Assessing Impact of Nutrition Care by Registered Dietitian Nutritionists on Patient Medical and Treatment Outcomes in Outpatient Cancer Clinics: A Cohort Feasibility Study

Abstract

More information is needed about the impact of outpatient nutrition care from a registered dietitian nutritionist (RDN) on patient outcomes. This study aimed to assess the feasibility of a cohort study design to evaluate impact of RDN nutrition care on patient outcomes, describe clinic malnutrition screening practices, and estimate statistical parameters for a larger study. Seventy-seven patients with lung, esophageal, colon, rectal, or pancreatic cancer from six facilities were included (41 received RDN care and 36 did not). RDN nutrition care was prospectively documented for six months and documented emergency room visits, unplanned hospitalizations and treatment changes were retrospectively abstracted from medical records. Most facilities used the Malnutrition Screening Tool (MST) to determine malnutrition risk. Patients receiving RDN care had, on average, five, half hour visits and had more severe disease and higher initial malnutrition risk, although this varied across sites. Documented medical and treatment outcomes were relatively rare and similar between groups. Estimated sample size requirements varied from 113 to 5856, depending on tumor type and outcome, and intracluster correlation coefficients (ICCs) ranged from 0 to 0.47. Overall, the methods used in this study are feasible but an interventional or implementation design might be advantageous for a larger study.

Acknowledgments

The authors would like to acknowledge Pam Beck, RN; and Teresa Titus-Howard, PhD, MHA, MSW formerly with Telligen, Inc. for their support of this project. The authors are also grateful to William Murphy, MS, RDN, formerly of the Academy of Nutrition and Dietetics, for his contributions to developing the study protocol.

Authors’ Contributions

Dolores D. Guest, Tricia Cox, Anne Coble Voss, Andreea Nguyen, Kerry McMillen, Valaree Williams, James A. Lee, Jennifer Petersen, Karilynne Lenning, and Elizabeth Yakes Jimenez contributed to the conception and design of the study. Dolores D. Guest, Kathryn Kelley, Jennifer Petersen, and Elizabeth Yakes Jimenez were responsible for oversight of study implementation and data collection and management. Dolores D. Guest, Kathryn Kelley, Xingya Ma, and Elizabeth Yakes Jimenez conducted and oversaw data analysis, and all authors participated in data interpretation. Dolores D. Guest and Elizabeth Yakes Jimenez wrote the first draft of the manuscript. All authors reviewed and commented on subsequent drafts of the manuscript.

Disclosure Statement

DDG, XM, JAL, JP, KL, and EYJ had contracts with the Academy of Nutrition and Dietetics, the national professional organization for registered dietitian nutritionists, during the course of the study. KK is an employee of the Academy of Nutrition and Dietetics.

Additional information

Funding

This work was supported by the Commission on Dietetic Registration. This research was partially supported by both the Behavioral Measurement and Population Science and Biostatistics shared resources at the UNM Comprehensive Cancer Center by an award from the National Cancer Institute, National Institutes of Health under grant P30CA118100 and by an award from the National Center for Advancing Translational Sciences, National Institutes of Health under grant number UL1TR001449.