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Keeping Cancer Patients Strong During Treatments and Beyond

May 25, 2010
Lebanon, NH

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Members of the Cancer Center's outpatient nutrition services team include, left, Jeannine Mills, and top to bottom, Filomena Kersey, Stephanie Schuck, and Lavanya Kethamukkala. "These dietitians do a fantastic job of taking care of our patients who are most at risk for having weight loss interfere with their treatments and healing," says cancer specialist Marc Pipas, MD.

Dry mouth, taste changes, sore or irritated throat, nausea, and difficulty swallowing are just some of the common side effects that cancer patients have to cope with while undergoing radiation and/or chemotherapy treatments. Helping patients manage these symptoms, while providing education and supportive care, is the work of the outpatient nutrition services team at Dartmouth-Hitchcock's Norris Cotton Cancer Center (NCCC).

"We see a lot of patients and our biggest concerns are that they maintain their weight and that they're well-nourished during treatments," says Jeannine Mills, MS, RD, CSO, LD. "If they are, we know that they're going to have a much greater ability to both tolerate and recover from their treatments. For example, recovery for a patient with head and neck cancer can go on for many months after their end date of treatment." (See patient story)

A Team Approach

Mills was the first outpatient oncology dietitian hired at NCCC back in 2000, and has seen the demand for services grow in recent years. "As the interdisciplinary clinics have been developed here at the Cancer Center, it has required the use of a dietitian on the team," she explains. "We also now attend many of the tumor boards, where specialists and care team members from all disciplines meet to discuss new patients. The earlier we can assess the needs of high-risk patients and provide input for their plan of care, the better chance they have of doing well through their treatments."

The Cancer Center currently has two dietitians available each day in the outpatient clinic. Mills, who specializes in head and neck, pancreatic and gastrointestinal (GI) patients, partners with Stephanie Schuck, whose concentration includes bone marrow transplant, thoracic, and GI patients. "In addition, Lavanya Kethamukkala who is available for our survivorship clinic and Filomena Kersey who handles our pediatric oncology group, are here on Fridays to lend their expertise."

"These dietitians do a fantastic job of taking care of our patients who are most at risk for having weight loss interfere with their treatments and healing," says Marc Pipas, MD, a hematologist/oncologist at Dartmouth-Hitchcock who leads the GI tumor board. "Nutrition services are something, I think, that are easily overlooked. But they're a critical part of our interdisciplinary approach here and our commitment to provide advanced, comprehensive cancer care to patients."

Becoming a Specialty

As technology and medical research have led to more treatment options for patients, those practicing in the field of oncology nutrition have felt the need to establish a more advanced level of training. "To best meet the needs of our patients, we need to continue to develop knowledge and expertise about all of the different treatment regimens being offered and the impact those will have on nutrition and eating," says Mills.

As a leading member of the Oncology Nutrition Dietetic Practice Group (ON DPG) - a 1,500-member professional practice group within the American Dietetic Association - Mills was involved in establishing a certification process for her field at the national level. Two years ago, the Commission on Dietetic Registration (CDR) began offering a board certification credential for registered dietitians in oncology nutrition.

"It's an exciting step forward for us - there's an exam we must take and a minimum number of practice hours required before we sit for the exam," explains Mills, who currently serves as Chair-elect for ON DPG. "We then get the designation of CSO, which we re-test for every five years."

Educating Patients and Families

As the role of oncology nutrition services has grown at NCCC, there have been more opportunities for the team to expand its scope of practice. "In addition to seeing patients, we participate in research projects and we're also involved with giving talks to support groups at the community and national levels," she says.

One of the most important aspects of the role is providing education to patients and families. "There's a lot of new information coming out all of the time, and it's easy for patients to get misinformed or confused about what they should or shouldn't be eating," says Mills. "Our goal is to give them a greater understanding about nutrition as it relates to their specific needs, and about what the latest evidence is saying."

"I had a great conversation with a pancreatic patient and her husband yesterday," she adds. "She went through chemotherapy and radiation therapy up front, then had her surgery back in January. They asked me what she could do now to stay healthy in the future. It was great to be able to educate them about where we're at with survivorship and nutrition."

Reprinted from Skylight Volume Nine, Number Two, Published by Dartmouth-Hitchcock, Spring 2010

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