2022 Symposium Recordings

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2022 Oncology Nutrition Symposium Recordings

BMT Pre-Conference - Elevating Your Clinical Practice in Hematopoietic Cell Transplantation to the Next Level

This workshop, hosted by the ON DPG BMT subunit, features sessions on medical nutrition therapy specifically for HCT patients, enteral nutrition, and building your HCT program from diagnosis through survivorship.

CPEU: 3.5
CPE Level: 3
Performance Indicators: 3.1.1, 3.2.4, 4.2.3

Medical Nutrition Therapy for Hematology and Autologous Hematopoietic Cell Transplant Patients

Speaker:

Patty McDonnell, RD, CSO, FAND, CD
Seattle Cancer Care Alliance

Learning Objectives

  1. Analyze the CBC¸ within the context of the nutrition assessment to detect nutrient deficiencies and identify expected disease/treatment related trends.
  2. Interpret evidence based medical nutrition therapy specific to hematologic diseases and treatments to prioritize patient care and influence patient outcomes.
  3. Determine and outline medical nutrition therapy specific for autologous transplant patients.

Enteral Nutrition: Applying Research to Your Hematopoietic Cell Transplant Clinical Practice

Speaker:

Katie Harper, MS, RD, CNSC, CSO
University of Colorado Hospital

Learning Objectives

  1. State the indications for enteral nutrition in HSCT patients
  2. Identify enteral tube placement issues to consider prior to placement in HSCT
  3. Address enteral nutrition complications that occur in HSCT patients

Building Your Hematopoietic Cell Transplant Nutrition Program: Optimal time points for RD intervention from Diagnosis through Survivorship and Program Support

Speaker:

Kerry McMillen, MS, RD, CSO, FAND
Seattle Cancer Care Alliance

Learning Objectives

  1. List optimal time points in the HCT process for dedicated RDN assessment.
  2. Describe evidence-based diet guidelines for the HCT population and identify methods for patient, caregiver and hospital staff education.
  3. Describe appropriate metrics and acuity measures to justify RDN staffing and program growth.

Expert Panel Q&A

Speakers:

Katie Harper, MS, RD, CNSC, CSO
University of Colorado Hospital

Patty McDonnell, RD, CSO, FAND, CD
Seattle Cancer Care Alliance

Kerry McMillen, MS, RD, CSO, FAND
Seattle Cancer Care Alliance


Advances and Trends in Oncology Nutrition - Palliative Care, Cooking Demonstrations, Weight Bias and Clinician Burnout

Come learn about cutting edge oncology nutrition from the leading experts in the field. This bundle of sessions is focused on Palliative Care, Cooking Demonstrations, Weight Bias and Clinician Burnout.

Won’t he starve? A Framework for Discussing Artificial Hydration and Nutrition with Patients who have Terminal Cancer

  1. Demonstration
    1. Discussion of artificial nutrition with a terminal cancer patient's spouse - pause when we get to a stuck point after nutritionist suggests it be stopped - "Won't he starve?"
    2. Audience response system to let audience respond with how they are feeling at this juncture.
  2. Nutrition at End of Life
    1. Mechanism of death: is not eating due to a physical obstruction vs symptom of cancer progression
    2. Different processes: anorexia-cachexia syndrome, competing mortality of organ failure, withdrawal of artificial nutrition
  3. Communication Skills presentation
    1. Discuss responding to emotion skills (NURSE)
    2. Tracking responses
    3. Responding to cultural/religious/personal reluctance to stop artificial nutrition
  4. Demonstration
    1. Unpause original demonstration using the skills and information from this didactic
    2. Audience response system to gather phrases/skills observed by the audience that led to a successful encounter
  5. Q&A

CPEU: 1.0
CPE Level: 3
Performance Indicators: 1.1.1, 1.3.3, 4.2.7

Learning Objectives

  1. Describe the different mechanisms and symptom burdens of death from cancer when artificial nutrition (AHN) is withdrawn
  2. Outline a mental model for approaching conversations about withdrawal of AHN
  3. Recognize the difference between information and emotional cues in difficult conversations

