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.
Highlights
Malnutrition is a frequent hallmark of cancer patients, resulting in unintentional weight loss due to a lack of intake or uptake of nutrients [1]
Weight loss and loss of skeletal muscle mass are two hallmarks of cancer cachexia, a well-known, gradual, and irreversible process in advanced cancer patients. This narrative review aimed to evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status with a particular emphasis related to the subsite of disease and phase of treatment, in order to help depict the heterogeneous pattern of malnutrition and to provide some practical conclusions to support the multidisciplinary management of this condition
Novel approaches to the diagnosis of sarcopenia have been evaluated to determine muscle mass, muscle function, skeletal muscle index (SMI) and impact on Qol [12,27,28] These methods consist of Computed tomography (CT)-based alternative lumbar measurements [13,29,30,31], ultrasounds assessment [32,33], specific biomarkers [34,35], score-based approaches [36], and Qol questionnaires [37,38]
Summary
Malnutrition is a frequent hallmark of cancer patients, resulting in unintentional weight loss due to a lack of intake or uptake of nutrients [1] This condition has a definitive impact on several aspects of cancer treatment and outcome: reducing treatment intensity, increasing treatment toxicities, worsening patients’ quality of life, and jeopardizing their survival. Weight loss and loss of skeletal muscle mass are two hallmarks of cancer cachexia, a well-known, gradual, and irreversible process in advanced cancer patients In this complex scenario, this narrative review aimed to evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status with a particular emphasis related to the subsite of disease and phase of treatment, in order to help depict the heterogeneous pattern of malnutrition and to provide some practical conclusions to support the multidisciplinary management of this condition. Each contribution was reviewed and harmonized with the others by all the authors and a final version of the paper was circulated and approved
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