PRINCESS MARGARET REGISTERED DIETITIAN ROLE
ONCOLOGY NUTRITION PRIORITIES AND TRIAGE
– GENERAL ONCOLOGY
At Princess Margaret Cancer Centre, registered dietitians (RD) are aligned with
specific cancer sites or cancer programs. The site-aligned RD is available for all patients
receiving treatment, regardless of inpatient or outpatient status. Patients, family members
and interprofessional team members are able to request an RD consultation. Referrals
can be sent via fax, email, page or telephone.
The primary goals of nutrition intervention are to reduce risk of malnutrition or reverse
malnutrition and ensure safe nutritional intake in the oncology population. The objectives
of nutritional counseling and intervention during cancer treatment are to optimize energy
and protein intake, ensure adequate fluid intake and manage nutrition impact symptoms.
This will assist patients in maintaining weight, limiting nutrient deficiencies, preserving
lean body mass and maintaining hydration, with the aim of reducing treatment delays and
improving quality of life. The RD also assesses complementary and alternative nutrition
therapies that patients are taking or considering and provides education on
contraindications and potential for harm.
Once a patient is referred to the RD, they are prioritized for nutrition counseling
according to level of nutrition risk. Patients are then triaged according to priority level as
well as patient and clinician availability by the responsible RD.
Priority 1 - High Nutrition Risk
The RD will see patients with one or more of the following factors for nutrition assessment
within 2 working days of receipt of consultation. (Triage may alter time frame.)
 unintentional weight loss
- > 10 % of usual body weight in 6 months
- > 7.5 % of usual body weight in 3 months
- > 5 % of usual body weight in 1 month
- > 2 % usual body weight in 1 week
 BMI < 18.5 undergoing active treatment
 nutrition impact symptoms resulting in significantly decreased intake and/or
increased risk of dehydration x 2 to 3 days
 Adverse Events (impacting nutrition status) graded 3 and 4
(NCIC CTCAE version 4.03)
 presence of pressure ulcers
(Braden scale 1 to 4)
 receiving nutrition support via enteral or parenteral routes
Last Revision Date – August 2015
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NPO/clear fluids x 5 days
therapeutic diets; examples:
- bowel narrowing/obstruction
- post gastro-intestinal surgery
- renal
texture modified diets for dysphagia
biochemical parameters
Priority 2 – Moderate Nutrition Risk
The RD will see patients with one or more of the following factors for nutrition
assessment within 5 working days of receipt of consultation. (Triage may alter time
frame.)
 anticipated nutrition impact symptoms that will significantly reduce intake
 use of alternate/complementary therapy, i.e. mega dosing of vitamins/minerals
 a secondary diagnosis/comorbidity with nutrition implications; examples:
- diabetes
- renal failure
- Crohn’s disease
- bariatric surgery or gastric bypass
 immunosuppression requiring food safety education
 BMI < 18.5 not undergoing active treatment
Priority 3 – Low Nutrition Risk
The RD will see patients with one or more of the following factors for nutrition
assessment as time permits. This may take place in a group setting.
The RD may forward referral to Toronto Western Hospital ambulatory care RD, as appropriate.
 seeking information related to quality of life issues
 seeking weight loss/management counseling
 seeking diet counseling to reduce risk of cancer recurrence
Patients and caregivers interested in nutrition and cancer survivorship information and
cooking demonstrations may access the Princess Margaret Health, Wellness and Cancer
Survivorship Centre (ELLICSR) located at Toronto General Hospital, or the Nourish
program at Wellspring.
References:
Porter J, Jamieson R. Triaging in dietetics: Do we prioritize the right patients?
Nutrition and Dietetics 2013; 70:21-26. DOI: 10.1111/j.1747-0080.2012.01637.x
Oncology Nutrition Practice Group. Oncology Toolkit: Outpatient Nutrition
Screening Criteria Suggestions. Academy of Nutrition and Dietetics, 2010.
Last Revision Date – August 2015