DENVER, Colo--Although oncologists have long been concerned about cachexia and other nutritional problems in cancer patients, nutritional oncology, which includes nutritional assessment and intervention for cancer patients, is just beginning to emerge as a recognized medical discipline and as an important adjunct to standard cancer therapy.
DENVER, Colo--Although oncologists have long been concerned aboutcachexia and other nutritional problems in cancer patients, nutritionaloncology, which includes nutritional assessment and interventionfor cancer patients, is just beginning to emerge as a recognizedmedical discipline and as an important adjunct to standard cancertherapy.
"It rounds out the armamentarium of the oncologist, withmedical, radiation, and surgical oncology," said Faith D.Ottery, MD, PhD, at the Second Denver Conference on Nutritionand Cancer. "Quality care, whether curative or palliative,demands such an integrated approach," she said.
Nutritional oncology includes not only an understanding of thebasic dietary needs of cancer patients, but also of the role ofnutrients in the pathogenesis of cancer and the role of diet inthe prevention and treatment of disease.
Unfortunately, the integration of nutritional thera-py into oncologictherapies has been hampered by misunderstandings in the oncologycommunity, said Dr. Ottery, who at the time of the talk was director,Nutrition Support and Nutritional Oncology Research, Departmentof Surgical Oncology, Fox Chase Cancer Center, Philadelphia.
She said that physicians frequently assume that weight loss isinevitable and unpreventable in cancer patients. They may viewnutritional support as, at best, an alternative therapy and, atworst, as an ineffective intervention that can even interferewith other therapies. They may also assume that nutritional supportadds cost and effort for little return.
Dr. Ottery noted that this kind of thinking, along with a lackof integrated clinical nutritional education in medical schools,has led to a certain inertia by the medical community in adoptingnutritional strategies.
Dr. Ottery's research shows that weight loss is not an inevitableside effect of malignant disease and cancer treatment. With thoroughnutritional assessment, education, and oral intervention, cancerpatients can maintain their optimal weight and increase theirchances of recovery, she said.
She described weight loss, one of the most frequent complaintsof cancer patients, as being responsible for 20% of all deathsdue to cancer-induced or treatment-related inanition (starvation).Up to 66% of patients suffer inanition during the course of theirdisease, she said, and weight loss of more than 10% of pre-illnessweight occurs in 45% of hospitalized patients.
At the Fox Chase nutrition clinic, Dr. Ottery and her associatestracked 186 consecutive patients whose average weight loss was16.8%. With nutritional treatment, 60% to 80% of these patientswere able to maintain or improve their weight during cancer therapyand in recovery.
Dr. Ottery noted that severe weight loss is just one more dailyreminder to the patient (and the physician) of the invasive diseaseprocess. Maintaining a healthy weight and balanced nutrition notonly helps the patient to withstand treatment but also to feelstronger and more positive, thus improving the patient's qualityof life.
In the end, research shows that patients who maintain a healthydiet and lose less weight live longer than patients who suffersevere weight loss during the disease, she said.
Dr. Ottery also pointed out that nutritional oncology is a cost-effectivetreatment that has already saved Fox Chase an estimated $500,000over 3 years and has the potential to cut, by her estimation,$1.4 billion annually from national health-care expenditures,primarily by reducing hospital stays.
At one large university hospital, published data from the mid-1980sshowed that DRG charges for patients varied as follows: malnourishedpatients--$16,700; borderline malnourished patients--$14,000;well-nourished patients--$7,700. For each group, the hospitalwas paid the same amount.
Dr. Ottery and her colleagues have developed a standardized andvalidated patient-generated nutritional assessment instrument(known as the subjective global assessment or SGA) and an algorithmof nutritional therapy to steer patients who need specializednutritional support to a qualified nutrition clinic.
In 1993, the Society for Nutritional Oncology Adjuvant Therapy(NOAT) was formed to promote the synergistic collaboration ofbasic scientists with nutritian and oncologic clinicians in anintegrated association with cooperative oncology groups.
For more information, write the Society at P.O. Box 7805, Philadelphia,PA 19101, or call 1-800-704-NOAT (6628).