Oncology

ONC: Introduction (2007)

Guideline Overview

Guideline Title

Oncology (2007) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on oncology nutrition practice during the treatment of adult patients with cancer.

Cancer is a complex multifactoral chronic disease that develops from an interaction between genetics and the environment. Treatment of cancer and nutrition impact symptoms should be based on a comprehensive nutrition assessment to maximize adequate intake and identify interventions. The goals of nutrition care to prevent or reverse nutrient deficiencies, preserve lean body mass, help patients better tolerate treatments, and minimize nutrition-related side effects and complications.

Guideline Development

This guideline is intended for use by dietetic practitioners involved in the nutrition care for patients undergoing cancer treatment. It is expected that this knowledge will be integrated into providing individualized nutrition care with practical recommendations that are based on the current state of the science for nutrition in cancer patients. Types of cancer during this phase of the Guideline included:

  • Breast Cancer
  • Colorectal Cancer
  • Head and Neck Cancer
  • Esophageal Cancer
  • Hematological Malignancies
  • Lung Cancer
  • Pancreatic Cancer

The topics presented in the guideline are the first step towards a comprehensive list of recommendations to address nutrition in oncology. A series of recommendations for hematological malignancies were added to the guideline after publication. These recommendations underwent an abbreviated review process and were published in May 2008 under the Major Recommendations section. Evidence analysis questions where no evidence was found (Grade V), did not warrant a recommendation.

There are a number of evidence analysis questions completed on other types of cancer that will be incorporated into the Oncology Evidence-based Nutrition Practice Guideline in future editions. This section (Oncology by Topic) in the Oncology and Nutrition evidence analysis project includes questions on:

  • Prostate Cancer
  • Testicular Cancer
  • Gynecological Cancer
  • Liver Cancer
  • Brain Cancer
  • Melanoma 
  • Various Cancer Sites

The recommendations involving nutrition and cancer treatment are based on the work performed by the ADA Oncology evidence analysis working group.   The number of supporting documents for these topics is below:

  • Recommendations: 32
  • Conclusion Statements: 41
  • Evidence Summaries: 41
  • Article worksheets: 60

To view the guideline development and review process, click here.

 

Application of the Guideline

This guideline will be accompanied by a set of companion documents (i.e., a toolkit) to assist the practitioner in applying the guideline. The toolkit will contain materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the Academy's Dietetic Practice-Based Research Network prior to publication.
Revision
The literature search will be repeated for each guideline topic on an annual basis to identify new research that has been published since the previous search was completed. Based on the quantity and quality of new research,  a determination will be made about whether new the information could change the published recommendation or rating. 

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see Methodology tab).

When the analysis is completed, the expert workgoup will approve and re-grade the conclusion statements and recommendations. The guideline will undergo a complete revision every three to five years. A set of recommendations on hematological cancer and HCT is scheduled to be completed and added to the library in early 2008.

Medical Nutrition Therapy and Cancer

Scientific evidence supports the effectiveness of nutrition therapy to increase effectiveness of oncology therapy and to reduce nutrition impact symptoms among individuals who have cancer. Topics included in this guideline are:
  • Use of medical nutrition therapy and dietitian intervention
  • Determination of RMR in cancer patients
  • Use of enteral and parenteral nutrition in cancer patients
  • Use of oral vitamin and antioxidant supplements
  • Use of omega-3 fatty acid-enhanced medical food supplement and oral supplements and EPA-enhanced medical food supplement and fish oil supplements.
The registered dietitian plays an integral role on the interdisciplinary healthcare team by making the optimal nutrition prescription and developing the nutrition intervention plan for patients undergoing cancer therapy.

Populations to Whom This Guideline May Apply

This guideline applies to adult cancer patients during or immediately after cancer therapy.

Other Guideline Overview Material

For more details on the guideline components, view the items below from the Introduction section:
  • Scope of Guideline
  • Statement of Intent and Patient Preference
  • Guideline Methods
  • Implementation of the Guideline
  • Benefits and Harms of Implementing the Recommendations.
Contraindications
 

Clinical judgment is critical. Careful consideration should be given to the application of these guidelines for patients receiving hospice, palliative care, or those with significant medical co-morbidities.