After a 2-year hiatus due to the COVID pandemic, the meeting of the Oncology Nutrition Dietetic Practice Group was held in Rosemont IL, June 10-12, 2022. This group is part of the Academy of Nutrition and Dietetics, the world’s largest group of nutrition professionals. The symposium theme was “Advances and Trends in Oncology Nutrition,” and The Leukemia & Lymphoma Society (LLS) was a sponsor. LLS Registered Dietitians Margaret Martin and Michelle Bratton attended and were able to connect, learn, and collaborate with 325 oncology dietitians and other health professionals from around the world. In this blog we will share our takeaways, and summarize our learning from the symposium.
At our exhibit booth, LLS Registered Dieticians shared our personalized nutrition consultations , LLS Health Manager™ mobile app, publications and other services with attendees. We also awarded prizes to the winners of our fun “Nutrition Jeopardy” game. Everyone was pleased to learn that our nutrition consultations are available for patients and caregivers of all cancer types.
Shortage of Oncology Registered Dietitian Nutritionists (RDNs)
A recurring theme at the symposium was the shortage of oncology registered dietitian nutritionists (RDNs) in outpatient cancer centers. Cancer patients are at risk for malnutrition, which can decrease patients’ ability to tolerate treatment and quality of life. The shortage of RDNs greatly limits access to Medical Nutrition Therapy (MNT) for patients even though MNT improves treatment outcomes. A 2019 study reported there is only 1 RDN for every 2,308 patients being treated in outpatient cancer centers. A desirable RDN to patient ratio is 1 RDN for every 120 cancer patients.
Screening for Malnutrition and Food Insecurity
Screening for malnutrition and food insecurity often during the cancer journey is a standard of care now in many cancer centers. Why? Studies have reported malnutrition in 30%-80% of patients with cancer. Poor access to quality, nutritious food increases the risk of malnutrition. According to the USDA, in 2020, 38.3 million people in the United States lived in food-insecure households. In a recent pilot study, the Seattle Cancer Care Alliance (SCCA) screened patients for food insecurity at each visit. SCCA views screening for food insecurity like checking other vital signs such as blood pressure, body weight and temperature. Members of the healthcare team provided patients who were at risk for food insecurity with information on the supplemental nutrition assistance program (SNAP), food pantries and other local food resources.
Prehabilitation for Cancer Patients
“Prehabilitation” refers to an exciting new area looking at the importance of improving a person’s physical function and nutritional status prior to cancer treatment, especially surgery. Research shows this can help patients better tolerate treatment and recover quicker. A useful analogy: Before you go on a long road trip it is good to make sure your car is running well. You fill up the gas tank and check the tires. Prehabilitation is like that – making sure your body is as strong and robust as it can be before treatment. Many cancer centers are trying to evaluate their patients earlier and provide support, including nutrition and physical therapy, to improve surgical and treatment outcomes.
Dietary Modification During Pediatric Leukemia
Researchers presented findings from the Improving Diet and Exercise in ALL (IDEAL) trial. Previous research shows that obesity increases the risk of minimal residual disease (MRD), and patients gain fat during the first month of treatment. MRD refers to the small number of cancer cells that remain in the body after treatment. The IDEAL trial aimed to see if changes to diet and exercise during the first month of treatment would decrease fat gain, improve overweight/obesity, and therefore, reduce MRD. The study also looked at the feasibility of interventions and adherence to changes to diet and exercise. The IDEAL trial included pediatric patients from 10 to 21 years old, newly diagnosed with ALL. During the study, the parents and patient worked with an (RDN) and physical therapist to receive a personalized meal and exercise plan, including educational resources and follow up. Outcomes from the study include a decrease in fat gain in patients with overweight/obesity at time of diagnosis (but not in those who were lean at diagnosis) and a reduction in MRD. Adherence to diet changes was good; however, adherence to exercise was poor. Research is ongoing with phase 2 of the study launched at multiple sites across the country.
Note: Do not make changes to you or your child’s diet or exercise without first talking to the healthcare team. Ask for a referral to an RDN for personalized recommendations.
Communicating about what to expect at end-of-life is important for everyone including caregivers and family members. Navigating the type of weight loss that comes at the end of life can be difficult and emotional. If the patient is receiving nutrition or hydration intravenously, or feeding tube, it is important to discuss the benefits and burdens of continuing artificial nutrition. Decreasing artificial nutrition may better support the patient and family’s end-of-life wishes. Empathy and honesty between healthcare workers and caregivers are key during this time.
Nutrition therapies and food resources remain as vital interventions in oncology care and survivorship. We will push forward toward better outcomes and quality of life in the families that LLS serves.