ONC: Medical Nutrition Therapy and Nutrition Intervention in Adult Oncology Patients (2011)

ONC: Medical Nutrition Therapy and Nutrition Intervention in Adult Oncology Patients (2011)

Overview

Medical Nutrition Therapy (MNT) is defined as an evidence-based application of the Nutrition Care Process and includes in-depth assessment, periodic re-assessment and intervention.

The Oncology Workgroup used the above definition for MNT and set the following criteria when evaluating the inclusion and exclusion of studies for the evidence analysis questions on this topic:

• RD (or equivalent food and nutrition practitioner) provided the intervention
• More than one nutrition encounter
• Individualized approach.

Several of the international studies were conducted in countries who had dietetic reciprocity with the Commission on Dietetic Registration (CDR). Other international studies used various terminology in describing the clinician providing the intervention. All international studies were considered for inclusion if the study reasonably described the food and nutrition practitioner as equivalent to RDs in the US.

The workgroup noted that not all articles considered for inclusion clearly described the practitioner providing the nutrition intervention. Due to the lack of consistent terminology used in the studies, the Work Group encourages future research to describe the specific profession of the clinician providing nutrition care and include a detailed description of the nutrition intervention.

For the Oncology Work Group's suggestions for future research on this topic, see ONC: Future Research Suggestions on the left.

• Intervention
  Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) as part of multi-modal therapy effective in adult oncology patients receiving chemotherapy treatment?

  • Conclusion

    Medical nutrition therapy provided by a registered dietitian (RD), as part of multi-modal therapy, was found to be effective in improving outcomes in adult breast cancer patients receiving chemotherapy treatment. Although all cancers were included in the search strategy, only one study of breast cancer patients met inclusion criteria.
     

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) as part of multi-modal therapy effective in adult oncology patients receiving chemotherapy treatment?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Block KI, Gyllenhaal C, Tripathy D, Freels S, Mead MN, Block PB, Steinmann WC, Newman RA, Shoham J. Survival impact of integrative cancer care in advanced metastatic breast cancer. Breast J. 2009 Jul-Aug; 15 (4): 357-366. Epub 2009 May 12
  • Search Plan and Results: ONC: Medical Nutrition Therapy and Chemotherapy Treatment 2011
     
  Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) as part of multi-modal therapy effective in adult oncology patients receiving radiation treatment?

  • Conclusion

    Three studies found that MNT provided by an RD (or equivalent food and nutrition practitioner) as part of multi-modal therapy was effective in improving outcomes in adult oncology patients receiving radiation treatment.
     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) as part of multi-modal therapy effective in adult oncology patients receiving radiation treatment?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Danielson B, Fairchild A. Beyond palliative radiotherapy: A pilot multidisciplinary brain metastases clinic. Support Care Cancer. 2011 Apr 9. doi: 10.1007/s00520-011-1149-1. 
         
      • Pituskin E, Fairchild A, Dutka J, Gagnon L, Driga A, Tachynski P, Borschneck JA, Ghosh S. Multidisciplinary team contributions within a dedicated outpatient palliative radiotherapy clinic: A prospective descriptive study. Int J Radiat Oncol Biol Phys 2010; 78 (2): 527-532.
  • Search Plan and Results: ONC: Medical Nutrition Therapy and Radiation Treatment 2011
     
  Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) effective in adult oncology patients receiving chemotherapy treatment?

  • Conclusion

    Medical nutrition therapy (MNT) provided by an RD (or equivalent food and nutrition practitioner) was effective in improving multiple treatment outcomes in adult oncology patients receiving chemotherapy in five studies examining patients with a variety of cancers (breast, ovary, lung, leukemias, colorectal, upper GI) prior to receiving chemotherapy in ambulatory and inpatient oncology centers.

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) effective in adult oncology patients receiving chemotherapy treatment?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dintinjana RD, Guina T, Krznaric Z, Radic M, Dintinjana, M. Effects of nutritional support in patients with colorectal cancer durng chemotherapy. Collegium Antropologicum 2008; 3: 737-740.
      • Glare P, Jongs W, and Zafiropoulos, B. Establishing a cancer nutrition rehabilitation program (CNRP) for ambulatory patients attending an Australian cancer center. Support Care Cancer. 2011, 19: 445-454.  
  • Search Plan and Results: ONC: Medical Nutrition Therapy and Chemotherapy Treatment 2011
     
  Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) effective in adult oncology patients receiving radiation treatment?

  • Conclusion

    Medical nutrition therapy (MNT) provided by an RD (or equivalent food and nutrition practitioner) was effective in improving multiple treatment outcomes in eleven studies examining 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.

     

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Is medical nutrition therapy (MNT) provided by a registered dietitian (RD) effective in adult cancer patients receiving radiation treatment?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Glare P, Jongs W, and Zafiropoulos, B. Establishing a cancer nutrition rehabilitation program (CNRP) for ambulatory patients attending an Australian cancer center. Support Care Cancer. 2011, 19: 445-454.  
      • Isenring EA, Bauer JD, Capra S. Nutrition Support Using the American Dietetic Association Medical Nutrition Therapy Protocol for Radiation Oncology Patients Improves Dietary Intake Compared with Standard Practice. J Am Diet Assoc 2007; 107 (3): 404-412.
      • Isenring E, Capra S, Bauer J, Davies PS. The impact of nutrition support on body composition in cancer outpatients receiving radiotherapy. Acta Diabetol. 2003 Oct; 40 Suppl 1: S162-S164.
      • Isenring E, Capra S, Bauer J. Patient satisfaction is rated higher by radiation oncology outpatients receiving nutrition intervention compared with usual care. J Hum Nutr Diet. 2004; 17: 145-152.
      • Isenring EA, Capra S, Bauer, J.D. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Brit J Cancer. 91: 447-452; 2004.
      • Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head and Neck. 2005 Aug; 659-668. 
      • van den Berg MGA, Rasmussen-Conrad EL, Wei KH, Lintz-Luidens H, Kaanders JHAM, Merkx MAW. Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy. Br J Nutr. 2010; 104: 872-877.
  • Search Plan and Results: ONC: Medical Nutrition Therapy and Radiation Treatment 2011