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

Elaine B Trujillo; Katrina Claghorn; Suzanne W Dixon; Emily B Hill; Ashlea Braun; Elizabeth Lipinski; Mary E Platek; Maxwell T Vergo; Colleen Spees

doi:10.1155/2019/7462940

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

J Oncol. 2019 Nov 22:2019:7462940. doi: 10.1155/2019/7462940. eCollection 2019.

Authors

Elaine B Trujillo¹, Katrina Claghorn², Suzanne W Dixon³, Emily B Hill⁴, Ashlea Braun⁴, Elizabeth Lipinski⁴, Mary E Platek⁵, Maxwell T Vergo⁶, Colleen Spees^{4

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Affiliations

¹ Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA.
² Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
³ Cambia Health Solutions, Portland, OR, USA.
⁴ School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA.
⁵ Department of Cancer Prevention and Control and Radiation Medicine, Roswell Park Comprehensive Cancer Center and School of Health Related Professions, D'Youville College, Buffalo, NY 14263, USA.
⁶ Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.
⁷ Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA.

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.