The Clinical Value of Nutritional Care before and during Active Cancer Treatment

Abstract

Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients’ overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients’ nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.

Association Between Pre-Treatment and Post-Treatment 3-Month Red Cell Distribution Width with Three-Year Prognosis of Prostate Cancer

“…Undernutrition is common among patients with cancer and can influence the prognosis of patients, 26 and a higher rate of cancer-related undernutrition status might impair erythropoiesis and influence abnormal red blood cell survival. Dietary factors (folate, vitamin B12, and iron) are fundamental to the generation of red blood cells, and low concentrations of any of these factors can lead to changes in red blood cell morphology and cause anemia.…”

Nutritional Support Indications in Gastroesophageal Cancer Patients: From Perioperative to Palliative Systemic Therapy. A Comprehensive Review of the Last Decade

“…International guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) and Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (ASPEN) recommend to screen, assess, and early treat malnutrition in all oncological patients. However, as recently reported by Aprile et al [ 9 ], only 30–70% of patients at risk of malnutrition are addressed by a nutritional assessment, and only 50% of them receive an appropriate intervention. Moreover, in the EGC field, few data exist on the actual impact of dietetic interventions and nutritional care in current clinical practice [ 10 ].…”

“…Malnutrition in oncology ranges from 30 to 70% and is strictly connected to sarcopenia, that affects at least 50% of hospitalized cancer patients and 30% of cancer outpatients. In the esophagogastric cancer (EGC) field, 48 to 85% of patients suffer from malnutrition and sarcopenia [ 9 , 10 ]. The reason for the high prevalence of malnutrition in this setting is multifactorial: Tumor site (causing stenosis with partial or complete gastrointestinal tract obstruction and early satiety), operative trauma, peri-operative diet control with caloric restriction, and side effects of systemic therapies [ 11 , 12 ].…”

“…No standardization exists about the time of reassessment: Monthly reassessment is advised, but the patient’s clinical condition and treatment plan must be considered. [ 9 ]…”

Bioelectrical Impedance Analysis and Mid-Upper Arm Muscle Circumference Can Be Used to Detect Low Muscle Mass in Clinical Practice

“…There is growing evidence that early and evidence-based dietary counselling leads to improved dietary intake (energy and protein), body weight, nutritional status, enhanced oncologic and quality of life outcomes, and reduced complications [ 12 , 13 , 14 , 15 , 16 ]. In the treatment of advanced cancer, assessment of muscle status serves as an important indicator for clinicians to decide whether or not to proceed with an intended cancer treatment [ 17 , 18 ]. Identification of low muscle mass becomes increasingly relevant due to its prognostic value in cancer patients [ 19 ].…”