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, 2019, 7462940

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


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

Elaine B Trujillo et al. J Oncol.


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.

Conflict of interest statement

The authors have no conflicts of interest.


Figure 1
Figure 1
Map of respondents from outpatient cancer centers across the US. The map depicts the location of the 215 cancer centers providing complete data for use in analyses. Forty-three states were represented, including centers from all geographic regions of the continental United States.
Figure 2
Figure 2
Malnutrition screening tools utilized. The pie graph represents malnutrition screening tools utilized by those routinely screening for malnutrition (n = 74). Approximately sixty-five percent of centers who routinely screened for malnutrition used a validated tool (n = 48). These validated screening tools are denoted above with an asterisk. PG-SGA SF (Patient-Generated Subjective Global Assessment Short Form); adapted (screening tool that is adapted from its validated version); MST (Malnutrition Screening Tool); MUST (Malnutrition Universal Screening Tool); no screening (no screening tool utilized); other tools (tools not listed above); PG-SGA (Patient-Generated Subjective Global Assessment).

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