Nutritional Support in Cancer patients: update of the Italian Intersociety Working Group practical recommendations

Abstract

Malnutrition is a frequent problem in cancer patients, which leads to prolonged and repeated hospitalizations, increased treatment-related toxicity, reduced response to cancer treatment, impaired quality of life, a worse overall prognosis and the avoidable waste of health care resources. Despite being perceived as a limiting factor in oncologic treatments by both oncologists and patients, there is still a considerable gap between need and actual delivery of nutrition care, and attitudes still vary considerably among health care professionals. In the last 5 years, the Italian Intersociety Working Group for Nutritional Support in Cancer Patients (WG), has repeatedly revisited this issue and has concluded that some improvement in nutritional care in Italy has occurred, at least with regard to awareness and institutional activities. In the same period, new international guidelines for the management of malnutrition and cachexia have been released. Despite these valuable initiatives, effective structural strategies and concrete actions aimed at facing the challenging issues of nutritional care in oncology are still needed, requiring the active participation of scientific societies and health authorities.

Malnutrition management in oncology: An expert view on controversial issues and future perspectives

“…This gap between the need and the actual nutritional interventions in cancer patients has also been pointed out in the 2022 updated practical recommendations of the Italian Intersociety Working Group for Nutritional Support in Cancer Patients ( 57 ). Although this group acknowledges the improvements that have occurred in Italy in the last 5 years in terms of awareness and institutional activities, it emphasizes the need for effective structural strategies and concrete actions to improve the clinical nutrition management of cancer patients ( 57 ). We agree with the recommendations of this group and believe that it is necessary to implement a new management model that will overcome the critical issues that have been encountered.…”

“…A timely diagnosis of nutritional problems is essential to ensure the correct management of malnourished cancer patients. Therefore, it is important to define standardized protocols that provide for nutritional screening to be performed upon diagnosis by an adequately trained physician or health worker ( 2 , 5 ) and the nutritional re-evaluation to be performed according to scheduled times ( 2 , 3 , 55 – 57 ). These clinical pathways would identify any variations, the impact of treatments on the nutritional status, in order to tailor patients’ therapies.…”

“…Screening tests are also recommended: the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening 2002 (NRS-2020), or the Mini Nutritional Assessment (MNA) for the early detection of malnutrition, anorexia, sarcopenia, and cachexia ( 3 , 4 , 55 – 57 ). The implementation of training courses for the medical and nursing staff on the execution and interpretation of these tests must be endorsed.…”

“…The implementation of training courses for the medical and nursing staff on the execution and interpretation of these tests must be endorsed. Furthermore, the inclusion of nutritional parameters in the patient medical record may help identify patients who need counseling or nutritional interventions according to guidelines recommendations ( 2 , 3 , 55 – 57 ) ( Table 1 ).…”

Multicentre, randomised, open-label, parallel-group, clinical phase II study to evaluate immunonutrition in improving efficacy of immunotherapy in patients with metastatic non-small cell lung cancer, undergoing systematic nutritional counseling

“…Anticancer treatments themselves (e.g. radiotherapy, chemotherapy and surgery) can enhance the deterioration of nutritional status, by increasing energy requirements, reducing food intake and/or impairing nutrients absorption [ 1 – 3 ]. An altered nutritional status is associated with a worse prognosis and the more frequent need to suspend/delay anticancer therapies [ 4 ].…”