Speakers:

Max Vergo, MD FAAHPM
Geisel School of Medicine at Dartmouth
Norris Cotton Cancer Center

Amelia Cullinan, MD
Geisel School of Medicine at Dartmouth
Norris Cotton Cancer Center

Professional Resilience: Self-Care and Prevention of Burnout

Dr. Deshields will present the concepts of compassion fatigue and burnout, and will review the signs and symptoms of both for the clinician. She will talk about the consequences of burnout for patients and for health care settings. The main focus of the presentation will be on practical strategies for developing professional resilience and combatting compassion fatigue and burnout., with the goal of participants developing a personal coping plan. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 3.1.1, 3.2.4, 4.2.3

Learning Objectives

  1. Identify the manifestations of burnout for the clinician
  2. List consequences of burnout for patients and the health care system
  3. Describe strategies to promote professional resilience

Speaker:

Teresa Deshields, Ph.D., ABPP
Rush University Medical Center

Setting Up Cooking Demonstrations: A Recipe for Success

Looking to expand your services with cooking demonstrations at your cancer center but unsure where to start? Cooking demonstrations provide an entertaining and educational outlet for RDNs to translate evidence-based nutrition content for cancer patients, cancer survivors, and caregivers. Cooking demonstrations can also build consumer confidence and stimulate behavior change, not only for healthier eating habits, but for food safety, and symptom management.

  • Learn the necessary elements needed for providing a cooking demonstration - from electricity to equipment set up for in-person, virtual, or hybrid demonstrations.
  • Who can be your partners for success? (i.e. cancer center funds, support services, partnering with other departments, local kitchens, etc...)
  • Format for success- literally- how to write your recipes, tray set ups, planning grocery and equipment list that transfers to any cooking demonstration.
  • Target Audience: cooking demonstrations are for every audience from survivorship, blenderized tube feeding, holiday and seasonal, and treatment/side effect management, etc...
  • Recipe Resources: You don't have to start from scratch. Reviewing what to look for in a recipe, permission access, and adaptation for use.

CPEU: 1.0
CPE Level: 3
Performance Indicators: 2.2.3, 8.5.1, 8.5.3

Learning Objectives

  1. Apply evidence-based nutrition information as the foundation for live cooking demonstrations.
  2. Outline the steps required to plan, prepare, and adapt a virtual cooking demonstration for various venues and audiences.
  3. Demonstrate a virtual cooking class with one nutrient-rich recipe and associated culinary and nutrition talking points.

Speaker:

Elise Cushman, MS, RDN, LD, CSO
Norris Cotton Cancer Center
Dartmouth Hitchcock Medical Center

Weight Bias: A Barrier to Compassionate Competent Care and How to Overcome It

Weight bias can’t possibly exist in healthcare, right? Despite decades of science documenting the impact weight bias and weight stigma have on public health, weight bias persists. Individuals are blamed for their weight and disease processes, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We will explore how weight bias and stigma can harm cancer patients and how we can overcome it. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 1.3.2, 4.2.2, 9.1.2

Learning Objectives

  1. Define weight bias and weight stigma
  2. Describe how weight bias can affect our patients
  3. List 3 ways to overcome weight stigma

Speaker:

Brittany Finley, RD
Finley Nutrition


Advances and Trends in Oncology Nutrition - Gastrointestinal Focus

Come learn about cutting edge oncology nutrition from the leading experts in the field. This bundle of sessions is focused on Gastrointestinal topics.

