Oncology

ONC: Scope of Guideline (2007)

Guideline Scope Characteristics

Disease/Condition(s)

The purpose of this guideline is to provide an evidence-based summary of effective practice in the nutrition management of oncology. Recommendations have been formulated for oncology within the context of the ADA Nutrition Care Process.
 
 
 

The major focus of this guideline is on nutritional assessment and treatment, and cancer site specific dietary interventions.

This guideline is intended for use by dietetics practitioners involved in care for patients undergoing cancer treatment. It is hoped that the information in this guideline will be used to provide individualized nutrition care with practical nutrition recommendations that are based on the current state of the science for nutrition in cancer patients.
 

Below you will find a list of characteristics that describe the Scope of this Guideline.

Guideline Category

Counseling, Management, Treatment

Clinical Specialty

Family Practice, Nutrition, Oncology, Pharmacology

Intended Users

 Registered Dietitians

Guideline Objective(s)

Overall Objective
 
 
To provide MNT guidelines aimed at managing symptoms, preventing weight loss and maintaining optimal nutritional status during cancer treatment.
Specific Objectives
  • To define evidence-based recommendations for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical, nutritional and behavioral elements
  • To reduce variations in practice among RDs
  • To promote self-management strategies that empower the patient to take responsibility for day-to-day management
  • To enhance the quality of life for the patient, utilizing customized strategies based on the individual’s preferences, lifestyle and goals
  • To develop guidelines for interventions that have measureable clinical outcomes
  • To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

 Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adults who are receiving oncology treatment or care.

Interventions and Practices Considered

 

This guideline is based on ADA's Nutrition Care Process and Model, which involves the following steps:
  • Assessment
  • Diagnosis
  • Intervention
  • Monitoring and Evaluation.
This guideline addresses topics that correspond to the following areas of the Nutrition Care Process. Please refer to the Algorithms in this guideline for a more detailed view of the recommendations and their application within the Nutrition Care Process.

I. Referral to a Registered Dietitian

II. Medical Nutrition Therapy
 
 
A. Nutritional Assessment and Treatment

Below you will find the nutrition assessment terms related to oncology care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition.

1. Medical history and relevant laboratory values

2. Nutrition-focused assessment including:
  • Height, weight and BMI
  • Comprehensive diet history, including current dietary intake and willingness to undertake behavior change
  • Physical activity pattern
  • Psychosocial and economic issues impacting nutrition therapy
  • Consideration of co-morbid conditions and need for additional modifications in nutrition care plan.
B. Nutrition Diagnosis

Below you will find the nutrition diagnoses related to oncology care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition

Hypermetabolism NI-1.1
  • Hypometabolism (NI 1.3)
  • Inadequate energy intake (NI-1.4)
  • Excessive intake (NI-1.5)
  • Inadequate oral food or beverage intake (NI-2.1)
  • Excessive oral food/beverage intake (NI-2.2)
  • Inadequate intake from EN or parenteral nutrition (PN) infusion (NI-2.3)
  • Excessive intake from EN or PN infusion (NI-2.4)
  • Inappropriate infusion of EN or PN infusion (NI-2.5).
  • Inadequate fluid intake (NI-3.1)
  • Excessive fluid intake (NI-3.2)
  • Inadequate bioactive substance intake (NI-4.1)
  • Excessive bioactive substance intake (NI-4.2)
  • Inadequate vitamin intake (NI-54.1)
  • Excessive vitamin intake (NI-54.2)
  • Swallowing difficulty (NC-1.1)
  • Altered GI function (NC-1.4)
  • Underweight (NC-3.1)
  • Involuntary weight loss (NC-3.2)
  • Involuntary weight gain (NC-3.4)
  • Food and Nutrition-Related Knowledge Deficit (NB-1.1)
  • Harmful beliefs/attitudes about food- or nutrition-related topics (NB-1.2)
  • Limited access to foods (NB-3.2)
C. Nutrition Intervention (Planning and Implementation)
Individualized prescription based on:
  1. Dietary interventions
  2. Physical activity interventions
  3. Behavioral interventions
  4. Pharmacotherapy or surgery, when indicated.

Below you will find the nutrition interventions related to oncology care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition

Modify distribution, type, or amount of food and nutrients within meals or at specified time Meals and Snacks (ND-1)
  • Initiate enteral or parenteral nutrition (ND-2)
  • Medical Food Supplements (ND-3)
  • Vitamin and Mineral Supplements (ND-3.2)
  • Bioactive Substance Supplement (ND-3.3)
  • Feeding Environment (ND-5)
  • Nutrition Education (E)
  • Nutrition Counseling (C)
  • Coordination of Nutrition Care (RC)
D. Monitoring and Evaluation

The monitoring of progress, measuring of outcomes, and evaluating of outcomes against criteria to determine changes in specific indicators of nutrition care outcomes.

Nomenclature

Please note that the terms "patient" and "client" are used interchangeably throughout this guideline to describe an individual receiving care.

Below you will find the nutrition monitoring and evaluation terms related to oncology care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition.