By Tammy McCausland
Medical nutrition therapy (MNT) improves patients’ ability to tolerate treatment, quality of life during and post-treatment, and survival. MNT reduces weight loss, unplanned hospitalizations, lengths of stay in hospital and breaks in treatment. More than 50 percent of cancer patients exhibit nutritional risk factors at their initial oncology visit, and roughly 80 percent of these patients experience malnutrition at some point during treatment.
Assessing an oncology patient’s nutrition status is a critical part of the care process. Dietitians are key members of the interdisciplinary care team. They work alongside clinicians, social workers and nurses.
Kathleen Newman, a registered dietitian and a board-certified specialist in oncology nutrition (CSO) at UC Davis Health Comprehensive Cancer Center, meets weekly with her cancer center’s head and neck team and the gastrointestinal team. She also attends an interdisciplinary huddle tasked with tracking and supporting high acuity multi-modality patients in the cancer center.
During a six- to seven-week course of radiation treatment, Newman sees patients at least once a week. If a patient’s having difficulties, she sees them more often. She may also see patients for follow-up visits post-treatment. She could meet with patients for five minutes or up to two hours depending on their needs.
Patients may not share problems—such as multiple bowel movements per day or constipation—with their oncologist but may do so with her, Newman says. She overlaps with their care team to notify them when a patient needs any adjustments to their medication or education by the nurse on bowel care or other subjects. She also talks to patients about the importance of taking their pain medications. “Patients may have poor support, and they’re trying to do this alone, or they’re far from home. I relay that to the care team so they can change the way they approach these patients, to understand what the shortcomings are and what support is needed,” she says.
Roughly 75 to 80 percent of patients are genuinely interested in improving their eating better going forward, Newman says. “Patients can Google what to eat, what not to eat and get a lot of false information. I see my job as trying really hard to figure out what won’t hurt them and might help and give patients the autonomy to do what they can do for themselves,” she says. “I’ve had patients sitting in front of me terrified to eat because everything they’ve read about according to the internet is dangerous and will kill them.”
It’s difficult to bill for dietitian services in cancer. While Medicare pays for nutrition services that are specific to renal and diabetes care, it doesn’t reimburse for cancer specifically. Many cancer centers include the services because they understand how important nutrition is for patients. And patients may not be willing to pay out-of-pocket for nutrition counseling.
Currently, there are 838 CSOs in the U.S. To qualify for the CSO exam, a registered dietitian needs at least 2,000 practice hours in oncology, which is roughly two years of practice experience. The Oncology Dietetic Practice Group within the Academy of Nutrition and Dietetics creates the exam, and the Commission of Dietetic Registration administers it. Registered dietitians with the CSO certification must take the exam every five years to maintain their certification.
The exam covers four areas: cancer and cancer treatment, nutrition assessment, nutrition interventions, and education and counseling. It’s practice-based and includes questions related to radiation oncology, chemotherapy, hematology/oncology and surgical oncology. Those taking the exam have to be familiar with all of the drugs, all of the interactions and all of the complications.
Nutrition is integral to cancer care and can impact how patients fare overall. Dietitians are an essential part of a patient’s interdisciplinary team and can provide insights to other team members about a patient’s problems and health concerns that may also lead to better health outcomes.
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