Nutrition Services in Oncology

Introduction

Nutrition influences cancer outcomes, yet access to registered dietitian nutritionists (RDNs) remains inconsistent. Patient-centered data can reveal gaps in care, unmet needs, and disparities, providing real-world insight into oncology nutrition services.  

Funding for the Cancer Experience Registry was provided by Bristol Myers Squibb, Genentech (a member of the Roche Group), and Novartis. Funding for data use and statistical analysis was provided by the Oncology Nutrition Dietetics Practice Group of the Academy of Nutrition and Dietetics. Nutrition Shared Resource (J.H.R.) funded in part by the National Cancer Institute Cancer Center Support grant P30CA168524.  

Authors

Erica E. Fortune, PhD, Bailey M. Foster, MS, RD, Melissa F. Miller, PhD, MPH, Cynthia A. Thompson, PhD, RD, Elaine B. Trujillo, MS, RD, Lauren Fay, MPH, RD-AP, Peter A. Adintori, MS, RD-AP, Renee Stubbins, PhD, RD, LD, CSO, Jill M. Hamilton-Reeves, PhD, RD, CSO

1. Cancer Support Community, Washington, DC, USA
2. University of Kansas Medical Center
3. TruNu Consulting
4. Inova Schar Cancer Institute
5. Mount Sinai Queens Cancer Center
6. Houston Methodist Neal Cancer Center
7. University of Kansas Medical Center

Methods

The cross-sectional study analyzed online surveys from the Cancer Experience Registry, an online patient-reported outcomes registry of cancer survivors in the United States and Canada, collected between November 2022 and November 2024. Analyses of this study were restricted to US participants. Participants included 1427 cancer survivors, predominantly women (76.5%), older adults (45.5% aged ≥65 years), and non-Hispanic White survivors (85.5%). Descriptive statistics summarized receipt of nutrition services, expressed need, timing, and priority areas. Bivariate and multivariable regression analyses examined differences in nutrition care need and RDN engagement across patient characteristics. 

Results

Since diagnosis, 53.6% reported receiving nutrition care, with 39.3% from an RDN. Need was met in 41.0%, unmet in 13.4%, no perceived need in 33.2%, and unsure in 12.5%. Among participants desiring nutrition care, demand peaked during treatment and posttreatment. Unmet need was more common after treatment and was linked to increasing energy level (P = .002), emotional health (P < .001), intentional weight loss (P < .001), and cancer worry (P < .001). Endorsement of symptom management (P = .008) and intentional weight gain (P = .001) as reasons for nutrition support was higher among participants who saw a provider (RDN or non-RDN) compared with those who did not. Participants with unmet needs were more often younger, women, food-insecure, lacking caregiving support, and had higher symptom burden, and no perceived need was associated with rural residence, lower education, lacking caregiver support, and private practice care (all, P < .05)

Conclusions

Unmet nutrition care needs were observed among cancer survivors and varied by sociodemographic and clinical characteristics. Future research should evaluate the impact of systematic malnutrition screening and referral pathways on access to RDN services and examine how nutrition care needs and engagement evolve from diagnosis through survivorship. Additional work is needed to understand and address disparities across population subgroups and care settings. 

Keywords

Diet & Nutrition Cancer Experience Registry Access to Care/Healthcare Utilization Health Equity Survivorship Patient Centered Care