Nutritional Support In Cancer Patients Research Articles

Nutritional support for cancer patients during chemoradiation treatment

An analysis of publications in the medical databases e-Library, PubMed, and Medline (2005–2024) was conducted to evaluate the impact of nutritional support on the tolerability of antitumor chemoradiotherapy. Based on the data collected, it was revealed that chemoradiotherapy is linked to a high risk of developing protein-energy malnutrition. Consequently, the initial nutritional deficiency and sarcopenia result in either a refusal to administer chemotherapy in favor of radiation treatment alone, a forced reduction in the dose of a cytostatic medication, or the disruption of the chemoradiotherapy course. Patients with malignancies of the head and neck who have received chemoradiotherapy with previous induction chemotherapy are in the “red zone” for the risk of developing protein-energy malnutrition. Nutritional support is one of the instruments that enhances the likelihood of treatment implementation and mitigates the risk of drug and radiation toxicity. The fundamental principles of nutritional support during chemoradiotherapy include timely prescription, adequacy, composition of a specialized mixture, and the choice of the most physiological way of its implementation. Supplementing nutritional support with feasible strength physical exercise triggers protein synthesis in skeletal muscles, increases muscular sensitivity to the anabolic properties of amino acids, and mitigates insulin resistance.

Adherence and acceptance of a new oral nutritional supplement in cancer patients - a pilot study in crossover design.

Oral nutritional supplements (ONS) play a key role in the therapy of cancer-cachexia, but adherence to ONS-intake remains challenging. To improve adherence, a wide variety of ONS is crucial. We compared the acceptance and adherence of a commercial liquid ONS (LS) with a newly developed, energy- and protein-rich, semisolid, fruit-gum based product (FG) in oncological patients. Forty cancer patients with indication for artificial nutritional therapy were randomly assigned to LS and FG in crossover design for 4 weeks with a 1-week washout phase in-between. Adherence to ONS was recorded with MARS-D questionnaire. Sensory properties were evaluated and safety monitoring was performed. Energy and nutrient intake, nutrition and performance status and quality of life remained stable in both groups throughout the study (all p-values for the comparison between baseline and after 9 weeks were >0.05). Taste (p=0.004), smell (p=0.025) and enjoyment (p=0.027) of the LS were rated significantly better compared to FG and a higher adherence (p=0.005) for the LS was found. Nevertheless, patients were very interested about the new alternative of ONS, so that 16 of the study participants would buy it or strive for a medical prescription. The balanced, protein-rich ONS based on fruit gum is an innovative formulation that stabilizes nutritional status and might therefore extend the options for nutritional support in cancer patients in the future. However, the sensory properties must first be further improved to increase acceptance and adherence.

Nutritional support in oncology: the place of parenteral nutrition (literature review)

Currently nutritional support is considered as one of the most important components of the treatment of cancer patients. This is due to the positive effect of correction of nutritional status on the course of the underlying disease, the tolerability of antitumor treatment, rehabilitation measures and quality of life. The most important principle of nutritional support is its continuity at all stages of the patient's curation: polyclinic, inpatient, rehabilitation. The purpose of the review was to discuss nutritional support for cancer patients with an emphasis on parenteral nutrition. Out of more than 120 initially selected literature sources from various databases (Scopus, Web of science, RSCI, etc.), 55 sources were left for analysis mainly over the past 5 years, earlier publications were used while maintaining their informativeness for clinicians. The modern concept of parenteral nutrition implies the appointment of drugs “three in one”. Parenteral nutrition should include not only macronutrients, but also micronutrients: fat- and water-soluble vitamins, ω-3 fatty acids. It has been established that the development of infectious complications with nutritional support is not related to its type, but to the calorie intake. The issues of additional parenteral nutrition with inadequate enteral nutrition are examined. The clinician should personalize nutritional support taking into account the type of tumor process, its stage, the characteristics of the patient and the severity of eating disorders. During the treatment of patients with oncological diseases, it is necessary to assess the state of their nutritional status and, if necessary, carry out correction. The doctor is obliged to choose the optimal way to provide the patient with energy and plastic materials – oral supplemental nutrition, enteral nutrition, parenteral nutrition or a combination of them. Clinical practice shows that the rejection of parenteral nutrition is accompanied by a decrease in the quality of nutritional support. The choice of the type of nutritional support is based on the indications for its implementation, which are detailed in the clinical recommendations. Strict adherence to the algorithm of correction of nutritional status depending on the stage of cancer, the patient's condition, the type of antitumor therapy will optimize the results of treatment and improve the quality of life.

