Abstract
Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using “OR” as a Boolean function and the results of the four components were combined by utilizing the “AND” Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1–2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.
Highlights
Cancer is a complex disease that results from multiple interactions between genes and the environment, and is regarded as one of the current leading causes of mortality worldwide [1,2]
Screening should be done as early as possible, and recent literature suggests that it should be done at diagnosis or at hospital admission; screening should be repeated in the course of treatment for referral for evaluation if needed [19,21,23,25,26,27]
Nutrition is a central factor in oncology, influencing the development of the disease, tumour inherent symptoms, response to, and recovery after anti-neoplastic treatment(s), having a strong impact on the quality of life and prognosis of the disease
Summary
Cancer is a complex disease that results from multiple interactions between genes and the environment, and is regarded as one of the current leading causes of mortality worldwide [1,2]. As cancer-related weight loss in obese patients cannot be identified by a low body mass index (BMI), sarcopenic obesity, defined as low lean body mass in obese patients, is frequently overlooked [10] In these patients, changes in body composition result in an increased metabolic risk, and it seems to be a significant predictor of treatment related adverse events [11,12]. Cancer cachexia is a complex multifactorial syndrome that results from a combination of metabolic alterations, systemic inflammation and decreased appetite It is characterised by an involuntary sustained weight loss and loss of skeletal muscle mass, with or without loss of fat mass that are irreversible by conventional nutritional support [13]. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and reducing complications and improving survival and quality of life
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