Patients and Oncology Care Team Members Weigh in on Outpatient Nutrition Care 

Outcomes for patients with cancer may be improved by shifting from reactive nutrition care to providing nutrition care more proactively. These findings were reported in the Clinical Journal of Oncology Nursing. 

A new study examined the experiences of nutrition care among patients receiving chemotherapy in the outpatient setting and oncology care team (OCT) members, revealing opportunities to increase awareness of outpatient nutrition care.

“Nurses are on the front line of patient care and are often the first providers to observe issues patients are experiencing,” the investigators wrote in their report, emphasizing the role of nurses in educating patients and advocating for appropriate referrals for specialized nutrition care.

The study was conducted as semistructured interviews with 90 patients with cancer receiving intravenous chemotherapy and 55 OCT members. It was part of a larger study conducted at a comprehensive cancer center aimed at gathering information on treatment side effects. 

Patients were asked about their demographic information, side effect and nutrition impact symptom burden, and experiences with nutrition services. They self-reported their primary cancer site, which was designated as high-nutrition risk (HNR) or low-nutrition risk (LNR). HNR cancers included gastrointestinal, pancreatic, hepatobiliary, and lung malignancies because nutritional status has a significant impact on treatment and outcomes. All other cancers were considered LNR.

OCT members received a similar survey. After survey completion, participants were invited to take part in a telephone interview to expand on their responses and provide more perspective. 

The study included 31 patients in the HNR group and 59 patients in the LNR group; a total of 73 participants reported having had at least 1 nutrition impact symptom. The proportion of patients experiencing most types of nutrition impact symptoms was greater in the HNR group than in the LNR group, but the only statistically significant difference was with diarrhea (odds ratio, 2.93; 95% CI, 1.13-7.59). 

Just 14 patients overall reported having discussed nutrition in visits with their OCT either often or at every visit. Contrarily, 40 OCT members reported initiating discussions of food intake, diet, appetite changes, and/or nutrition either often or at every patient visit; however, 13 of them expressed being unfamiliar with local nutrition resources.

Most patients preferred discussing nutrition with a registered dietician nutritionist (RDN) or an OCT member over being given resources to review on their own. Many also reported not being screened or referred to an RDN unless they had demonstrated weight loss. 

Among 5 patients who reported being referred to an RDN, each expressed appreciating the care received and considered the experience helpful. The participants consistently noted that patients in rural areas face greater challenges regarding transportation, travel time, and separate appointments with an RDN. 

“This study’s results suggest an incongruity between patients reporting infrequent nutrition discussions with providers and nurses and oncology care team members reporting a high frequency of nutrition discussions,” the study investigators wrote in their report.