DEFINITION OF STANDARDIZED NUTRITIONAL ASSESSMENT AND INTERVENTIONAL PATHWAYS IN ONCOLOGY

Weight loss and nutritional deterioration are associated with adverse outcomes in terms of cancer prognosis (response rate and survival) as well as increased complications, prolonged hospitalizations, increased risk of unplanned hospitalization, increased disability, and increase d overall cost: of care. The nutritional oncology service at Fox Chase Cancer Center defined a proactive, standardized assessment and interv entional approach from 1987-1994. In 186 consecutive patients referred to the nutrition clinic and managed solely by oral intervention and a ggressive symptom management, the team demonstrated a 50%-80% success rate in getting patients to maintain or gain weight during therapy, wi th a similar success in maintaining or improving visceral protein stat us as determined by serum transferrin and/or albumin. Evaluation of th e home parenteral nutrition program (n = 65, from 1987-1993) demonstra ted similar success when appropriate triaging was carried out, with 58 % of patients able to be tapered off parenteral nutrition (PN) entirel y or with transition to enteral tube feeding. The assessment of succes s for a nutritional intervention (e.g., a disease-specific nutritional supplement) requires the standardization of definitions,assessment to ols, criteria for nutritional intervention, and appropriate end points for the assessment of outcomes. The Patient-Generated Subjective Glob al Assessment of nutritional status is used in conjunction with the nu tritional risk of planned cancer therapy to define a standardized inte rventional approach in oncology patients, which can be used in clinica l practice, cooperative oncology group protocols, and clinical trials of nutritional intervention regimens.