The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

Abstract

Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population.

Impact of Sarcopenia and Inflammation on Patients with Advanced Non-Small Cell Lung Cancer (NCSCL) Treated with Immune Checkpoint Inhibitors (ICIs): A Prospective Study

“…Sarcopenia is a condition characterized by loss of skeletal muscle mass and decreased muscle function, mainly caused by aging, but even malnutrition, chronic diseases and cancer [ 3 ]. A tumor itself can also cause significant decreases in muscle mass and be responsible of secondary sarcopenia [ 4 , 5 ]. Sarcopenia occurs in approximately 50% of advanced cancer patients, being related to malnutrition, inflammation and tumor treatments [ 6 ].…”

Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors

“…Malnutrition affects as many as 75% of cancer patients, with the highest prevalence in those with tumors of the gastrointestinal tract [109]. The association between malnutrition and infections is well-established and can be explained by impaired cell-mediated immunity, phagocyte function, cytokine production, and complement system function [110].…”

Commentary: Quality nutrition care is integral to the Oncology Care Model

“…There is strong evidence associating poor nutrition status with decreased tolerance to chemotherapy and radiation treatment, increased lengths of hospital stay, lower quality of life, and mortality [4]. Poor nutrition in cancer most often manifests as protein-energy undernutrition/malnutrition and is a persistent problem; up to 80% of older patients with cancer develop malnutrition [5,6] and patients' nutritional issues frequently change over time and are complicated by cancer cachexia [7]. Guidelines and positions on the management of these conditions therefore emphasize early diagnosis of malnutrition and cachexia [8], the importance of dietary counseling [9], and supportive care including nutritional support [10].…”