Nutrition in Oncology

Cancer is a complex disease with patients becoming at high risk of malnutrition both as a consequence of their illness and its treatment¹. Over 50% of cancer patients present with weight loss at diagnosis and, for many patients, nutritional status continues to deteriorate during and after treatment.^2,3

Up to 80% of all cancer patients will be malnourished.⁴

Cancer related malnutrition is driven by a combined effect of reduced nutritional intake and metabolic changes^5-7. These factors contribute to negative energy and protein balance leading to weight and muscle mass loss¹.

Poor nutritional status in addition to weight and muscle mass loss can lead to poorer outcomes for the patient. Clinically this impacts not only the patient but also the healthcare setting in a number of ways.

Patient impact

Lower quality of life⁸
Increased risk of treatment interruption or delay⁹
Decreased survival^9-11
Decreased physical function¹²

Healthcare setting impact

Extended hospital stays^13,14
Increased risk of hospital re-admissions^13,14
Increased costs of hospitalisation^13,14
Increased post surgery complications¹⁵

Importance of good nutrition in cancer patients

Managing Malnutrition in Oncology

Identification of Malnutrition

Identification of malnutrition through screening is imperative, as recognised by the National Institute for Health and Care Excellence (NICE)¹⁶ and the European Society for Clinical Nutrition and Metabolism (ESPEN).^5,17 Screening should be performed at the time of diagnosis.

Screening for malnutrition using 'MUST'

Need help in screening your patients for malnutrition? Nutricia are developing a free e-learning to support your knowledge of screening and managing malnutrition. Find out more here

Early nutritional intervention is key to support patient outcomes

Benefit of nutritional intervention on several quality of life aspects during treatment.¹⁸

Up to 50% reduction in post-operative complications after pre-operative ONS intervention.^19,20

Up to a 3-day reduction in length of hospital stay.²⁰

20% increase in probability of survival following early nutritional intervention and weight gain in some cancer patients.²¹

Oral Nutritional Supplements can play a role in a Cancer Patients Journey

ESPEN (2016)⁵andESPEN (2021)¹⁷ highlight the role that nutritional intevention plays in Oncology patients.

“Nutritional interventions are recommended to increase oral intake in cancer patients who are able to eat but are malnourished or at risk of malnutrition. This includes dietary advice, the treatment of symptoms and derangements impairing food intake (nutrition impact symptoms), and offering oral nutritional supplements.”

Oral nutritional supplements in Oncology

The causes of reduced nutritional intake are complex and multifactorial.⁵ Two prevelant causes of malnutrition in oncology patients are taste disturbance and poor appetite:

Supporting taste disturbance in Cancer patients through ONS

Taste and smell alterations may develop throughout the course of the disease, before, during and up to one year after treatment.⁵Taste alterations could lead to a reduced intake of food and therefore have a negative impact on the nutritional status with up to 25% reduction in nutritional intake, leading to greater weight loss.^22,23

Importance of sensory alterations for cancer patients with taste alteration

The Journal of Supportive Care in Cancer published a new study, showing that taste and smell alterations are common in patients receiving systemic antitumor therapy and that nutritional support specifically designed to better address sensory alterations, is appreciated in these patients.

Fortisip Compact Protein - innovative taste sensations

The Fortisip Compact Protein range has been developed with a wide range of flavours, providing a flavour variety to your patients can help prevent taste fatigue.²⁴ A high energy, high protein, low volume ONS with specific warming and cooling sensations appreciated in patients with Cancer.* Addressing the needs of taste alterations in cancer through creating sensations could help with compliance.

Supporting reduced appetite in Cancer patients through ONS

Low volume ONS may make it easier to consume the energy levels needed^{25, 26}, particularly with reported side effects in oncology patients. Compliance with low volume 125ml ONS is significantly better than standard ONS.^25,26

Compliance with ONS

Adapted from Hubbard et al. 2012²⁶

Fortisip Compact Protein - high energy, high protein, low volume

Fortisip Compact Protein has been developed, offering a high energy, high protein, low volume ONS with 90% compliance.²⁷

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References

Arends, et al. Clin Nutr. 2017;36(5):1187-1196.
DeWys WD et al. 1980; 69: 491-497.
Stratton RJ et al. 2003.
Ravosco, et al. J Clin Med. 2019; 8:1211.
Arends et al. Clin Nutr. 2016;36(1):11-48
Marín Caro et al. Clin Nutr. 2007;26(3):289-301
Fearon, et al. Lancet Oncol. 2011;12(5):489-495.
Sánchez-Lara, al. Nutr Cancer. 2012;64(4):526-534
Ross et al. Br J Cancer. 2004;90(10):1905-1911.
Martin et al. J Clin Oncol. 2015;33(1):90-99.
Gannavarapu et al. J Oncol Pract. 2018;14(4):e238-e250
Mariani et al. Support Care Cancer. 2012;20(2):301-309
Planas et al. Support Care Cancer. 2016;24(1):429-435.
Gourin et al. Ann Otol Rhinol Laryngol. 2014;123(2):101-110.
Yu et al. Eur J Clin Nutr. 2013;67(7):732-737
NICE. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical Guideline CG32. https://www.nice.org.uk/Guidance/CG32 [Accessed October 2020].
Muscaritoli, Arends, Bachmann et al. Clin Nutr. 2021; 40: 2898-2913
Baldwin et al. J Natl Cancer Inst. 2012, 104(5): 371-385
Kabata et al. Support Care Cancer. 2015; 23: 365-370.
Maňásek et al. Klin Onkol. 2016; 29: 351-357.
Trestini et al. Eur J Clin Nutr. 2018;72:772-779
Spotten et al. Ann Oncol. 2017;28(5):969-984.
Brisbois et al. J Pain Symptom Manage. 2011;41(4):673-683.
Ravasco. Eur J Oncol Nurs. 2005;9 Suppl 2:S84-91.
Hubbard et al. Prov Nutr Soc. 2010;69E164
Hubbard GP et al. Clin Nutr. 2012;31(3):293-312.
Brown et al. Journal of Nutrition, Health and Ageing. 2020;24:305–11.
Cawood et al. Ageing Res. Rev 2012;11(2):278-96

*de Haan et al. Support Care Cancer. 2021. . https://doi.org/10.1007/s00520-021-06049-4

Fortisip Compact Protein is a Food for Special Medical Purposes for the dietary management of disease related malnutrition and must be used under medical supervision.

Nutrition in Oncology