Nutrition Services in Oncology: A Cross-Sectional Survey of Patient Experiences, Needs, and Gaps in Care

BACKGROUND: Nutrition influences cancer outcomes, yet access to Registered Dietitian Nutritionists (RDNs) remains inconsistent. Patient-centered data can reveal gaps in care, unmet needs, and disparities, providing real-world insight into oncology nutrition services.

OBJECTIVE: The objective of this study was to characterize cancer survivors' experiences with professional nutrition care since diagnosis, including sources, met and unmet needs, timing, and priority areas, and to examine variation by sociodemographic and clinical characteristics.

DESIGN: The cross-sectional study analyzed online surveys from the Cancer Experience Registry, an online patient-reported outcomes registry of cancer survivors in the United States and Canada, collected between November 2022 and November 2024; analyses of this study were restricted to U.S.

PARTICIPANTS/SETTING: Participants included 1,427 cancer survivors, predominantly women (76.5%), older adults (45.5% aged ≥65 years), and non-Hispanic White (85.5%), with smaller proportions identifying as non-Hispanic Black (5.6%), Hispanic (3.2%), and non-Hispanic other race (4.3%) (1.5% missing). The most common cancers were breast (32.6%), blood (29.6%), and gastrointestinal (10.5%).

MAIN OUTCOMES MEASURES: Primary outcomes included receipt of nutrition care since cancer diagnosis (any nutrition care and care from an RDN and patient-reported nutrition care need, categorized as met (wanted and received support), unmet (wanted but did not receive support), no perceived need (did not want support), or unsure.

STATISTICAL ANALYSES PERFORMED: Descriptive statistics summarized receipt of nutrition services, expressed need, timing, and priority areas. Bivariate and multivariable regression analyses examined differences in nutrition care need and RDN engagement across patient characteristics.

RESULTS: Since diagnosis, 53.6% reported receiving nutrition care, with 39.3% from an RDN. Need was met in 41.0%, unmet in 13.4%, no perceived need in 33.2%, and unsure in 12.5%. Among participants desiring nutrition care, demand peaked during treatment and post-treatment. Unmet need was more common after treatment and linked to increasing energy level (p=.002), emotional health (p<.001), intentional weight loss (p<.001), and cancer worry (p<.001). Endorsement of symptom management (p=.008) and intentional weight gain (p=.001) as reasons for nutrition support was higher among participants who saw a provider (RDN or non-RDN) compared with those who did not. Participants with unmet need were more often younger, women, food-insecure, lacking caregiving support, and had higher symptom burden, while no perceived need was associated with rural residence, lower education, lacking caregiving support, and private practice care (all p values <.05).

CONCLUSIONS: Unmet nutrition care needs were observed among cancer survivors and varied by sociodemographic and clinical characteristics. Future research should evaluate the impact of systematic malnutrition screening and referral pathways on access to RDN services and examine how nutrition care needs and engagement evolve from diagnosis through survivorship. Additional work is needed to understand and address disparities across population subgroups and care settings.