrition Therapy (MNT) 2008
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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Recommendation(s)
ONC: HEM: Chemotherapy and MNT
Medical Nutrition Therapy (MNT) that consists of nutrition assessment, intensive intervention, and ongoing monitoring and evaluation by a registered dietitian may be of benefit to patients with acute leukemias undergoing chemotherapy. Daily monitoring of intake and incorporating patient preferences have been shown to increase nutrition intake which positively affects body weight and tumor-therapy side effects (e.g., fatigue and anorexia).
Rating: Weak
Imperative-
Risks/Harms of Implementing This Recommendation
No potential risks and harms are associated with the application of this recommendation.
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Conditions of Application
No conditions limit the application of this recommendation.
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Potential Costs Associated with Application
Costs of MNT sessions and reimbursement vary.
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Recommendation Narrative
- In one small, neutral quality RCT, Ollenschlager et al, 1992 found that in 29 hospitalized patients nutritional care by an RD resulted in positive nutrition outcomes for patients receiving chemotherapy for acute lymphocytic and nonlymphocytic leukemia.
- Daily contact for assessment, education and motivation by an RD was effective in increasing body weight in the intervention group earlier and more often than in the control group.
- Nutrition intake was highly correlated with body weight status.
- Mean daily energy intake of 23.3 ± 11.4 kcals/kg/day was associated with weight loss; 30.9 ± 13.1 kcals/kg/day was associated with stable weight; and 39.3 ± 12.2 kcals/kg/day was associated with weight gain (P < 0.0001).
- A significant correlation was found between nutritional intake and tumor-therapy side effects (e.g., anorexia and fatigue) (P-values <0.01) was found.
- More research is needed to evaluate the impact of dietitian interventions on treatment related outcomes and survival.
- In one small, neutral quality RCT, Ollenschlager et al, 1992 found that in 29 hospitalized patients nutritional care by an RD resulted in positive nutrition outcomes for patients receiving chemotherapy for acute lymphocytic and nonlymphocytic leukemia.
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Recommendation Strength Rationale
- Based on one small RCT of neutral quality, conclusion statement is Grade III.
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Risks/Harms of Implementing This Recommendation
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Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).