Malnutrition management in oncology: An expert view on controversial issues and future perspectives

Abstract

Cancer and anticancer treatments can lead to several negative side effects, including malnutrition. Despite the recognized need for adequate nutritional support in cancer patients, in daily clinical practice, nutrition is still not considered one of the first aspects to be considered. Malnutrition negatively affects the clinical outcomes, treatment response, and overall survival of cancer patients. In this study, three of the most controversial issues related to malnutrition, which emerged during an Italian Consensus Conference, were addressed specifically for patients with head and neck as well as gastrointestinal cancer. The timing of nutritional evaluation and intervention, extension of the Enhanced Recovery after Surgery (ERAS®) protocols, and cost-effectiveness of nutritional interventions have been considered. This study aimed to illustrate the state-of-the art of each issue and hypothesize future perspectives and actions to be taken, trying to suggest a new nutritional management model for cancer patients in Italy that overcomes the critical issues encountered. Of note, the timely diagnosis of nutritional issue appears to be essential to ensure the correct management of malnourished cancer patients as well as those who are at high risk of malnutrition. Standardized protocols, screening tests, and the inclusion of nutritional parameters in patient medical records would help to achieve good clinical outcomes. Finally, appropriate nutritional support is also associated with cost savings, and it seems necessary to promote its clinical and economic value to obtain improvements in both outcomes and management costs.

May Nutritional Status Positively Affect Disease Progression and Prognosis in Patients with Oesophageal and Pharyngeal Cancers? A Scoping Review of the Current Clinical Studies

“…Cancers of the oesophagus and the pharynx can impair feeding in patients, and lead to undernutrition [7][8][9]. Nutrition impact symptoms negatively influence cancer patients beyond the acute phase of cancer therapy [10,11]. These symptoms are linked with reduced nutrition and quality of life.…”

“…These symptoms are linked with reduced nutrition and quality of life. Notably, 23.8-48.9% of patients with oral cancers are diagnosed with malnutrition [10,11], while the rates for oesophageal cancer patients reach 79% [9].…”

May Nutritional Status Positively Affect Disease Progression and Prognosis in Patients with Esophageal and Pharyngeal Cancers? A Scoping Review of the Current Clinical Studies

“…Cancers of the esophagus and the pharynx can impair feeding in patients and lead to undernutrition [ 11 , 12 , 13 ]. Nutrition impact symptoms negatively influence cancer patients beyond the acute phase of cancer therapy [ 14 , 15 , 16 ]. These symptoms are linked with reduced nutrition and quality of life.…”

“…These symptoms are linked with reduced nutrition and quality of life. Notably, 23.8–48.9% of patients with oral cancers are diagnosed with malnutrition [ 14 , 15 ], while the rates for esophageal cancer patients reach 79% [ 13 ].…”

“…Nutritional assessment is important in order to prevent and manage malnutrition [ 15 ], whilst nutritional status acts as a prognostic factor for disease progression [ 17 ]. A substantial concern regarding malnutrition is underdiagnosis [ 18 ], even if nutritional assessment testing is recommended to be accomplished during the diagnostic procedure [ 16 ].…”