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F. Other Organ Systems
F.2 Hematology/Oncology
Content
Areas
- Nutritional
epidemiology
- Malignancy-associated
malnutrition
- Nutrition-related
anemias
- Nutritional
consequences of cancer chemotherapy and radiation
- Nutrition
support in cancer patients
- Complementary
and alternative therapies
- Prevention
of cancer and anemia
- Medical
nutrition therapy
| After
training, the learner will be able to: |
| Knowledge
Objectives: Medical Students |
- Distinguish
among the various nutritional anemias, including those caused
by deficiencies of iron, folate, Vitamin B12
, and pyridoxine.
- List
the appropriate laboratory tests used to assess the nutritional
status of malnourished patients, and identify tests that
distinguish between nutritional anemias and hematopoetic
disorders.
- Summarize
the proposed mechanisms by which antioxidants protect against
cancers. Identify the four antioxidants for which the evidence
of efficacy is strongest.
- Summarize
the proposed mechanisms by which folate, fiber, and excess
dietary fat increase or decrease the risk of specific cancers.
- Summarize
the American Cancer Society’s Dietary recommendations.
- Identify
the vitamins and minerals that cause or ameliorate nutrition-related
anemias, and explain how these effects arise.
- List
at least eight common foods that are high in bioavailable
iron that are appropriate for inclusion in the diet of a
patient with iron-deficiency anemia.
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| Knowledge
Objectives: Residents |
- List
the most prevalent drug and nutrient interactions associated
with cancer chemotherapy, and explain how each intervention
can reduce the efficacy of the other.
- Explain
how cancer causes malnutrition and cachexia.
- Explain
how common cancer treatments alter nutritional status.
- List
at least four common foods that are high in bioavailable
folate and four that are high in Vitamin B12
that are appropriate for inclusion in the diet of a patient
with a megaloblastic anemia.
- List
at least two foods and two common medications that can increase
or decrease absorption of each of the following: iron,
folate, Vitamin B12.
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| Knowledge
Objectives: Specialists |
- Identify
the nutritional components known to enhance or prevent the
initiation, promotion, and progression of carcinogenesis,
and explain how these effects arise.
- Summarize
and evaluate the epidemiological, clinical, and basic science
evidence linking nutrients, dietary intake, obesity, smoking
and lifestyle with increased cancer risk.
- Compare
and contrast the strengths and limitations of randomized
clinical trials, within-country case-control trials, and
cohort studies as experimental designs for the study of
the role of nutrition in cancer.
- Define
and explain how to use the Bradford-Hill criteria to evaluate
the evidentiary support for the role of a specific nutrient
in a specific type of cancer.
- Compare
and contrast the different methods used to assess dietary
intake and nutritional status.
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| Practice
Behavior Skills: Medical Students |
- Take
a thorough medical history that includes social and dietary
history, family history of cancer, history of recent weight
change, and use of nutritional supplements and herbal therapies.
- Given
the height and weight of a patient with a common hematologic
or oncologic disease, calculate the BMI, explain to the
patient how their disease alters nutritional status, and
make appropriate nutritional recommendations.
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| Practice
Behavior Skills: Residents |
- Given
the history of a patient with hematologic/oncologic disease,
recommend therapies that may help to alleviate adverse chemotherapy
and radiation effects including nausea, mouth sores, odynaphagia,
dysaphagia, and diarrhea.
- Effectively
counsel patients patient with a strong family history of
cancer or a precancerous lesion to make informed nutritional
decisions consistent with maintaining a healthy lifestyle
and decreasing cancer risk, establishing appropriate dietary
and behavioral goals and adopting strategies to achieve
and maintain these goals.
- Identify
oncology patients who would benefit from nutritional guidance
and supplementation to increase energy and protein intake.
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| Practice
Behavior Skills: Specialists |
- Provide
individualized dietary counseling to a patient with a common
hematologic or oncologic disease based on an assessment
of dietary intake that focuses on total calories and protein,
as well as fruits, vegetables, whole grains, and alcohol.
- Conduct
a Medline search focusing on the role of specific nutrients
in the development of cancer, classify each study by type
of design, and use the Bradford-Hill criteria to evaluate
the strength of the evidence for the role of each nutrient
in oncogenesis.
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| Attitude
Objectives: All Learners |
- Recognize
the value of early nutrition intervention during cancer
treatment to reduce or delay the development of malnutrition.
- Demonstrate
a commitment to include nutritional assessment and therapy
in routine patient care to prevent cancer and anemia.
- Recognize
the importance of nutrition and healthy lifestyle behaviors
in the decreasing risk of cancer.
- Recognize
the value of utilizing a team approach in the treatment
of cancer that includes registered dietitians and other
credentialed nutrition professionals, as well as exercise
physiologists, clinical psychologists/behavioral medicine
specialists, nurse practitioners, and clinical pharmacists.
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