Experience in organizing nutritional support in cancer patients at the Tsyb Medical Radiological Research Centre

Literature data and own experience of nutritional support in oncology has been analyzed. Nutritional support is an integral part of the management of cancer patients. Diagnosis of nutritional deficiencies is important, with an accent on early detection of muscle loss and severely malnourished patients. The main methods of nutritional support are oral nutritional supplements, enteral and parenteral nutrition, as well as dietary advice and maintenance of physical activity. Oral nutrition should always be used in the absence of absolute contraindications. The effectiveness and indications of prehabilitation measures require further study, but now it is possible to single out a category of patients in whom they can be fully implemented. It can be cases requiring neoadjuvant chemotherapy.

Characterization and monitoring of nutritional risk and nutritional status in oncological patients admitted to an oncological surgery unit: A longitudinal study

malnutrition is a common phenomenon in people with cancer and can occur at all stages of the disease trajectory. Prevention, early identification of patients at risk of malnutrition, nutritional diagnosis, and personalized intervention, monitoring and follow-up are essential measures to minimize the occurrence of malnutrition and its consequences. This study aims to evaluate if current institutional practices regarding nutritional intervention guarantees nutritional/dietary care for cancer patients. adescriptive, analytical and longitudinal study was carried out, lasting five months, in a hospital inpatient surgical oncology unit. All patients admitted to the unit in the period between 1 March and 31 July 2022, who underwent nutritional screening at the time of admission to the service, were included. During hospitalization, they were subjected to periodic assessments of weight, body mass index and nutritional screening every 7 days until discharge. a total of 659 patients were admitted to the inpatient unit. The highest prevalence of malnutrition was observed in Head and Neck (37.6%), Genitourinary (30.8%) and Digestive (27.7%) cancers. Weight loss was especially significant in digestive, skin and sarcoma cancers, as well as genitourinary cancers, but not in breast cancer patients. During the hospitalization period, 14.0% of the hospitalized patients received nutrition-related nursing intervention, and 21.5% were referred for clinical dietetic intervention (by a registered dietitian). this work reinforces the high prevalence of malnutrition in oncological patients and the need to systematically track cancer patients throughout their disease/treatment trajectory, from admission to the hospital, to the day of admission to inpatient unit, and subsequent follow-up. We also propose expedited referrals to different specialized centres in nutritional support for cancer patients from the first day of hospitalization. Assessment of patients should always be accompanied by active referral capacity to a specialized and duly trained nutritional care team that is quick, proactive, and responsive.

European Cancer Summit 2022 submission for Workforce NetworkWhat is it valuable for trainees in Interprofessional education in cancer care: a qualitative approach

BackgroundThe INTERACT Europe project is developing an inter-specialty oncology curriculum. As part of this project the team wanted to explore, “What is it valuable for trainees to learn in order to work more effectively with different specialties and professions to deliver better care and to provide psychosocial and nutritional support for cancer patients?”.To answer some of the concerns a learning needs analysis with a questionnaire was distributed to develop the curriculum on what health care professionals require to care for people affected by cancer and their family. This study reports the qualitative aspects of this questionnaire. MethodsThe qualitative data which consisted of eight questions and was transcribed verbatim using thematic analysis1. The transcripts were read until the project team were familiar with the content and analysed to identify emerging themes. The themes were compared, and any discrepancies discussed in more detail with all the participants from the INTERACT working package. The team then conducted a cross analysis and mapped the themes to derive overlapping concepts which then informed the curriculum. Results115 respondents from the 219 participants answered some or all the qualitative survey questions. Respondents were from all around Europe and had representation from different professions including doctors, nurses and patient advocates and from a large range of clinical experience (from newly qualified to more than 15 years of experience).Fifteen themes were initially identified during initial coding. After comparison and discussion with all the co-investigators they were merged into 5 themes that included: “Unsure of Interprofessional education meaning”, “Barriers and challenges”, “open channels of communication and respect”, “support throughout the cancer journey “and “new way of working” ConclusionsThe results of the survey alongside the quantitative part will serve to build the curriculum of interprofessional training in cancer care. Participants identified many obstacles in their actual practices to use interprofessional training, but the value to improve teamwork, communication and to improve patient experience and treatment was also captured.

Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study.

A survey study based on a 21-item questionnaire was conducted to assess knowledge and practices of digestive surgeons focused on nutritional support in gastrointestinal cancer patients. At least 5 staff digestive surgeons from 25 tertiary care hospitals throughout Spain were invited to participate and 116 accepted. Malnutrition was correctly defined by 81.9% of participants. In patients undergoing major abdominal surgery, 55.2% considered that preoperative nutritional support is indicated in all patients with malnutrition for a period of 7-14 days. For the diagnosis of malnutrition, only 18.1% of participants selected unintentional weight loss together with a fasting or semi-fasting period of more than one week. Regarding the advantages of enteral infusion, 93.7% of participants considered preservation of the integrity of the intestinal mucosa and barrier function, and in relation to peripheral parenteral nutrition, 86.2% selected the definition of nutrient infusion through a peripheral vein and 81.9% its indication for less than 7 days. Digestive surgeons had a limited knowledge of basic aspects of clinical nutrition in cancer patients, but there was some variability regarding clinical practice in individual cases. These findings indicate the need to develop standardized clinical protocols as well as a national consensus on nutrition support in cancer patients.

