NutriCare: Integrating Nutrition into Oncology Care for Vulnerable Cancer Patients

Evidence-based nutritional care is largely lacking in the current model of outpatient oncology. This poses a particular challenge to vulnerable patients diagnosed with cancer who face the burden of both treatment-related toxicities (affecting nutritional intake) and health and financial barriers (affecting access to healthcare and nutritious foods).

A paradigm shift is necessary to advance the current model of healthcare to cancer patients who are at high risks of malnutrition. Vulnerable patients are especially affected by malnutrition-associated poor survival and quality of life impairments due to limited access to healthcare and financial barriers to accessing nutritious foods. Leveraging the close bonds between patients with cancer and their oncology providers, this study aims for implementing and evaluating an innovative strategy to integrate nutritional care into standard oncology care.

Project Summary

The NutriCare study aims to develop, implement, and evaluate the efficacy of an innovative intervention strategy to integrate nutrition into standard oncology care on improving outcomes of the vulnerable patient population with lung cancer. The strategy adapts and implements an evidence-based framework to streamline oncology patients into nutritional care, by providing nutrition prescription, nutrition counseling, and medically tailored meals to vulnerable lung cancer patients.

The study will evaluate the efficacy of the intervention on optimizing the nutritional status, reducing treatment-related toxicities, and improving the quality of life of lung cancer patients who are economically disadvantaged, uninsured, racial and ethnic minorities, the elderly, and rural residents from four medical centers in diverse regions of the United States.

Study Design

Using a randomized controlled trial (RCT) design, we aim to enroll 150 newly diagnosed stage I-IV lung cancer patients who will begin systemic therapy, multimodality therapy, or post-surgery adjuvant therapy (chemotherapy alone or followed by radiation therapy) from four U.S. medical centers: Tufts Medical Center; Fox Chase Cancer Center; MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center.

NutriCare Overview

Following a 5As framework, oncology care providers will assess patients’ nutritional needs using a Nutrition Assessment for Cancer Patients Form (Ask), and advise patients to follow evidence-based nutrition recommendations using a Nutrition Prescription (Advise). Providers will further refer patients to oncology RDs who will assess patients’ individual nutritional needs along with treatment plan, and their ambivalence regarding behavior change (Assess). The RDs will assist patients with individualized goal setting (Assist) as part of the Nutrition Prescription. Providers will subsequently refer patients to RDs for remotely-delivered Nutrition Counseling and home delivery of Medically Tailored Meals and arrange follow-up visits (Arrange).

Outcomes

This project will generate key findings to inform health policy change to advocating for full integration of nutrition care into the current standard of care for vulnerable cancer patients. Subsequent large implementation trials and cost-effectiveness assessments will validate our findings and reinforce the message.

Funding Agency: Bristol-Myers Squibb Foundation Project

PI:

  • Fang Fang Zhang, MD, PhD, Friedman School of Nutrition Science and Policy, Tufts University
  • Colleen Spees, PhD, Med, RDN, LD, FAND, The Ohio State University Medical Center Project Site

PI & Co-I:

  • Lori Pai, MD, Tufts Medical Center
  • Jessica Bauman, MD, Fox Chase Cancer Center
  • Joya Chandra, PhD, M.D. Anderson Cancer Center
  • Carolyn Presley, MD, The Ohio State University Comprehensive Cancer Center