Nutrition in Cancer Patients

Abstract

Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using “OR” as a Boolean function and the results of the four components were combined by utilizing the “AND” Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1–2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.

Quality of Life (QoL) of cancer patients and its association with nutritional and performance status: A pilot study

“…This has resulted in an increased interest in exploring the health-related quality of life (HRQoL) of cancer survivors. So, there is a consequent need to satisfy cancer patients' requirements which would enable them to live a healthy life [ 7 ]. In many cases, cancer patients experience sleep disturbance, depression and poor quality of life after being diagnosed and treated for cancer.…”

“…In many cases, cancer patients experience sleep disturbance, depression and poor quality of life after being diagnosed and treated for cancer. So, the assessment of QoL among cancer patients is essential in order to design interventions for improving patients’ outcomes [ 7 , 8 ]. Likewise, QoL assessment assists people realize how treatment, disease, and health impact quality of life.…”

“…Cancer and various types of treatments of cancer affect nutritional status of patients through various types of alterations such as alterations in physiological and psychological functions. And along with that reduction in food intake may have an impact on a patient's QoL by negatively influencing the nutritional status [ 7 , 9 ]. Social factors may have a very different impact on different cancer types and on different steps along the cancer continuum, from the time of an individual's exposure to a carcinogenic agent to early diagnosis, treatment, and survival [ 10 ].…”

Preoperative Controlling Nutritional Status (CONUT) Score Predicts Short-Term Surgical Prognosis in Patients with Gastric Cancer After Laparoscopy-Assisted Radical Gastrectomy

“…Gastric cancer patients often suffer from malnutrition which is usually associated with humoral and cellular immune dysfunction in ammatory response alterations and poor wound healing 3 . As an independent risk factor malnutrition contributes to the occurrence of postoperative complications 4 reduces the body response to antitumor treatment and ultimately impairs long-term survival 5 . Several nutritional assessment scales or systems have been developed to detect the adverse condition of nutrition such as the modi ed Glasgow Prognostic Score (mGPS) 6 Prognostic Nutritional Index (PNI) 3 Naples Prognostic Score (NPS) 7 Platelet-Lymphocyte Ratio (PLR) 8 Skeletal Muscle Index (SMI) 9 or the Malnutrition Universal Screening Tool (MUST) 10 among others.…”

Nutritional Management and Outcomes in Malnourished Medical Inpatients in 2020: The Evidence Is Growing!

“…The articles included cover the process of nutritional care, including screening tools to identify nutritional risk (Nutritional risk screening and assessment [11]), patient muscle mass assessment including bioimpedance analysis (Clinical value of muscle mass assessment in clinical conditions associated with malnutrition [12]; Decreased bioelectrical impedance phase angle in hospitalized children and adolescents with newly diagnosed type 1 diabetes: a case-control study [13]), nutritional biomarkers (Nutritional laboratory markers in malnutrition [14]), nutritional therapy planning (Indirect calorimetry in clinical practice [15]; Micronutrient deficiencies in medical and surgical inpatients [16]), use of nutritional support overall (Efficacy and efficiency of nutritional support teams [17]; Challenges and perspectives in nutritional counselling and nursing: a narrative review [18]) and in specific patient populations (e.g., medical patients, critical care patients, geriatric patients, oncologic patients, patients after allogenic stem cell transplantation, patients with dysphagia or eating disorders, as well as the nutritional challenges associated with metabolic disorders) (Nutritional management of medical inpatients [19]; Medical nutrition therapy in critically ill patients treated on intensive and intermediate care units: a literature review [20]; Metabolic and nutritional characteristics of long-stay critically ill patients [21]; Protein intake, nutritional status, and outcomes in intensive care unit survivors: a single-center cohort study [22]; Early supplemental parenteral nutrition in critically ill children: an update [23]; Management of malnutrition in older patients-current approaches, evidence, and open questions [24]; Nutrition in cancer patients [25]; Management of dehydration in patients suffering swallowing difficulties [26]; Nutrition in gastrointestinal diseases: liver, pancreatic, and inflammatory bowel diseases [27]; Nutritional management and outcomes in malnourished medical inpatients: anorexia nervosa [28]; Nutritional challenges in metabolic syndrome [29]; Nutritional challenges in patients with advanced liver cirrhosis [30]). Potential complications of nutritional interventions, such as refeeding syndrome (Management of refeeding syndrome in medical inpatients [31]), and treatment challenges posed by gastric motility disorders are discussed (Gastroparesis and dumping syndrome: current concepts and management [32]).…”