Nutritional support management in resectable gastric cancer.

Gastric cancer is the sixth most common malignancy in the world. However, its mortality has been decreasing in the last years thanks to improvement in diagnostics and therapeutics. Nevertheless, the high rate of malnutrition in patients with gastric cancer still has a major impact on the overall survival and quality of life of patients. The narrative review presents the most recent data on nutritional support in the resectable stages of gastric cancer, with a particular focus on perioperative strategies, and discusses malnutrition in gastric cancer, nutritional support before and after surgery, and the relationship between nutritional support and chemotherapy. Despite the predominantly methodological limitations related to the difficulty of performing randomized controlled trials on nutritional support in cancer patients, this review highlights important points. Nutritional counselling is essential starting from diagnosis. In limited or locally advanced forms (about 40% of cases), the therapeutic cornerstone is represented by gastric surgery. In most of these cases, perioperative chemotherapy is also indicated. Of note, nutritional support varies before and after surgery. In the preoperative period, the goal is to prepare the body for surgery, with available evidence recommending the prescription of immunonutrition (both oral and artificial, as appropriate). In the postoperative period, on the other hand, the objective is to facilitate recovery and adaptation to the new anatomy; an early and combined strategy (oral and enteral) seems to be the most suitable to pursue this. Unfortunately, rigorous data on the relationship between nutritional support and chemotherapy treatments used in resectable gastric cancer are not available. In the absence of strong scientific evidence, it may be useful to adopt a personalized multidisciplinary strategy for each patient wherein the chemotherapy programme is modulated based on nutritional status.

Malnutrition management in oncology: An expert view on controversial issues and future perspectives.

Cancer and anticancer treatments can lead to several negative side effects, including malnutrition. Despite the recognized need for adequate nutritional support in cancer patients, in daily clinical practice, nutrition is still not considered one of the first aspects to be considered. Malnutrition negatively affects the clinical outcomes, treatment response, and overall survival of cancer patients. In this study, three of the most controversial issues related to malnutrition, which emerged during an Italian Consensus Conference, were addressed specifically for patients with head and neck as well as gastrointestinal cancer. The timing of nutritional evaluation and intervention, extension of the Enhanced Recovery after Surgery (ERAS®) protocols, and cost-effectiveness of nutritional interventions have been considered. This study aimed to illustrate the state-of-the art of each issue and hypothesize future perspectives and actions to be taken, trying to suggest a new nutritional management model for cancer patients in Italy that overcomes the critical issues encountered. Of note, the timely diagnosis of nutritional issue appears to be essential to ensure the correct management of malnourished cancer patients as well as those who are at high risk of malnutrition. Standardized protocols, screening tests, and the inclusion of nutritional parameters in patient medical records would help to achieve good clinical outcomes. Finally, appropriate nutritional support is also associated with cost savings, and it seems necessary to promote its clinical and economic value to obtain improvements in both outcomes and management costs.

Nutritional support in surgical oncology: A survey by SICO in collaboration with the Intersociety Italian Working Group for Nutritional Support in Cancer Patients

PurposeNutritional support is a keystone component in perioperative care in patients undergoing oncological surgery with a direct impact on surgical outcomes. This study aimed to evaluate how nutritional support in the surgical setting is managed and applied in Italian hospitals. MethodsA national survey was designed by the Italian Society of Surgical Oncology (SICO) and disseminated in early 2021. The results were analyzed for the entire population and for comparing the following different subgroups: northern vs. southern regions; high-volume vs. low-volume centers; and junior vs. senior surgeons. ResultsOut of the 141 responses collected from all Italian regions, 43.2% of the participants worked in a surgical unit where nutritional status evaluations and interventions were not routinely practiced, although the key features (nutritional counseling, oral supplementation, enteral and parenteral nutrition) were available in 77.3% of the hospitals. Among the participating centers, the ERAS protocol was systematically applied in only 29.5% of cases, and in 25.5% of cases, most of the items were followed, although not systematically. Among the surgeons who practiced in compliance with the ERAS pathways, almost half of the participants declared that the protocol was applied only for low-risk patients.No significant differences were documented when comparing Italian regions, high-volume vs. low-volume institutions or junior vs. senior participants. ConclusionNutritional support in oncological surgery is frequently neglected in Italian hospitals, regardless of the geographic distribution and volumes of the institutions. A cultural change and an improvement in the availability of nutritional services are needed for widespread implementation.