Management of Gastrointestinal Side Effects of Cancer Treatment

Outline the types of GI side effects seen with cancer therapies highlighting some of the unique features of cancer therapy toxicity. Colitis secondary to immunotherapy would be an example. Discuss the differential diagnosis and the initial steps in working up these side effects since it is important to consider other causes of symptoms in addition to the patients therapy. Discuss treatment and management options and consider when it is important to involve specialists and subspecialists in the patient's care. Introduce potential benefits and limitations of endoscopy in the workup and management of these patients. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.2.3, 10.3.9, 8.2.4

Learning Objectives

  1. Familiarity with common GI side effects of cancer therapy
  2. Recognizing the second level management options
  3. Identify when to refer the patient out to a Gastroenterologist

Speaker:

David Richards, MD
The University of Texas MD Anderson Cancer Center

An Oncologist's Perspective: Malnutrition in the Gastrointestinal Cancer Clinic

This session will use 2 cases to highlight the role and practical benefits of malnutrition screening, will review our published data on large scale screening and ongoing work looking at the available evidence for outpatient malnutrition screening, then review common complications of certain anti-cancer therapeutics in GI cancers and finally review novel therapeutics as they relate to malnutrition and cachexia. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.1.2, 10.4.4, 8.2.3

Learning Objectives

  1. Review the evidence and practical aspects of malnutrition screening in ambulatory oncology
  2. Discuss complications of GI anti-cancer therapies and their effect on optimal nutritional care
  3. Summarize current novel therapeutics in cancer cachexia

Speaker:

Kunal Kadakia, MD
Levine Cancer Institute, Atrium Health

Prehabilitation for Cancer Patients

This session will discuss the rationale for cancer prehabilitation and provide examples of its execution across various cancer diagnoses. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.1.3, 10.3.9, 8.2.3

Learning Objectives

  1. Describe the rationale for cancer prehabilitation.
  2. Describe some outcomes of interest for cancer prehabilitation.
  3. Describe the challenges in cancer prehabilitation research and practice.

Speaker:

Nathan Parker, PhD, MPH
Moffitt Cancer Center

Nutrition Implications of Hyperthermic Intraperitoneal Chemotherapy

This presentation will describe the clinical history, purpose, and administration of hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in various cancers involving the peritoneum. Common nutrition-impact symptoms, appropriate medical nutrition therapy, and metabolic needs will be thoroughly discussed in the preoperative, early postoperative, and long-term postoperative contexts. Participants will learn the importance of incorporating certain non-traditional elements into assessments and recommendations, and have the opportunity to apply these concepts in a case-study format. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.5.3, 8.2.1, 8.2.3

Learning Objectives

  1. Describe HIPEC and how its administration differs from standard chemotherapy;
  2. Review the disease states commonly treated using HIPEC and the nutrition concerns arising directly from these conditions;
  3. Explore various approaches for perioperative nutrition management of patients undergoing HIPEC.

Speaker:

Stacy Shawhan, RD, CSO, LD
University of Cincinnati Cancer Center


Advances and Trends in Oncology Nutrition - Electrolyte Management, CAR-T and Bariatric Surgery

Come learn about cutting edge oncology nutrition from the leading experts in the field. This bundle of sessions is focused on Electrolyte Management, CAR-T and Bariatric Surgery.

Clinical Strategies for Fluid and Common Electrolyte and Mineral Deficiencies

This session will review 4 common deficiencies in the oncologic patient population, including hypokalemia, hypomagnesemia, iron deficiency and B12 deficiency. The session will review risk factors for the development of these deficiencies, clinical manifestations of the deficiency, interpretation of laboratory parameters, recommendations for replacement/treatment and potential adverse effects and monitoring with replacement. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.2.14, 8.1.4, 8.1.5

Learning Objectives

  • For hypokalemia, hypomagnesemia, iron deficiency and B12 deficiency in oncology patients:
    1. Identify risk factors and etiology for the development
    2. List clinical manifestations

Speaker:

Rina Patel, PharmD, BCNSP
UT MD Anderson

What the Oncology Dietitian Needs to Know about Immunotherapy and CAR T-cell Therapy

