AOCNP Nutrition, Cachexia, and Supportive Care in Oncology

Question 1

Which validated screening tool is most widely recommended for identifying nutritional risk in hospitalized oncology patients?

Accepted Answer

NRS-2002 (Nutritional Risk Screening 2002) or MUST (Malnutrition Universal Screening Tool)

Answer

The NRS-2002 and MUST are validated, guideline-endorsed tools for systematic nutritional risk screening in hospitalized patients, including those with cancer. They account for BMI, recent weight loss, reduced intake, and disease severity. BMI alone misses patients with significant weight loss but normal BMI. Serum albumin reflects inflammation as much as nutrition and is no longer recommended as a sole nutritional marker. A 24-hour recall is an assessment tool, not a validated screening instrument.

Question 2

Cancer-associated cachexia is best characterized by which of the following pathophysiologic features?

Accepted Answer

Metabolic dysregulation with systemic inflammation causing loss of muscle and fat that is not fully reversible with nutrition alone

Answer

Cancer cachexia is a complex metabolic syndrome characterized by systemic inflammation (elevated IL-6, TNF-α, etc.), increased catabolism, and negative protein and energy balance. Critically, it is NOT simply starvation — aggressive caloric supplementation alone cannot fully reverse the muscle wasting because the underlying metabolic dysfunction persists. This distinguishes cachexia from malnutrition alone and explains why nutritional support must be multimodal.

Question 3

An oncology NP is advising a patient undergoing FOLFOX chemotherapy who wants to take high-dose St. John's Wort for depression. What is the primary clinical concern with this supplement?

Accepted Answer

St. John's Wort is a potent CYP3A4 inducer that can significantly reduce plasma levels of chemotherapy and other co-administered drugs

Answer

St. John's Wort (Hypericum perforatum) is a potent inducer of CYP3A4 and P-glycoprotein, significantly increasing the metabolism and clearance of many drugs. In oncology patients, this can reduce plasma concentrations of chemotherapy agents, targeted therapies (including irinotecan's active metabolite SN-38), and other co-medications, potentially compromising treatment efficacy. This is a clinically significant and well-documented herb-drug interaction that the oncology NP must screen for.

Question 4

For a patient with head and neck cancer undergoing concurrent chemoradiation who cannot maintain adequate oral intake due to mucositis, which nutritional support route is most appropriate?

Accepted Answer

Enteral nutrition via nasogastric or gastrostomy tube

Answer

When the GI tract is functional, enteral nutrition (via NG tube or prophylactic PEG/RIG) is the preferred route and is supported by ASPEN, ESPEN, and ASCO guidelines for patients who cannot maintain adequate oral intake. Enteral feeding maintains gut integrity, reduces infection risk, and is more physiologic than parenteral nutrition. TPN is reserved for patients with a non-functional GI tract. Oral supplements alone are insufficient if mucositis prevents adequate intake. IV dextrose provides calories but no protein or micronutrients.

Question 5

Which omega-3 fatty acid supplement has the most evidence supporting its use in cancer patients for attenuating weight loss and improving outcomes during chemotherapy?

Accepted Answer

EPA (eicosapentaenoic acid) from fish oil

Answer

Eicosapentaenoic acid (EPA), a long-chain omega-3 fatty acid found in fish oil, has the most evidence in oncology nutrition for its anti-inflammatory properties and potential to attenuate cancer cachexia, particularly in pancreatic and upper GI cancers. Multiple trials have examined EPA supplementation for preservation of lean body mass. Evening primrose oil, CLA, and flaxseed-derived ALA (which must be converted to EPA/DHA with limited efficiency) have significantly less evidence in this context.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Nutrition, Cachexia, and Supportive Care in Oncology