Cancer and Cancer Treatment
20.8%of exam
Treatment modalitiesSymptom recognitionUrgent escalationFunctional status
Nutrition Assessment
33.6%of exam
Intake and body compositionPG-SGA and GLIMRequirements and social contextLaboratory interpretation
Nutrition Interventions
28.0%of exam
Individualised routesRefeeding precautionsMonitoring and referralCare coordination
Education and Counseling
17.6%of exam
Teach-backFood and supplement safetySurvivorship and goalsCommunity education
Quick Facts
- Questions
- 150: 125 scored + 25 pretest
- Testing
- 180 minutes; 20-minute tutorial extra
- Fee
- USD 350 examination fee
- RD Status
- At least 2 years
- Initial Practice
- 2,000 hours within preceding 5 years
- Substitutions
- Approved: up to 40% / 800 hours
- Retake
- 60 days; CDR reauthorization
- Validity
- 5 years; eligible pilot alternative
Irinotecan Diarrhoea Timing
Early
- During/shortly after infusion
- Cholinergic symptoms may occur
Late
- Usually more than 24 hours
- Dehydration or sepsis risk
Use the oncology treatment plan
Treatment and Functional Status
- TNM
- Primary tumour, nodes, distant metastasis
- Histological Grade
- Differentiation; distinct from anatomical stage
- ECOG 3
- Limited self-care; bed/chair >50% waking
- ECOG 4
- Complete disability; no self-care
- Early Irinotecan Diarrhoea
- During/shortly after infusion; cholinergic symptoms
- Late Irinotecan Diarrhoea
- Usually >24 hours; dehydration risk
Treatment Effects and Escalation
- Neutropenia With Abdominal Pain
- Urgent assessment; no automatic PN
- Checkpoint-Inhibitor Colitis
- Escalate diarrhoea, bleeding and dehydration
- CAR-T Altered Alertness
- Urgent assessment; check swallowing safety
- Head-and-Neck Radiotherapy
- Monitor intake, mouth and swallowing
- Pelvic Radiotherapy Diarrhoea
- Assess causes, losses and tolerance
- Allogeneic HSCT
- Assess GVHD, toxicity and intake
GLIM: One AND One
Phenotype AND etiology; assess before diagnosing
Weight, BMI or muscleIntake/assimilation or inflammationSeverity uses phenotypic criteria
Screening vs Assessment
Screening
- Rapid risk identification
- Triggers further evaluation
Assessment
- Characterises nutritional problems
- Supports diagnosis and care plan
Risk is not a complete diagnosis
Assessment and Triage Pathway
- Screen indicates nutritional risk→Complete assessment and symptom review(Include access and cultural context)
- PG-SGA score is ≥9→Arrange urgent symptom/nutrition intervention(Global category requires separate assessment)
- GLIM diagnosis is considered→Find phenotypic and etiologic evidence(Assess all criteria)
- Weight rises despite poor intake→Examine fluid and body composition(Weight gain can mask tissue loss)
Screening, Assessment and Cachexia
- Positive Screening
- Risk identified; comprehensive assessment follows
- PG-SGA Numerical Score ≥9
- Urgent symptom and nutrition intervention
- PG-SGA Global A/B/C
- Separate assessment; not score bands
- GLIM Diagnosis
- ≥1 phenotypic AND ≥1 etiologic criterion
- Fearon: Six-Month Weight Loss
- >5%; assess full clinical syndrome
- Fearon Alternative
- >2% loss plus BMI<20 or sarcopenia
PG-SGA Score vs Global Category
Numerical score
- Intervention triage
- ≥9 signals urgent need
A/B/C category
- Clinical nutritional-status judgement
- Not numeric score bands
Record score and global category separately
Weight, Muscle and Fluid
- Weight-Loss Percentage
- Lost weight ÷ usual weight ×100
- 80 kg → 74 kg
- 7.5% loss; interpret timeframe
- High BMI
- Does not exclude muscle depletion
- Muscle Thresholds
- Method and population must match
- Ascites/Oedema
- Assess fluid; no fixed-kilogram subtraction
- Albumin
- Inflammation-sensitive; not stand-alone nutrition diagnosis
Food Deprivation vs Cachexia
Food deprivation
- Insufficient nutrient supply
- Investigate access and reversible barriers
Cancer cachexia
- Intake plus metabolic disturbance
- Nutrition alone may not reverse
Treat causes as well as intake
Biochemistry and Clinical Context
- Refeeding Electrolytes
- Track phosphorus, potassium and magnesium
- Refeeding Diagnosis
- Post-feeding change plus clinical context
- Tumour Lysis Pattern
- High potassium/phosphate/urate; low calcium
- Tumour Lysis Response
- Urgent team care; individualise electrolytes
- Ferritin
- Inflammation may mask iron deficiency
- Food Insecurity
- Assess access, affordability and facilities
Requirements and Assessment
- ESPEN Estimated Energy
- 25–30 kcal/kg/day; individualise
- ESPEN Protein (g/kg/day)
- Above 1; if possible, 1.5
- Reference Weight
- Assess fluid and body composition
- Gastrectomy
- Monitor intake, B12 and iron
- Abiraterone Food Rules
- Check exact formulation and label
- GLIM 2026 Intake Guidance
- Usual intake; symptoms and duration
Refeeding: Before, Begin, Reassess
Thiamine, electrolytes, cautious calories, monitoring
Severely low: delay and correctCount IV dextroseAdvance with clinical stability
Enteral vs Parenteral Nutrition
EN
- Uses gastrointestinal tract
- Preferred when feasible
PN
- Intravenous nutrient delivery
- When EN is insufficient/impossible
Individualise by function, goals and tolerance