  1. Introduction/Background
    1. The term “Immunotherapy”
      1. Different types of Immune Effector Cells (IECs)
      2. Monoclonal Antibodies/Checkpoint Inhibitors
    2. Not a new concept (1977 Nutrition and Chemotherapy/Immunotherapy paper)
  2. Immunotherapy (Checkpoint inhibitors)
    1. Case Introduction
    2. MOA
      1. CTLA4
      2. PD1/PDL1
    3. Place in therapy
    4. Side Effects
      1. Common
      2. Immune Mediated Adverse Effects (irAEs)
      3. Side effect management
        1. Highlight steroids
        2. Highlight infliximab
        3. Possibility of diabetes
      4. Drug-Food Interactions
  3. Car-T Cell Therapy
    1. Patient Case
    2. MOA (CD19, mention BCMA)
    3. Place in therapy
    4. Side effects
      1. Common
      2. CRS
      3. Neurotoxicity
      4. Management of side effects, additional therapies (prophylaxis, etc.)
    5. Drug-Food Interactions
  4. Summary – Role of the Dietician (objective 5) 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.4.1, 10.4.5, 8.1.1

Learning Objectives

  1. Explain the pharmacology of immunotherapy agents (checkpoint inhibitors) and CAR T-cell therapy, and discuss their current place in cancer therapy
  2. Describe common and unique side effects of these agents
  3. Summarize common supportive care measures utilized in conjunction with these therapies

Speaker:

Helen Marshall, PharmD, BCPS, BCOP
Seattle Cancer Care Alliance

When Two Worlds Collide: Intersection of Bariatric and Oncology Nutrition

As more and more people undergo bariatric surgery oncology dietitians are increasingly likely to interact with this patient population. In 2019, the American Society for Metabolic and Bariatric Surgery estimated 256,000 patients received bariatric surgery. Bariatric patients present a unique challenge to the oncology dietitian. The intersection of patients being treated for cancer and having a history of bariatric surgery poses the risk for significant malnutrition which can negatively impact cancer treatment and outcomes. This talk will educate oncology dietitians on the common side effects of bariatric surgery and nutrition recommendations for bariatric patients including vitamins and minerals. Attendees will learn strategies to manage oncology patients with a history of bariatric surgery, including those who are malnourished and/or require nutrition support. Case studies will be used to illustrate management of this complex patient population.

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.1.2, 10.1.3, 8.1.4

Learning Objectives

  1. Describe nutritional challenges unique to cancer patients with a history of bariatric surgery.
  2. Describe common nutrition issues seen in post bariatric surgery patient.
  3. Develop/create/individualize treatment approaches to meet the needs of oncology patients who have undergone bariatric surgery.

Speakers:

Carole Havrila, RD, CSO
UVA Health System/Morrison Health Care

Rebecca Heming, RDN, CNSC
UVA Health System/Morrison Healthcare


Advances and Trends in Oncology Nutrition - Research Focus

Come learn about cutting edge oncology nutrition from the leading experts in the field. This bundle of sessions is focused on the topic of Research.

Change in Malnutrition Risk and Sarcopenia in Radiation Treated Head and Neck Cancer Patients

Inconsistent malnutrition screening practices have contributed to a poor understanding of malnutrition risk among head and neck cancer patients receiving outpatient curative radiotherapy. These patients are not only at increased risk for malnutrition, but emerging evidence indicates they also suffer skeletal muscle loss (sarcopenia). Both the decline in nutritional status and the loss of muscle status negatively impacts treatment delivery and clinical outcomes. In the era of increased prevalence of overweight and obesity among cancer patients, it is difficult to determine the level of pretreatment weight or amount of unintentional weight loss that predicts malnutrition risk. Simple weight loss may not be a reliable predictor of need for nutrition intervention. In this pilot study, a validated malnutrition screening survey, Short Form Patient Generated Subjective Global Assessment (SF-PGSA), was completed by head and neck cancer patients undergoing radiation therapy at Roswell Park Comprehensive Cancer Center at the beginning and at the end of treatment. Change in muscle status for a sample of radiation treated head and neck cancer patients was also estimated using clinically available computed tomography (CT) scans. Patients suffered declines in both malnutrition risk and muscle mass from the beginning of treatment to the end of treatment (approximately 7 weeks) regardless of weight status. Changes in malnutrition risk by last treatment indicated a critical need for nutrition intervention and symptom management, yet most patients did not see a Registered Dietitian Nutritionist. Results align with others reported in the literature indicating a need for change in nutrition and dietetic practice in outpatient oncology. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.1.2, 10.3.2, 8.2.4

