Oncology

Oncology

Welcome to the Medical Nutrition Therapy for Oncology Project


Umbrella Review

Malnutrition frequently affects adults with cancer and is associated with reduced quality of life and increased mortality risk. To guide payers and policymakers in identifying effective care strategies, a clearer understanding of the role dietitians play in cancer care is essential. This umbrella review of systematic reviews aims to assess the impact of dietitian-led interventions—compared to no intervention or standard care—on nutrition-related outcomes in adults across all cancer types and stages. Outcomes of interest included:

  • Nutrition status
  • Quality of life
  • Length of stay
  • Mortality
  • Weight
  • Protein Intake
  • Energy intake

Key Findings:

In adults with cancer, dietitian interventions may have a beneficial effect on nutrition status, length of stay, quality of life, and protein and energy intake. However, the certainty of evidence was low due to risk of bias, unclear effect sizes, and small sample sizes. The impact of dietitian interventions on body weight in adult cancer patients was mixed but may have some beneficial impact for adults with head and neck cancer.  There was no impact of dietitian interventions on mortality. 

Dietitian-led interventions show promise in enhancing a broad spectrum of nutrition-related outcomes in adults with cancer. Policymakers and healthcare payers can support the well-being of individuals with cancer by enabling coverage and access to medical nutrition therapy (MNT) delivered by registered dietitian nutritionists (RDNs).

 

Evidence-Based Nutrition Practice Guideline

The focus of the 2013 Oncology guideline is on oncology nutrition practice during the treatment of adult patients with cancer. Cancer is a complex group of multifactoral diseases that develops from interactions between genetics and environment. Screening for malnutrition risk and performing a comprehensive nutrition assessment are required to identify intervention to maximize adequate intake.

This edition lays the foundation to establish the need for Medical Nutrition Therapy (MNT) in the adult oncology population, since nutrition plays a key role in all cancers and cancer treatments.


Systematic Review

The aim of the systematic review focused on nutrition screening and assessment. The workgroup focused on four subtopic areas:

  • The relationship between nutrition status and the following morbidity outcomes in adult oncology patients: hospital admissions or readmissions; hospital length of stay; quality of life; radiation treatment tolerance; and chemotherapy treatment tolerance
  • The expert panel reviewed articles on screening and assessment in the oncology population in order to evaluate the available tools and provide evidence-based guidance for the oncology dietitian caring for those patients experiencing nutrition impact symptoms or those at risk for malnutrition.
  • 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 expert panel this 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; and individualized approach.
  • The effect of dietary supplements and medical food supplements (MFS) containing fish oil (specifically eicosapentaenoic acid [EPA]) on body weight and lean body mass (LBM) in cancer cachexia was reviewed. A dietary supplement is a single nutrient supplement in the form of a pill, capsule, liquid, chew, or other form. An MFS is a commercial or prepared food or beverage that supplements energy, protein, carbohydrate, fiber, or fat intake.

Use the left navigation to view the results of the guideline and systematic review. The complete guideline can be downloaded in PDF format from here.

Expand the section below titled Project Team for a listing of individuals who contributed to the development of the project, conflict of interest disclosures, and project funding information. Expand the section titled Project Resources to view resources developed from this project.

 

  • Project Articles and Resources

    The following articles and resources were developed: 

    • Rozga M, Moloney L, Handu D. Dietitian-Provided Interventions for Adults with Cancer: An Umbrella Review of Systematic Reviews. Nutr Cancer. 2025 Mar 19:1-15. doi:10.1080/01635581.2025.2480317. Epub ahead of print. PMID: 40108878.
       
    • Oncology Guideline Presentation - this 45-slide MS PowerPoint presentation includes all the recommendations and ratings of the Oncology 2010 Evidence-based Nutrition Practice Guideline. Ideal for you to use for meetings, in-service presentations and classes (not designed for the consumer). Click to order.    
  • Project Team and Disclosures (2024-2025)

    The following individuals contributed their valuable time and expertise to this project:

    Content Advisors

    • Mary Rozga, PhD, RDN
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Lisa Moloney, PhD, RDN
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Deepa Handu, PhD, RDN
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Information Specialist

    • Amanda Wanner, MLIS, AHIP
      Consultant, Saint John, NB, Canada

    Project Manager & Methodologist

    • Mary Rozga, PhD, RDN
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Financial Contributors

    • Academy of Nutrition and Dietetics

    The views or interests of the funding bodies did not influence the development of the systematic review.

    Disclosures of Potential Conflicts of Interest

    In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic within 5 years of the start of the project through completion of the project. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

  • Project Team and Disclosures (2011-2013)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Laura Elliott, MPH, RD, LD, Chair
    • Vanessa fuchs, PhD, MD, RD
    • Barbara Grant, MS, RD, CSO
    • Maureen Huhmann, DCN, RD, CSO
    • Rhone Levin, Med, RD, CSO, LD
    • Anne Voss, PhD, RD, LD

    Project Manager

    • Tami Piemonte, MS, RDN/LDN

    Lead Analyst

    • Kyle Thompson, MS, RD, CSG, CO, CNSD


    Financial Contributors

    • Academy of Nutrition and Dietetics

     


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

     

    • Laura Elliott: Grants/Research Support from American Cancer Society.
    • Maureen Huhmann: Employment: Nestle Nutrition, Publications: ASPEN Guidelines for the use of Enteral and Parenteral Nutrition in Cancer (2009).
    • Rhone Levin: Consultancy: Critical Care Systems Infusion, Honorarium: previous Oncology DPG funding, Membership: Oncology DPG.
    • Anne Voss: Employment: Abbott Nutrition, Grants/research Support: European Union Palliative Care Research Consortium, Membership: American Cancer Society,