Impact of dietitian intervention (DI) on treatment tolerance during chemoradiation (CRT) in a community-based oncology practice.

Abstract

465 Background: Patients receiving CRT for head and neck (HAN), thoracic, and upper gastrointestinal (UGI) cancers are at high risk for treatment-related side effects including malnutrition, dysphagia, mucositis, and anorexia. Prior studies have shown that structured interventions including pre-treatment assessments, scheduled dietitian visits, and use of oral nutrition supplements can reduce weight loss and treatment interruptions, both of which are associated with oncologic outcomes. However, these studies were primarily conducted in academic centers and many community oncology practices lack formal intervention programs. Methods: We performed a retrospective review of consecutive patients receiving definitive CRT for HAN, thoracic, and UGI cancers at a community-based oncology practice between July 2022-June 2025. Outcomes compared patients who did not receive dietitian interventions (NDI) and those treated after DI were implemented in 2024. DI consisted of at least two one-on-one patient education visits with a dietitian during treatment. Endpoints were percent weight loss and rates of malnutrition (≥5% weight loss one month post-treatment), treatment delay (≥1 day), hospitalization, and feeding tube (FT) placement. Results: We identified 58 patients (33 DI, 25 NDI). There were no statistically significant differences in age, sex, performance status, primary site, or ECOG performance status, although the DI cohort contained a numerically higher proportion of male (82% vs 60%) and of HAN (45% vs 24%) patients. Significantly higher rates of malnutrition were found in the DI cohort (57.6% vs 22.2%, p=0.010). There were lower rates of hospitalization (21.2% vs 33.3%, p=0.213), FT placement (6.1% vs 11.1%, p=0.530), and treatment delay (24.2% vs 48%, p=0.059) in the DI cohort, which did not meet statistical significance. Similar trends were observed in non-HAN patients, with patients receiving DI having numerically lower rates of hospitalization (22.2% vs 38.1%, p=0.250) and FT placement (0% vs 5.2%, p=1.00); significantly lower rates of treatment delay (22.2% vs 52.4%, p=0.049) were seen. Conclusions: Despite having a higher malnutrition rate, patients receiving DI while undergoing definitive CRT had numerically lower rates of treatment delay, hospitalization, and FT placement, suggesting improved treatment tolerance. Future work with larger sample sizes will be necessary to confirm these findings. This was the first implementation of a formal DI program in a community-based oncology practice. More aggressive interventions including remote patient monitoring and more frequent dietitian visits may help improve outcomes for pts undergoing CRT.