Learning Objectives

  1. Describe the short- and long-term outcomes associated with poor nutritional status among head and neck cancer patients undergoing radiation therapy
  2. Discuss the differences between cancer related malnutrition, sarcopenia, and cachexia among cancer patients
  3. Identify potential preventive and management strategies for cancer related malnutrition

Speaker:

Mary Platek, PhD, MS, RD, CDN
D'Youville College
Roswell Park Comprehensive Cancer Center

BMT Subunit Talk: Bridging Research in Clinical Practice

This presentation will focus on the clinical RDN's role in research and, specifically, how to bridge research and clinical practice. Utilizing examples of the emerging evidence for the role of EN in the HCT population, diet recommendations for the neutropenic/immunosuppresed patients, impact of lean body mass on outcomes and metabolic syndrome as a Survivorship topic in the HCT population, this presentation will show that research can be done while practicing clinically and provides great value. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 6.1.6, 6.2.1, 7.4.5

Learning Objectives

  1. Describe various research methodologies and identify how to utilize the latest research to inform best practices as a clinical RDN.
  2. Describe approaches to implement RDN led research and/or partner in multi-disciplinary research in a clinical oncology setting.
  3. Formulate ideas for a Quality Improvement/Quality Assessment project in current area of practice.

Speaker:

Kerry McMillen, MS, RD, CSO, FAND
Fred Hutchinson Cancer Center

RDN Impact on Oncology Outcomes: Findings from a Feasibility Study

Our overall goal is to discuss how care from a Registered Dietitian Nutritionist (RDN) can potentially improve treatment and medical outcomes for cancer patients in the outpatient setting. 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.1.2, 10.1.3, 3.3.1

Learning Objectives

  1. Describe what is currently known about the need for dietitians and impact of nutrition care on oncology outcomes in the oncology outpatient setting.
  2. Compare and contrast malnutrition screening and referral practices across outpatient oncology clinics.
  3. Evaluate the results of a feasibility study examining the impact of nutrition care from a dietitian on treatment and medical outcomes for patients in the oncology outpatient setting.

Speakers:

Tricia Cox, MS, RD, CNSC, LD
Baylor Scott
White Health

Dolores Guest, PhD, RD
University of New Mexico

Pediatric Subunit Talk: Modifying Dietary Intake to Impact Pediatric Leukemia Outcomes

Through a biopsychosocial and culturally humble lens:

  • Background -- review the key findings and factors that led to the conception for the IDEAL I trial.
  • Methods -- review the key aspects of the study, including an in-depth review of the diet intervention
  • Results -- present the key results of the statistical and dietary analyses
  • Discussion -- review implications of the study results and the pros, cons, opportunities, and challenges of implementing a dietary intervention in this patient population.
  • Limitations -- acknowledge various limitations of this pilot study
  • Future Direction -- present initial information on the next steps for this work
  • Questions 

CPEU: 1.0
CPE Level: 3
Performance Indicators: 10.3.1, 8.1.1, 8.2.4

Learning Objectives

  1. Attendees will increase their understanding of adverse outcomes associated with overweight and obesity in pediatric ALL.
  2. Attendees will be able to describe the key components of the study dietary intervention.
  3. Attendees will consider the challenges and opportunities of using strict dietary interventions during induction chemotherapy in pediatric patients with ALL.

Speaker:

Celia Framson, MPH, RD, CSP
Children's Hospital Los Angeles