PHILADELPHIAThe Society for Nutritional Oncology Adjuvant
Therapy (NOAT) is an interdisciplinary professional organization that
addresses the role of nutrition and metabolism in oncology. Founded
in 1994, NOAT is the first organization devoted solely to studying
the role of nutrition in cancer (see box).
Society fosters the integration of the principles of nutritional
oncology in supportive care, adjunctive therapy, and prevention.
In a panel session at NOATs 5th International Congress, experts
advised the Society on how to best advance the role of nutrition in
the treatment of cancer.
Evidence-based medicine is the coin of the realm, and it is the
means that will allow nutrition to enter the mainstream of oncology.
That is why NOAT must do a major literature review, said
Jeffrey Lerner, PhD, vice president of strategic planning, ECRI
(Plymouth Meeting, Pennsylvania), an independent evaluator of health
He recommended that NOAT perform, on a voluntary basis, an in-depth
literature review to be published in a major journal, such as JAMA or
the New England Journal of Medicine. It has to be
objective and thorough, he said. It has to deal with the
truly important theoretical and practical issues in your field.
Gaining Public Support
Such a study would lead in the long run to getting support from
public and private payers, Dr. Lerner said. Gaining support is
a very complicated process, he said. It involves consumer
demand, private demand, industry demand, and media pressure, but one
of the key areas payers rely on in making reimbursement decisions is
evidence-based medicineliterature reviews and technology
A good literature review, he said, would make it possible for the
Society to ask the Agency for Healthcare Research and Quality (AHRQ),
part of the US Department of Health and Human Services, to commission
a technology assessment for nutritional oncology adjuvant therapy.
Such assessments are used by Medicare and private payers to develop
clinical practice guidelines.
AHRQ will pay for an assessment if you convince them that your
topic is worth it, he said.
Dr. Lerner also pointed out that the recommended literature
review would help in the Societys effort to include nutritional
assessments in the design of clinical trials.
Margaret McCarthy, founding volunteer executive director of the
Alliance for Lung Cancer Advocacy, Support and Education (ALCASE),
advised the group that its key talking point should be
that patient nutrition is a confounding factor in clinical trials
and, consequently, every clinical trial should include a nutrition
and supplemental summary for every patient enrolled.
Getting the Point
Ms. McCarthy said that NOAT has to get this point into the mind
set of the clinicians who are doing clinical trialsthat what
patients eat and what they take in the form of supplements may, in
fact, influence whether the treatment under study is successful or not.
The only way to do this, she said, is with a lot of pressure
from the people who know these facts the best. If you pick a really
hot issue and focus on that for a year, I think youll see some
movement toward its acceptance.