By Esther Trepal RD. MS. CDN
Having access to Medical Nutrition Therapy can be key. When Bob (not his real name), a 50-year-old man, was undergoing chemotherapy for bladder cancer at the New York Presbyterian Herbert Irving Cancer Center in New York City, he found that when he ate, he filled up so quickly that he ended up not eating enough. He was losing weight. In fact, he lost 5% of his weight in one month. Adding to his problems, he experienced heartburn, nausea and constipation. What recourse did he have? While medications may help with some of these symptoms, making changes in food choices and eating habits can make a real difference. But access to nutrition counseling is limited.
Lucky for Bob, his cancer center had a registered dietitian on staff, Shayne Robinson, RD, CSO, CDN. Working with the client’s food preferences, Shayne identified foods and eating patterns that would maximize his nutrition intake and reduce his symptoms. On a follow-up visit, he told her he felt 100% better. He was able to maintain his weight and remain free of symptoms throughout the treatment process.
Cleveland, Ohio-based Lindsey Newman, MS, RDN, LD, clinical dietitian at a pedriatric and Young Adult Cancer Center had a 7-year-old patient being treated for medullablastoma who was a thin child to begin with. His therapy called for simultaneous chemo and radiation, a known high risk for weight loss, which this child could ill afford. Lindsay intervened at the get-go. The boy experienced some weight fluctuation, but with her help his weight never got so low that it interfered with his treatment.
These stories illustrate that for those whose lives are touched by cancer, nutrition counseling can affect outcomes. Better health means treatment is better tolerated. As a result, the patient receives the complete therapy, while maintaining a more normal life. What can happen otherwise? Severe weight loss leads to malnutrition and low blood counts (e.g., white blood cells and platelets), which in turn can lead to delays in treatment, unscheduled hospital stays or tube feedings.
Cancer treatment can produce a variety of side effects. Cheryl Wachtel, RD, at Trinitas Comprehensive Cancer Center in Elizabeth, New Jersey frequently helps patients deal with fatigue, difficulty swallowing, taste changes, mouth sores, diarrhea and even with financial issues that limit food choices. While such side effects are not uncommon, nutrition counseling (officially medical nutrition therapy, or MNT) is not always available.
Debra Katz, MPH, RD, Manager Community and Population Health Nutrition at New York Presbyterian Hospital in New York City, states that Certified Cancer Centers like the Herbert Irving Cancer Center have to have a registered dietitian on staff to provide nutrition counseling as needed for patients receiving chemotherapy or radiation therapy. Similarly Cheryl’s cancer center is also a certified Comprehensive Cancer Center. She must be available to meet with patients, to check on them as they receive treatment, respond to referrals from the staff or if a patient has requested to speak with her. Cheryl finds that patients appreciate her and she develops close relationships with them over the course of care.
But unfortunately not all cancer centers are certified and have a registered dietitian on hand for patients. In these cases, the patient will need to work through their health insurance carrier to see a registered dietitian either in a clinic or in a private practice. According to Debra going this route is not easy. Although medical conditions, such as diabetes, are frequently covered, cancer and its side effects are not. For example, straight Medicare covers MNT for diabetes and kidney disease only. There can be a few workarounds on this if the dietitian is in an MD’s office. For Medicare Advantage Plans, it can depend on the individual plan, while managed Medicaid plans are often much more liberal.
To maximize success in getting reimbursed, the patient should first obtain a referral from their doctor listing the diagnoses (e.g., nausea, weight loss, cancer) along with a diagnosis code, known as the ICD-10 code. Next, they would check with their insurance carrier to see if nutrition counseling or MNT is covered for the specific ICD-10 code (very important). Assuming the insurance plan will pay for services, the next step is to locate an RD that participates in your plan. Your insurance company can provide you with a list. Be sure to also find out how many visits are allowed. If they do not pay for services, you can find an RD in your area on the Academy of Nutrition and Dietetics website (http://www.eatright.org).
Although dealing with the insurance company may seem like an extraordinary hassle, embracing nutrition as part of your self-care can ease the road ahead. If you’re newly diagnosed, undergoing treatment or moving beyond treatment, viewing nutrition as part of the treatment process goes a long way toward patient satisfaction and improved outcomes. It’s worth it.