Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE)

Abstract

Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support.We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. “Alternative hypocaloric anti-cancer diets” (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status.Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients.

The Efficacy of Oral Nutritional Intervention in Malnourished Cancer Patients: a Systemic Review

“…The nutritional status of cancer patients is a critical determinant of successful treatment and quality of life (QOL). Cancer therapy-induced adverse events also contribute to malnutrition and delays in cancer therapies and may contribute to cancer deaths in a large proportion of patients [2345]. …”

Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy

“…If oral intakes were <60% of estimated requirements for two consecutive weeks despite the use of ONS, artificial nutrition support (enteral or parenteral as appropriate) was started …”

Practical Management of Cancer Cachexia

“…Based on the severity of weight loss or the aggressiveness of anti-cancer therapy, cancer patients should be monitored every 1-3 months to assess efficacy (i.e., quality of life, nutritional parameter, cancer therapy-related toxicity, etc.) and to adapt rapidly to the changing needs MUST, NRS-2002, PG-SGA) have been demonstrated to identify the patients at higher clinical risk and should be preferred over local, not validated tools [15]. Also, changes in appetite can be used to identify the patients at higher clinical risk [16].…”