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Recommendations Summary

ONC: Medical Nutrition Therapy in Adult Oncology Patients Undergoing Chemotherapy or Radiation Therapy 2013

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.


  • Recommendation(s)

    ONC: Medical Nutrition Therapy (MNT) in Adult Oncology Patients Undergoing Chemotherapy or Radiation Treatment

    If an adult oncology patient is undergoing chemotherapy or radiation treatment,  the registered dietitian nutritionist (RDN) should provide medical nutrition therapy (MNT). MNT has been shown to be effective in improving multiple treatment outcomes in patients undergoing chemotherapy, radiation or chemoradiotherapy in ambulatory or outpatient and inpatient oncology settings.

    Rating: Strong
    Conditional

    ONC: Medical Nutrition Therapy (MNT) as Part of Multi-modal Therapy in Adult Oncology Patients Undergoing Chemotherapy or Radiation Treatment

    The RDN should be a member of the interdisciplinary team providing multi-modal therapy to adult oncology patients undergoing chemotherapy or radiation treatment. Multi-modal therapy includes coordinated interventions from a variety of health care disciplines. Multi-modal therapy that includes MNT demonstrates positive outcomes.

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      Recommendations apply to adult oncology patients receiving chemotherapy or radiation treatment.

    • Potential Costs Associated with Application

      Although costs of MNT sessions and reimbursement vary, MNT sessions including collaboration with other healthcare professionals are essential for improved outcomes.

    • Recommendation Narrative

      A total of 19 studies were included in the evidence analysis for this recommendation:

      • Six positive quality randomized controlled trials (RCTs): Isenring et al, 2007;  Isenring et al, 2003;  Isenring et al, 2004 (Brit J Cancer); Ovesen et al, 1993; Ravasco et al, 2005 (J Clin Oncology); Ravasco et al, 2005 (Head and Neck)
      • One positive quality before and after study: Ravasco et al, 2003
      • Five neutral quality non-randomized controlled trials: Danielson and Fairchild,  2011; Dawson et al, 2001; Dintinjana et al, 2008; Goncalves et al, 2005; van den Berg et al, 2010  
      • Two neutral quality prospective cohorts: Glare et al, 2011; Pituskin et al, 2010
      • Two neutral quality RCTs: Isenring et al, 2004 (J Hum Nutr Diet); Ollenschläger et al, 1992
      • One neutral quality retrospective cohort: Odelli et al, 2005
      • One neutral quality case control: Glimelius et al, 1992 
      • One neutral quality case study or case series: Block et al, 2009. 

      MNT and Chemotherapy

      • Five international studies provided evidence that MNT provided by an RDN or equivalent food and nutrition practitioner was effective in improving multiple treatment outcomes in adult oncology patients receiving chemotherapy
      • These studies examined patients with a variety of cancers (breast, ovary, lung, leukemias, colorectal, upper GI) prior to receiving chemotherapy in ambulatory and inpatient oncology centers
      • Evidence is based on the following studies: Dintinjana et al, 2008; Glare et al, 2011; Glimelius et al, 1992; Ollenschläger et al, 1992; Ovesen et al, 1993.

      MNT as Part of Multi-modal Therapy and Chemotherapy

      • One study provided evidence that MNT provided by an RDN as part of multi-modal therapy was effective in improving outcomes in adult oncology patients receiving chemotherapy treatment
      • Evidence is based on the following study: Block et al, 2009.

      MNT and Radiation Therapy

      • Eleven international studies provided evidence that MNT provided by an RDN or equivalent food and nutrition practitioner was effective in improving multiple treatment outcomes. These studies examined patients with a variety of high-risk cancers (head and neck, gastrointestinal) prior to receiving radiotherapy or combined radiotherapy in ambulatory and inpatient oncology centers.
      • Evidence is based on the following studies: Glare et al, 2011; Goncalves et al, 2005; Isenring et al, 2007; Isenring et al, 2004 (Brit J Cancer.); Isenring et al, 2004 (J Hum Nutr Diet.); Isenring et al, 2003; Odelli et al, 2005; Ravasco et al, 2005 (J Clin Oncology.); Ravasco et al, 2005 (Head and Neck); Ravasco et al, 2003; van den Berg et al, 2010. 

      MNT as Part of Multi-Modal Therapy and Radiation Therapy

      • Three studies provided evidence that MNT provided by an RDN or equivalent food and nutrition practitioner as part of multi-modal therapy was effective in improving outcomes in adult oncology patients receiving radiation treatment
      • Evidence is based on the following studies: Danielson and Fairchild,  2011; Dawson et al, 2001; and Pituskin et al, 2010. 

    • Recommendation Strength Rationale

      • Conclusion statement regarding MNT provided by an RDN in adult oncology patients receiving chemotherapy is a Grade II
      • Conclusion statement regarding MNT provided by an RDN in adult oncology patients receiving radiotherapy or combined radiotherapy is a Grade I
      • Conclusion statement regarding MNT provided by an RDN as part of multi-modal therapy in adult oncology patients receiving radiation treatment is Grade II
      • Conclusion statement regarding MNT provided by an RDN as part of multi-modal therapy in adult oncology patients receiving chemotherapy treatment is Grade III.

    • Minority Opinions

      None.