Nutrition Services

Recommendation:

Nutrition services are available for patients and their families and caregivers offering surveillance, education, and coordination of services needed to maintain hydration, weight, and nutritional status, as well as dietary and lifestyle guidance associated with reduced cancer risk.

Overview

Proactive nutrition services help patients thrive, with better adherence to cancer treatment and supportive care goals, improving their continuity of treatment. Nutrition has quickly become a service that patients expect, and one that can determine their choice of treatment center.

The Commission on Cancer requires accredited programs to have a referral system for nutrition services.  While this can be on- or off-site under current standards, the strong preference would be for easy/on-site access for patients. The National Accreditation for Breast Centers standard 2.15 lists nutrition counseling as a support service, though again not as a requirement.

Dietitian responsibilities:

• Collaboration and coordination of care in a multidisciplinary team setting, managing issues impacting the patient’s nutrition and hydration status through appropriate nutrition screening, assessment, and intervention across the care continuum.
• Addresses and integrates side effect management amd integrative medicine issues in the context of evidence-based nutrition care and services.
• Provides nutrition and diet information about reducing cancer risk and cancer recurrence risk through direct education, educational materials, and services to the community.

Standard

• American College of Surgeons Commission on Cancer Optimal Resources for Cancer Care: 2020 Standards, Standard 4.7 Oncology Nutrition Services

Certification

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN), who has worked in clinical practice for at least 2 years, including 2,000 hours working with oncology patients during the past 5 years, can sit for an exam to become a board certified as a specialist in oncology nutrition (CSO) This credential is offered through the Commission on Dietetic Registration (CDR), on successful passing of this exam. As of 2016, there were 744 CSOs in the U.S., with representation in every state. Learn more.

Resources to Help

• ACCC Nutrition Resources
• National Academy of Medicine (formerly, Institute of Medicine) Workshop on Nutrition and Cancer, Examining Access to Nutrition in Outpatient Cancer Centers
• Complete Resource Kit for Oncology Nutrition
• Oncology Nutrition for Clinical Practice, Academy of Nutrition and Dietetics
• oncologynutrition.org: Website from the Oncology Dietitians Practice Group (ONDPG).  Reliable information on selected topics is available to healthcare providers and patients. However, full access requires membership in the Academy of Nutrition and Dietetics, and the ONDPG subgroup, permitting participation in their electronic mailing list, and free access to multiple resources and the following articles:
  • Oncology Evidence-Based Nutrition Practice Guidelines For Adults, 2017
  • Revised Standards of Practice and Standards of Professional performance for registered dietitians in oncology nutrition care
  • Patient-Generated Subjective Global Assessment

Certification

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN), who has worked in clinical practice for at least 2 years, including 2,000 hours working with oncology patients during the past 5 years, can sit for an exam to become a board certified as a specialist in oncology nutrition (CSO) This credential is offered through the Commission on Dietetic Registration (CDR), on successful passing of this exam. As of 2016, there were 744 CSOs in the U.S., with representation in every state.

Insurance Considerations

Coverage for nutrition services is limited under Medicare to those with a renal or diabetic diagnosis, but is often available for patients with commercial insurance. At this time, most cancer program report that they do not bill for nutrition services, in order to eliminate any financial barrier to care. Nutrition is considered supportive care, keeping patients on therapies that are reimbursable and improving the cancer program's bottom line by attracting patients with the “added value.” Additional information can be found at eatright.org, under medical nutrition therapy, with information on templates, forms and reimbursement issues.