Did you know that two recent studies showed that the more you see a dietitian, the better your nutritional outcomes will be? In the NOURISH study published in 2021, just seeing a dietitian one time actually did not make any difference. But when there was repeated visits with a dietitian (3 or more), this multicenter study found the patients had significantly less weight loss. A previous study by Thompson et al (2017) found that 8-9 nutrition interventions over a period of 4.5 months improved weight gain, decreased hospital admissions, hospital length of stay, tolerance of cancer treatment, and overall improved quality of life.
In head and neck cancer, low BMI (a calculation from height and weight) and % weight loss predicted survival independent of how advanced the cancer was and the specific site where the cancer was located (Martin et al, 2015). Often head and neck cancer, gastrointestinal cancer (pancreas, gastric, esophageal, biliary, colon cancer), and lung cancer are the highest risk of malnutrition and weight loss and require more intensive nutrition intervention.
Despite this knowledge, cancer centers remain vastly under staffed with Registered Dietitians. Looking at 215 cancer centers in the United States, most cancer centers only employ 1-2 dietitians (Trujillo et al, 2019). On average, this means 1 dietitian to cover 2,308 patients! Due to the nature of head and neck cancers (and thus other high risk cancers), the current recommended staffing is 1 dietitian for 120 head and neck patients.
Note from the author: In caring for these types of patients for 20 years now, I have seen patients on tube feedings that have not seen a dietitian in years. I have seen other patients that had a feeding tube placed due to their malnutrition, but no nutritional follow-up, so the tube was never used and the patient continued to become more and more malnourished. I have seen patients coming from facilities that have "a dietitian" but the patient never saw them, so they continued to become more malnourished during treatment. Do you have access to a dietitian? If so- ask for them! Use them! They can really make a difference to your care. If you don't have a dietitian, or if the dietitian available to you does not have a specialization in tube feeding- contact us at Enteral. We would love to help you get through your treatment.
References:
Deftereos I, Yeung J, et al. Preoperative Nutrition Intervention in Patients Undergoing Resection for Upper GI Cancer: Results from the Multi-Center NOURISH point prevalence study. Nutrients. 2021.
Thompson K, Elliott L, Fuchs-Tarlovsky V, et al. Oncology Evidence-Based Nutrition Practice Guideline for Adults. Journal of the Academy of Nutrition and Dietetics. 117(2):2017; 297-310.
Martin L, Gillis C, et al. Preoperative Nutrition Care in Enhanced Recovery after surgery programs: are we missing an opportunity? Clinical Nutrition. 2021.
Trujillo, Claghorn et al. Inadequate Nutrition Coverage in Outpatient Cancer Centers: Results of a National Survey. J Oncology. 2019.
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