Nutrition and physical activity: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS)

Abstract

This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently, in addition to anticancer treatments, supportive care including nutritional support and PA plays a central role in the management of digestive cancers. It is crucial to detect malnutrition (diagnostic criteria updated in 2019) early, to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition and PA in digestive oncology for each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). Guidelines for nutrition and PA management aim at increasing awareness about malnutrition in oncology. They are continuously evolving and need to be regularly updated.

Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus

“…Detecting early malnutrition signs is crucial not only at the time of diagnosis, but also at all times of the treatment pathway [ 20 , 22 – 24 , 26 ].…”

Physical Activity as the Best Supportive Care in Cancer: The Clinician’s and the Researcher’s Perspectives

“…The accumulating evidence supports the benefits of physical exercise and nutritional management, during and after anticancer treatments, and these interventions are now recommended in routine practice [ 2 , 3 ]. Nutritional interventions are essential to prevent and reduce malnutrition, sarcopenia and cachexia [ 2 , 4 , 5 ].…”

“…Adapted physical activity is used in combination with nutritional interventions to fight malnutrition and to reduce the symptom burden related to the tumor and treatments. Multidisciplinary supportive care, integrating the dimensions of nutrition, exercise, and the psychosocial environment, alongside oncological treatments, is now regarded as a new paradigm to improve patient survival and the HRQoL [ 3 ]. Additionally, observational studies have shown that diet, physical activity, and weight control are associated with a decreased risk of cancer, and of recurrence and death after a cancer diagnosis, and preclinical models provide insight for specific antitumor effects of physical activity [ 6 , 7 , 8 , 9 ].…”

Time from first seen in specialist care to surgery does not influence survival outcome in patients with upfront resected pancreatic adenocarcinoma

“…Moreover, pancreatic resection is one of the most challenging surgery, with significant postoperative morbidity and mortality [ 10 ]. Improving preoperative status—by means of biliary drainage, hemostasis correction, prehabilitation with nutritional and adapted physical activity interventions [ 11 ]—is needed before surgery as complications are more frequent in unfit patients [ 12 ]. Shorter TTS may not allow to optimize prehabilitation but could improve carcinologic prognosis.…”