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Oncology

ONC: Benefits and Risks/Harms of Implementation (2013)

Benefits and Risks/Harms of Implementing the Recommendations

Safety issues should be considered for each form of treatment recommended. A description of the general benefits and risk associated with the implementation of this guideline must be addressed.

When using these treatment recommendations:

  • Review the patient’s age, socioeconomic status, cultural issues and other health conditions.
  • Consider a referral to social services to assist patients with financial arrangements if economic issues are a concern.
  • Use clinical judgment when evaluating patients with co-morbid conditions or those receiving palliative care. Such conditions may include: cancer cachexia, renal dysfunction, diabetes, food allergies, pregnancy, HIV/AIDS, psychiatric disorders, metabolic diseases and hepatic encephalopathy or endstage chronic kidney disease. 

Potential Benefits

  • The primary goal of implementing these recommendations includes improving the percentage of individuals who are able to meet their nutritional needs, reducing incidence of treatment interruptions, and positively impacting the patient’s treatment and clinical outcomes.
  • Identification of malnutrition using standardized language within the NCP may lead to reimbursement for RDNs. 

Risk/Harm Considerations

To view more information, select the link to the topic listed after each potential risk/harm.

  • Failure to assess for the stages of cancer cachexia may lead to lack of nutrition intervention and increased risk of mortality 
  • Failure to make a malnutrition diagnosis may lead to lack of nutrition intervention and increased risk of mortality 
  • Risks associated with parenteral glutamine administration are similar to those of parenteral nutrition (i.e., increased risk of infection) 
  • As with all supplement use, there are potential interactions with treatment that may be unknown 
  • Use caution when considering provision of parenteral glutamine to adult oncology patients who have hepatic failure or insufficiency and are receiving hematopietic cell transplantation.  

Factors to consider when exploring treatment options include:

  • Although costs of MNT sessions and reimbursement vary, MNT sessions including collaboration with other healthcare professionals are essential for improved outcomes 
  • RDNs should be appropriately trained to conduct a nutrition-focused physical exam 
  • Costs include staff time to complete screening and referral 
  • If necessary data are not available, the RDN should use professional judgment to request or obtain additional data 
  • For some individuals, unintended weight loss may be irreversible due to underlying medical conditions
  • Consider advance directives when planning nutrition intervention 
  • Accessibility and costs of additional laboratory or other testing should be considered 
  • Availability of medical food supplements containing fish oil in the United States is limited 
  • Additional costs may be incurred with use of supplemental IV glutamine and other nutrition substances 
  • Ability and access to supplemental IV glutamine 
  • There may be an increased cost for intake of dietary supplements and MFS containing fish oil.