Evidence-Based Medicine Key to Mainstreaming of NOAT

PHILADELPHIA—The Society for Nutritional Oncology Adjuvant Therapy (NOAT) is an interdisciplinary professional organization that addresses the role of nutrition and metabolism in oncology. Founded in 1994, NOAT is the first organization devoted solely to studying the role of nutrition in cancer (see box).

The Society fosters the integration of the principles of nutritional oncology in supportive care, adjunctive therapy, and prevention.

In a panel session at NOAT’s 5th International Congress, experts advised the Society on how to best advance the role of nutrition in the treatment of cancer.

“Evidence-based medicine is the coin of the realm, and it is the means that will allow nutrition to enter the mainstream of oncology. That is why NOAT must do a major literature review,” said Jeffrey Lerner, PhD, vice president of strategic planning, ECRI (Plymouth Meeting, Pennsylvania), an independent evaluator of health care technology.

He recommended that NOAT perform, on a voluntary basis, an in-depth literature review to be published in a major journal, such as JAMA or the New England Journal of Medicine. “It has to be objective and thorough,” he said. “It has to deal with the truly important theoretical and practical issues in your field.”

Gaining Public Support

Such a study would lead in the long run to getting support from public and private payers, Dr. Lerner said. “Gaining support is a very complicated process,” he said. “It involves consumer demand, private demand, industry demand, and media pressure, but one of the key areas payers rely on in making reimbursement decisions is evidence-based medicine—literature reviews and technology assessments.”

A good literature review, he said, would make it possible for the Society to ask the Agency for Healthcare Research and Quality (AHRQ), part of the US Department of Health and Human Services, to commission a technology assessment for nutritional oncology adjuvant therapy. Such assessments are used by Medicare and private payers to develop clinical practice guidelines.

“AHRQ will pay for an assessment if you convince them that your topic is worth it,” he said.

 Dr. Lerner also pointed out that the recommended literature review would help in the Society’s effort to include nutritional assessments in the design of clinical trials.

Margaret McCarthy, founding volunteer executive director of the Alliance for Lung Cancer Advocacy, Support and Education (ALCASE), advised the group that its “key talking point” should be that patient nutrition is a confounding factor in clinical trials and, consequently, every clinical trial should include a nutrition and supplemental summary for every patient enrolled.

Getting the Point

Ms. McCarthy said that NOAT has to get this point “into the mind set of the clinicians who are doing clinical trials—that what patients eat and what they take in the form of supplements may, in fact, influence whether the treatment under study is successful or not.”

The only way to do this, she said, is “with a lot of pressure from the people who know these facts the best. If you pick a really hot issue and focus on that for a year, I think you’ll see some movement toward its acceptance.”