Overview
Nutrition plays a pivotal role in oncology, profoundly impacting clinical outcomes and overall quality of life.1 Malnutrition, sarcopenia, and cachexia are associated with higher mortality2, higher treatment-related toxicity3, and higher risk of post-operative complications.4 Medical nutrition intervention can help mitigate treatment side effects, improve clinical outcomes, and enhance patient well-being.5,6,7
Symptoms
Oncological patients may present with anorexia, dysgeusia, dysphagia, nausea, emesis, diarrhea, mucositis, sarcopenia, and cachexia, reflecting the disease's systemic impact and treatment-related toxicities.8 Early identification and management of these symptoms and conditions are essential to preserve nutritional status and support physiological resilience.9
Diagnosis
Nutritional assessment in oncology involves a thorough evaluation of the patient's dietary intake, weight history, and potential symptoms affecting nutrition9. Healthcare professionals use tools like nutritional risk screenings and physical examinations to identify malnutrition or risk thereof, tailoring interventions to each patient's specific needs.10,11
Management
Management strategies are comprehensive, involving individualized dietary counseling and modifications to manage symptoms, ensure adequate nutrient intake, and maintain or improve the patient's nutritional status throughout the course of their cancer treatment.10,11
The American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) provide evidence-based recommendations for nutritional care in oncology, emphasizing the importance of integrating nutritional support into the overall treatment plan to address specific patient needs and improve outcomes.10,11
1. Caccialanza R, Pedrazzoli P, Cereda E, et al. 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). J Cancer. 2016;7(2):131-135.
2. Zhang X, Tang T, Pang L, et al. Malnutrition and overall survival in older adults with cancer: A systematic review and meta-analysis. J Geriatr Oncol. 2019;10(6):874-883.
3. Kazemi-Bajestani SM, Mazurak VC, Baracos V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes. Semin Cell Dev Biol. 2016;54:2-10.
4. Weerink LBM, van der Hoorn A, van Leeuwen BL, de Bock GH. Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2020;11(3):636-649.
5. van der Werf A, Langius JAE, Beeker A, et al. The effect of nutritional counseling on muscle mass and treatment outcome in patients with metastatic colorectal cancer undergoing chemotherapy: A randomized controlled trial. Clin Nutr. 2020;39(10):3005-3013.
6. Cereda E, Cappello S, Colombo S, et al. Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy. Radiother Oncol. 2018;126(1):81-88.
7. Zhang F, Shen A, Jin Y, Qiang W. The management strategies of cancer-associated anorexia: a critical appraisal of systematic reviews. BMC Complement Altern Med. 2018;18(1):236
8. Garutti, Mattia et al. “Nutritional Management of Oncological Symptoms: A Comprehensive Review.” Nutrients vol. 15,24 5068.
9. Muscaritoli, Maurizio et al. “Oncology-Led Early Identification of Nutritional Risk: A Pragmatic, Evidence-Based Protocol (PRONTO).” Cancers vol. 15,2 380.
10. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021 May;40(5):2898-2913.
11. Arends J, Strasser F, Gonella S, et al. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines. ESMO Open. 2021;6(3):100092.