Nutrition in Advanced Thyroid Cancer Patients

Abstract

In the last decade, multikinase inhibitors (MKIs) have changed the paradigm of treatment of advanced and progressive thyroid cancer. Compared with the traditional treatment with chemotherapy and radiotherapy, these new drugs have shown a good efficacy in controlling the neoplastic disease, and also a different toxicity profile compared to traditional chemotherapy, milder but still present and involving mainly the nutritional profile. Weight loss, nausea, anorexia, stomatitis, diarrhea may be associated with malnutrition and cancer-related cachexia. The latter is characteristic of the advanced cancer stage and may be present before starting MKIs, or may develop afterwards. Adverse events with nutritional impact may cause a significant impairment of quality of life, often requiring dose reduction and sometimes drug discontinuation, but with a lower efficacy on the neoplastic disease. The aim of this paper was to discuss the role of nutritional therapy in advanced thyroid cancer and the importance of prevention, early recognition and careful management of malnutrition and cachexia during systemic therapy with MKIs.

Nutrition and Cancer Care – American and European Context

“…Many cases of cancer could be prevented by adopting a healthful lifestyle which includes a healthy dietary pattern [1][2][3]. While historically there have been insufficient effective treatments such as radiotherapy, chemotherapy, or local therapies in oncology patients, the therapy paradigm has been revolutionised in the last decade by the introduction of systemic therapies and lately with next-generation targeted therapies [4,5].…”

“…Diet-related unmet care needs, including poor appetite and gas­trointestinal symptoms, are common among those with cancer [6]. Malnutrition is common in cancer patients and is caused by an impaired ingestion or assimilation of nutrients, which is connected either to the cancer itself or its specific treatments [4]. Cachexia, a multifactorial syndrome characterised by a continuous loss of skeletal muscle mass (frequently sarcopenia) with or without loss of fat mass is also common [3, 4, 7, 8].…”

“…Malnutrition is common in cancer patients and is caused by an impaired ingestion or assimilation of nutrients, which is connected either to the cancer itself or its specific treatments [4]. Cachexia, a multifactorial syndrome characterised by a continuous loss of skeletal muscle mass (frequently sarcopenia) with or without loss of fat mass is also common [3, 4, 7, 8]. Malnutrition can negatively impact tolerance to treatment, quality of life, and survival [9].…”

Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective

“…Overall, a nutritional screening before starting MKI and during follow-up seems essential to guarantee a safe start and a better tolerance to treatments and improve patients’ prognosis. 31 Multimodal prehabilitation programmes have been introduced in the management of several solid tumours, including TC. 32 Cancer prehabilitation includes the identification and the optimization of care of pre-existing comorbidities, nutritional counselling, physical exercise programme, and psychological support, aiming to improve the patient’s functional capacity with targeted interventions before the start of a treatment.…”

A meta-analysis of the efficacy and toxicity of tyrosine kinase inhibitors in treating patients with different types of thyroid cancer: how to choose drugs appropriately?

“…The Global Cancer Statistics 2020 revealed 586 202 new cases and 43 646 new deaths of TC, accounting for 3% of the global incidence rate and 0.4% of the global death rate among 36 cancers in 185 countries [1 ▪ ]. Well differentiated thyroid carcinoma usually has a good prognosis, with a 5-year survival rate as high as 98.3% [2 ▪ ]. Women are more likely to develop TC [3 ▪ ].…”