Abstract
Cancer is a global major public health problem, particularly in Western countries, where it represents the second leading cause of death after cardiovascular disease. Malnutrition is common in cancer patients and differs from starvation-related malnutrition, as it results from a combination of anorexia and metabolic dysregulation, caused by the tumor itself or by its treatment, and causing cachexia. Cancer-associated malnutrition can lead to several negative consequences, including poor prognosis, reduced survival, increased therapy toxicity, reduced tolerance and compliance to treatments, and diminished response to antineoplastic drugs. Guidelines issued by the Ministry of Health in 2017, the most recent ESPEN guidelines and the PreMiO study highlighted an inadequate nutritional support in cancer patients since their first visit, and recommended an optimization of the quality of life of cancer patients in each stage of the disease, also through specific nutritional interventions by multidisciplinary teams. Based on the evidences summarized above, a survey has been carried out on a sample of 300 Italian hospital medical oncologists to evaluate their level of awareness and perception of cancer-related malnutrition and their proposals to implement effective strategies to improve nutritional care in the setting of hospital oncology departments in Italy. The survey results indicate that, despite high levels of awareness among Italian oncologists, malnutrition in cancer patients remains, at least in part, an unmet medical need, and additional efforts are necessary in terms of increased training and hiring of personnel, and of creation of organizational pathways aimed at treatment optimization based on available evidences.
Highlights
The term “malnutrition” is generically used to include both overnutrition [1], as well as undernutrition and nutritional risk
With reference to nutritional-metabolic problems of cancer patients, 71% of medical oncologists declared to be aware of the Guidelines for nutritional pathways in cancer patients issued by the Italian Ministry of Health (MoH) in 2017 [15] that, according to 54% of interviewees, were not adequately implemented in reference geographical regions, but resulted to be acknowledged and applied in 77% of their centers
The 100% of invited medical oncologists participated to the survey we described here and completed the questionnaire vs. the 5.7% of participants to a previous exploratory national survey conducted by the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE) in 2015, highlighting a current increased awareness and consideration of nutritional issues among Italian oncologists [27]
Summary
The term “malnutrition” is generically used to include both overnutrition (leading to overweight and obesity, which are recognized risk factors for onset and progression of hormone-dependent endometrial and breast cancer tumors) [1], as well as undernutrition and nutritional risk. Cancer-associated malnutrition can lead to cachexia, a multifactorial syndrome frequent in chronic diseases and considered as a comorbidity of cancer, characterized by severe, involuntary loss of skeletal muscle mass, with or without loss of fat mass, increased systemic inflammatory response [2] and increased protein catabolism [3, 4]. Cachexia by itself may account for up to 20% of cancer deaths [6], and the progressive loss of muscle mass in cancer has been identified in particular as an independent and significant predictor of overall survival [7]. Cancer cachexia is currently classified into three stages, namely pre-cachexia, cachexia, and refractory cachexia [5]
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