Inadequate Nutrition Coverage in Outpatient Cancer Centers: Results of a National Survey

Abstract

Cancer-related malnutrition is associated with poor health outcomes, including decreased tolerance to cancer therapy, greater treatment toxicities, and increased mortality. Medical nutrition therapy (MNT) optimizes clinical outcomes, yet registered dietitian nutritionists (RDNs), the healthcare professionals specifically trained in MNT, are not routinely employed in outpatient cancer centers where over 90% of all cancer patients are treated. The objective of this study was to evaluate RDN staffing patterns, nutrition services provided in ambulatory oncology settings, malnutrition screening practices, and referral and reimbursement practices across the nation in outpatient cancer centers. An online questionnaire was developed by the Oncology Nutrition Dietetic Practice Group (ON DPG) of the Academy of Nutrition and Dietetics and distributed via the ON DPG electronic mailing list. Complete data were summarized for 215 cancer centers. The mean RDN full-time equivalent (FTE) for all centers was 1.7 ± 2.0. After stratifying by type of center, National Cancer Institute-Designated Cancer Centers (NCI CCs) employed a mean of 3.1 ± 3.0 RDN FTEs compared to 1.3 ± 1.4 amongst non-NCI CCs. The RDN-to-patient ratio, based on reported analytic cases, was 1 : 2,308. Per day, RDNs evaluated and counseled an average of 7.4 ± 4.3 oncology patients. Approximately half (53.1%) of the centers screened for malnutrition, and 64.9% of these facilities used a validated malnutrition screening tool. The majority (76.8%) of centers do not bill for nutrition services. This is the first national study to evaluate RDN staffing patterns, provider-to-patient ratios, and reimbursement practices in outpatient cancer centers. These data indicate there is a significant gap in RDN access for oncology patients in need of nutritional care.

Impact of Early Incorporation of Nutrition Interventions as a Component of Cancer Therapy in Adults: A Review

“…RDNs are uniquely trained to address malnutrition and can provide the individualized nutrition counseling and MNT needed, but they are inadequately staffed in cancer centers. A recent study found that the RDN-to-patient ratio in U.S. oncology centers is 1:2308 [50]. Indeed, only half (53.1%) of oncology centers screen for malnutrition, and a majority (76.8%) of these centers do not bill for nutrition services [50].…”

“…A recent study found that the RDN-to-patient ratio in U.S. oncology centers is 1:2308 [50]. Indeed, only half (53.1%) of oncology centers screen for malnutrition, and a majority (76.8%) of these centers do not bill for nutrition services [50]. The recently introduced US Medical Nutrition Therapy Act of 2020 (H.R.…”

Opportunities for Quality Improvement Programs (QIPs) in the Nutrition Support of Patients with Cancer

“…The Academy, in describing their first ever malnutrition eCQMs, recognized the availability of these eCQMs as a “tremendous opportunity to advance patient/client nutrition care.” They further underscored that “the development of the eCQMs and tools to support implementation is one of the most innovative initiatives undertaken by the Academy of Nutrition and Dietetics” [ 62 ]. Consistent malnutrition screening is critical for the early identification and treatment of malnutrition; however, in a survey of U.S. ambulatory oncology settings, only about half reported screening for malnutrition [ 12 ]. Targeting the development of malnutrition quality measures specific to cancer care should be a priority for nutrition and oncology organizations because eCQMs are an effective tool to help identify where malnutrition screening is not occurring as well as to document the burden of malnutrition and the positive outcomes that are realized when malnutrition is better identified and treated.…”

“…However, in the American outpatient setting, where nearly all oncology patients receive treatment, ambulatory nutritional care standards and interventions for cancer are ambiguous and inconsistently applied [10]. This is further complicated by the fact that registered dietitian nutritionists (RDNs) are not routinely employed in outpatient cancer centers and the medical nutritional therapy that they provide is not consistently a part of multidisciplinary outpatient cancer care or adequately reimbursed [12]. The lack of systematic malnutrition screening and intervention in ambulatory cancer care has especially significant consequences for both patient and healthcare outcomes and thus the nutrition support of patients with cancer represents an important area for quality improvement.…”

Pancreatic Cancer (PDAC): Introduction of Evidence-Based Complementary Measures into Integrative Clinical Management

“…Consequently, there will be some degree of ‘hit-and-miss’, which patients (and professionals) will need to experiment with. If available and affordable, a professional dietician with expertise in the cancer area could also help improve the patient survival rate [ 357 ]. Thus, integrated management may work better on some patients than others.…”