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

Abstract

Purpose Malnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients. Methods A Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients. Results The panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment. Conclusions There is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.

Nutritional Support in Pancreatic Diseases

“…According to some consensus documents [ 5 ], after the stratification of the patients using the screening tools, the subsequent approach can be decided by the patient. Low risk patients could be controlled and followed by the gastroenterologist, oncologist or surgeon.…”

“…Nutritional counselling is the first step; it provides patients adequate information about the dietary changes needed to achieve adequate calories and protein intake in their diet. This counselling must always be performed by a healthcare professional, and if possible, by a nutritionist with experience in the management of oncologic patients [ 5 , 101 ].…”

“…These could reduce the risk of infection, as well as reducing the preparation time in the Pharmacy Unit. To convert multi-chamber bags into complete ready-to-use all-in-one admixtures, pharmaceuticals with experience in this field are necessary [ 5 ].…”

“…For patients who are going to receive neoadjuvant treatment with chemotherapy, radiotherapy, or both, or who will receive adjuvant treatment, a nutritional evaluation is necessary before starting treatment and between sessions. It is also necessary to treat tumor-related or treatment-related symptoms such as anorexia, nausea and vomiting, pain or PEI, as these symptoms may affect the patient’s nutritional status [ 5 ].…”

“…For patients with severe malnutrition, the use of oral supplements, EN, or even TPN, can be considered to improve nutritional status before surgery. After surgery, an early onset of oral tolerance is recommended, and if postoperative complications do not allow oral feeding or cover patient nutritional requirements, the use of early TPN is an adequate strategy [ 5 ].…”