Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatment can impact their nutritional status2.
Up to 70% of cancer patients unintentionally lose weight, and it is estimated that the deaths of 10-20% of patients with cancer can be attributed to malnutrition rather than to the malignancy itself. Despite this, studies have shown that only 30-60% of patients with cancer who are at risk of malnutrition receive nutritional support2. This is due in part to the fact that many cancer patients do not look visibly malnourished, and many may even be categorised as overweight despite the presence of significant cachexia and sarcopenia3.
Unintentional weight loss in cancer patients can have a devastating impact on health outcomes. Malnutrition in cancer is associated with decreased performance status, reduced quality of life, increased morbidity and mortality, poorer response to cancer treatment and decreased survival4. Both a low body weight and amount of weight loss independently predict overall survival4.
The first step to managing malnutrition in cancer is early identification of risk which should be done by performing nutritional screening of each cancer patient early in his/her cancer treatment2. Assessment should include identification of signs or symptoms of anorexia, cachexia and sarcopenia and this should be done as early as possible.
There is no one size fits all management for malnutrition in cancer. The form of nutritional intervention depends on the patients’ medical history, appetite, type of cancer, stage of cancer, and his/her response to treatment.
Nutritional counselling should address the presence and severity of symptoms such as anorexia, nausea, mucositis, dysphagia, and gastrointestinal symptoms2. Oral nutritional support includes regular food and fortified foods as meals or snacks and/or oral nutritional supplements (ONS) to increase nutritional intake. The European Society of Clinical Nutrition and Metabolism (ESPEN) have concluded that ONS, used in combination with dietary advice, can prevent therapy-associated weight loss and interruption of therapy, as well as enhance quality of life4.
It is difficult to give exact guidance on which ONS is most suitable for cancer patients, as requirements will be determined by a range of factors including:
Nutritional intervention plans should be individualised to increase nutritional intake, and should ideally be combined with optimal medical and oncological strategies to minimise cancer cachexia5,6.
A 50% reduction in complications and improved patient outcomes has been observed among cancer patients who used medical nutrition preoperatively7.
Cancer patients who are initiated on ONS have, on average, a shorter hospital stay post-operatively than those who are not prescribed ONS, resulting in reduced healthcare costs8.
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