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Oncology

ONC: Future Research Suggestions (2013)

SUGGESTIONS FOR FUTURE RESEARCH

During the literature review process several points regarding future research directions became clear. The Oncology Work Group suggest that research methods and consistency in outcomes reporting by investigators be addressed as follows:
  • The qualifications of clinicians (eg, RDN; nutrition and dietetics technician, registered; or nurse) providing the nutrition intervention can be described for studies to be compared or repeated in other settings.
  • Validated malnutrition screening and nutrition assessment tools can be used and clearly stated. Nutritional status (reported as PG-SGA or Subjective Global Assessment score)1,2,3 may improve, although weight does not.
  • Research is needed in US patients, under the US health care system, with RDNs providing or leading the intervention as MNT.
  • Body weight (reported as kilograms and pounds) and LBM can be reported as lost, gained, or maintained.
  • Use of validated tools for measuring QoL can include oncology-specific instruments such as the Functional Assessment of Anorexia Cachexia Therapy4 and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30).5
  • Performance status as a means of quantifying patients’ general well-being can be reported using Karnofsky Performance Score or Eastern Cooperative Oncology Group score,6,7 (also called World Health Organization [WHO] or Zubrod score). A translation of Zubrod and Karnofsky scales has been validated in lung cancer7; performance is sometimes used as a QoL surrogate.
  • Research is needed on oncology treatment outcomes anticipated to change by nutrition intervention, such as dose reductions, treatment delays, treatment completion, or treatment toxicities (reported as Common Terminology Criteria for Adverse Events current version)8
  • Efforts can be made to blind investigators who report and evaluate outcomes.
  • Because trials are in the design phase, investigators can have inclusion of the study in metaanalyses or systematic reviews as a goal. Inclusion of studies in meta-analyses or systematic reviews is a means to the creation of strong guidelines.
References
  1. Bauer JCS, Ferguson M. Use of the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002; 56(8): 779-785.
  2. Laky B, Janda M, Cleghorn G, Obermair A. Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr. 2008; 87(6):1,678-1,685.
  3. Persson MD, Brismar KE, Katzarski KS, Nordenström J, Cederholm TE. Nutritional status using Mini Nutritional Assessment and Subjective Global Assessment predict mortality in geriatric patients. J Am Geriatr Soc. 2002; 50(12): 1,996-2,002..
  4. Ribaudo JM, Cella D, Hahn EA, et al. Revalidation and shortening of the functional assessment of anorexia/cachexia therapy (FAACT) questionnaire. Qual Life Res. 2000; 9(10):1,137-1,146.
  5. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5): 365-376.
  6. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5(6): 649-655.
  7. Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: A prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer. 1996; 32A(7): 1,135-1,141.
  8. Hay J, Atkinson T, Reeve B, et al. Cognitive interviewing of the US National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Qual Life Res. 2014; 23(1): 257-269.