Route Selection After Assessment
- Oral intake is safe and feasible→Optimise foods, symptoms and supplements(Monitor achieved intake)
- Oral measures remain inadequate→Use enteral support when feasible(Assess swallowing and bowel function)
- Enteral support insufficient or impossible→Consider supplemental or total PN(Balance expected benefit and burden)
- Clinical state or goals change→Reassess route and nutrition targets(Avoid automatic treatment duration)
Gastrointestinal Nutrition Decisions
- Faecal Elastase <100 μg/g
- Supports EPI; formed stool sample
- Faecal Elastase 100–200 μg/g
- Indeterminate; assess further
- Adult PERT Starting Dose
- ≥40,000 USP lipase units/meal
- PERT Snacks
- Half meal dose; take with food
- Chyle Leak
- Individualise fat; preserve essential fats
- High Ileostomy Output
- Assess hydration; specialist fluid plan
At-Risk Adult Refeeding Pathway
- Before feeding or IV dextrose→Give thiamine; check P/K/Mg(ASPEN: thiamine 100 mg)
- Electrolytes are severely low→Delay initiation/increases; replace and monitor(Individualise for renal and clinical status)
- Starting feeds with monitoring established→10–20 kcal/kg across first day(Count dextrose from all sources)
- Electrolytes fall precipitously→Reduce calories; treat and reassess(Advance only with clinical stability)
Nutrition Routes and Refeeding
- Oral Intake Inadequate
- Counsel, fortify, consider supplements
- Oral Measures Insufficient
- Enteral nutrition when feasible
- Enteral Support Inadequate/Impossible
- Consider PN; assess benefit and burden
- ASPEN At-Risk Adult Thiamine
- 100 mg before feeding/dextrose
- ASPEN Calories: First 24 Hours
- 10–20 kcal/kg; include IV dextrose
- Severely Low Electrolytes
- Delay feeding/increases; treat and monitor
Monitoring and Team Decisions
- PN Monitoring
- Glucose, electrolytes, fluid, triglycerides, liver
- Gastrostomy Before Radiotherapy
- Individual risk-benefit discussion; not universal
- Symptomatic GI GVHD
- Choose route by function and tolerance
- Swallowing Red Flags
- Cough, wet voice, suspected aspiration
- Monitoring Plan
- Define outcomes, timing and response
- Home Enteral Coverage
- CMS: long and indefinite impairment
Food Safety: Four Actions
Clean, Separate, Cook, Chill
Choose safer foodsCheck preparation temperaturesFollow transplant precautions
Laboratory Signal vs Clinical Evidence
Laboratory/animal
- Mechanistic signal
- May prompt precaution
Human clinical
- Patient outcomes studied
- Design and context still matter
Laboratory results do not prove harm
Counselling and Shared Decisions
- Patient proposes restrictive cancer diet→Explore aims and explain evidence(Assess risk without dismissing concerns)
- Patient uses supplements or herbs→Record product; request interaction review(Distinguish preclinical from human evidence)
- Teaching an individual or group→Agree practical goals; use teach-back(Adapt language, access and preferences)
- Prognosis or goals change→Discuss expected benefit and burden(Comfort care includes mouth care)
Education, Safety and Goals
- Food-Safety Framework
- Clean, separate, cook and chill
- Immunosuppression: Deli Meats
- Heat to 165°F or steaming
- EGCG–Bortezomib Evidence
- Laboratory/animal findings; human significance uncertain
- High-Dose Antioxidants
- No routine recommendation during treatment
- WCRF Cooked Red Meat
- Limit about 350–500 g/week
- Dying Phase
- Prioritise comfort and individual goals
Common Traps
PG-SGA Triage versus Global Category
Score ≥9: urgent nutrition/symptom intervention ≠ Global C: separate clinical assessment
Nutrition Route: Bowel Function Matters
Severe GI symptoms: assess function/tolerance ≠ Automatic PN solely from symptom severity
Fluid-Affected Weight versus Fixed Subtraction
Fluid shifts can conceal tissue loss ≠ Universal kilogram subtraction for dry-weight
Refeeding: Serial Change versus Snapshot
After increased calories: serial electrolyte changes ≠ Diagnosis from one phosphorus cutoff
EGCG–Bortezomib: Evidence Level Matters
EGCG–bortezomib preclinical findings ≠ Proof of human clinical antagonism
CSO Recertification: Standard versus Limited Alternative
Standard route: examination ≠ Eligible longitudinal-assessment pilot: alternative route
Last Minute
- 1.Separate 150 total from 125 scored
- 2.Calculate weights using scored items
- 3.PG-SGA score differs from global category
- 4.GLIM requires phenotype AND etiology
- 5.Interpret weight alongside fluid and muscle
- 6.Escalate urgent oncology symptoms
- 7.Individualise energy, protein and reference weight
- 8.Choose route by function and goals
- 9.Use refeeding precautions when indicated
- 10.Review exact drug formulation and supplements
- 11.Adapt counselling to access and culture
- 12.Document outcomes and reassessment
Free CEThird-party resources · We may earn a commission from purchases.
CSO EXAM STUDY GUIDE 2026–2027: A Focused Study Guide to Oncology Nutrition, Cancer Treatment, Nutrition Assessment, Medical Nutrition Therapy, Patient Counseling, and Exam-Style Practice
By Publications, Silverline
$36.99 · 
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