Are Guideline Recommendations on Supportive Nutrition and Exercise Therapy for Cancer Patients Implemented in Clinical Routine? A National Survey with Real-Life Data

Abstract

Malnutrition and cancer cachexia are highly prevalent comorbidities of cancer, limiting patients’ quality of life and being relevant to prognosis. International and national clinical guidelines recommend supportive nutrition and exercise therapy for cancer patients. However, there is little current epidemiological evidence on the implementation of these guideline recommendations in clinical routine. To close this data gap, a national survey in Germany using an online questionnaire was conducted. There were 261 of a total of 5074 contacted hospitals and medical offices who participated in the survey (5.1% response rate). The data indicated that nutrition and exercise therapy for cancer patients is so far inadequately implemented, with 59% of the respondents reporting nutrition therapy as an integral part of oncological treatment, 66.7% having a nutrition specialist/team, and 65.1% routinely conducting a screening for nutritional status. Only half of the participants stated that there are defined goals in nutrition therapy. The majority of respondents (85.8%) generally recommend exercise therapy, but only a few of them provide specific offers at their own institution (19.6%) or at cooperation partners (31.7%). In order to implement the recommended combined nutrition and exercise therapy as part of regular care, there is a need for nationwide availability of multidisciplinary nutrition teams and targeted offers of individualized exercise therapy. Health policy support would be important to create the structural, financial, and staff conditions for appropriate guideline implementation in order to achieve the optimal treatment of cancer patients.

The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery

“…Cachexia, sarcopenia, and malnutrition are common concomitants of systemic chemotherapeutic treatment—as opposed to tumor burden itself—with an estimated 20% to 25% of all patients with cancer dying as a result of cancer cachexia 176,177 . Early individualized supportive nutrition therapy and exercise programs can help prevent muscle wasting, but implementation of nutrition guidelines is suboptimal partly because of unestablished roles of who should perform initial and repeated screenings 177 . Nutritional interventions are noted to be most effective before the development of cachexia, but most patients with cancer in a nationwide survey reported that nutrition consultation occurred only after there was an obvious deficiency 177 .…”

“…Early individualized supportive nutrition therapy and exercise programs can help prevent muscle wasting, but implementation of nutrition guidelines is suboptimal partly because of unestablished roles of who should perform initial and repeated screenings 177 . Nutritional interventions are noted to be most effective before the development of cachexia, but most patients with cancer in a nationwide survey reported that nutrition consultation occurred only after there was an obvious deficiency 177 . Unclear roles in screening and delayed nutrition consultation both highlight the need for early and continued multidisciplinary collaboration with medical oncology and nutrition.…”

Effectiveness of an ERAS-based exercise-nutrition management model in enhancing postoperative recovery for thoracoscopic radical resection of lung cancer: A randomized controlled trial

“…Studies have shown that an intervention model combining nutrition and physical exercise is most effective in the pre-cachexia stage and can also enhance immunity, thereby supporting the rehabilitation process of cancer patients. [ 8 , 9 ]…”