Comprehensive rehabilitation of cancer patients: A review

Due to the improvement of the results of combined treatment of malignant tumors the survival rate of cancer patients is increasing. The issue of improving the quality of life, both during treatment and after its completion, is becoming more and more urgent. Conducting an individually selected comprehensive rehabilitation treatment conducted by a multidisciplinary team aimed at correcting not only medical problems but also the social capabilities of the patient taking into account the personal experience of the patient, his psychological traits, habits, etc., helps reduce the number of complications significantly, improve the quality of life of patients. The article discusses the stages, methods of rehabilitation, nutritional support for cancer patients.

Nutritional support in the perioperative period of treatment of cancer patients: Retrospective cohort study

Background. The most important component of multimodality treatment of cancer is nutritional support. The management of the correct full nutritional support in the perioperative period will help to maintain body weight and muscle function, to reduce the frequency of development of postoperative complication severity and to reduce hospital length of stay. To provide full nutritional support is necessary to cover all energy requirements in patients (30 kcal/kg body weight per day), protein requirements (1.5 g of protein/kg of body weight per day) and eicosapentaenoic acid requirements (2 g/day), applying clinical nutrition through the appropriate routes of administration (oral, enteral, parenteral or combined).
 Materials and methods. The trial studied the dynamics of the nutritional status of 400 oncological patients who underwent surgical treatment at the Hertsen Moscow Oncology Research Institute the branch of the National Medical Research Radiology Centre from 2019 to 2021. The patients were divided into 2 groups: the main (n=200) and the control (n=200). The patients of the main group received full nutritional support. The control group consisted of the patients, according to retrospective analysis of the patients, with the traditional approach to nutritional support. The study included patients with nutritional deficiency confirmed by clinical criteria, as well as patients with malignant neoplasms of the upper gastrointestinal tract the gastrointestinal tract (esophagus and stomach), colon and rectum, as well as head and neck.
 Results. The application of nutritional therapy in the perioperative period can improve the nutritional status of the patients with head and neck and upper gastrointestinal tract cancer (the statistically significant increase in body weight by 1 kgs and 0.5 kgs, respectively). In patients with colorectal cancer, body weight during the treatment was stable with the tendency to increase by 0.4 kg. Perioperative nutritional support for patients with head and neck and upper gastrointestinal tract cancer showed statistically significant increase of the level of both complete protein by 2.8 and 4.1 g/l, respectively, as well as serum albumin by 5.2 and 3.3 g/l, respectively. The absolute lymphocyte count increased at the trend level. No statistically significant difference was obtained during treatment in patients with colorectal cancer. Nutritional support in cancer patients during the surgical treatment allowed to reduce the total number of surgical complications by 36%, including the incidence of anastomotic failure by 3 times (p=0.014), infectious complications by 1.5 times (p=0.074), to reduce the duration of stay in the intensive care unit, as well as inpatient stay in hospital to 0.3 and 1.08 bed days, respectively (p0.05).
 Conclusion. The application of nutritional support can help to reach more favorable perioperative course in cancer patients and also can lead to a decrease in the number of complications and early rehabilitation for patients, and on the other hand, will help to reduce the duration of stay in the intensive care unit as well as inpatient stay in hospital, reducing the cost of treating patients.

Effects of nutritional support in cancer patients receiving chemotherapy

Introduction. Nutritional support is an important component of multimodal cancer therapy. It is well known that proper nutrition supplemented by necessary nutrients can support muscles and their function, reduce the incidence and severity of complications associated with cancer therapy, and facilitate recovery. Proper nutritional support is planned according to patient’s need for energy (30 kcal / kg body weight per day), protein (1.5 g protein / kg body weight per day), and eicosapentaenoic acid (2 g per day).Materials and methods. We analyzed the dynamics of nutritional status of 632 cancer patients treated in P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia between 2019 and 2021. Study participants were divided into two groups: experimental (n = 316) and control (n = 316). Patients in the experimental group received proper nutritional support. This study included patients with confirmed gastrointestinal cancers (esophageal and gastric), colon cancer, head and neck cancer, and lung cancer.Results. Nutritional therapy in the process of drug antitumor treatment has improved the trophological status of patients with tumors of the head and neck, lungs, upper gastrointestinal tract. As a result of the work, there was a tendency to increase the body weight of patients in these subgroups, whereas in the control group there was a statistically significant decrease in body weight compared to the initial indicators by 9.4; 9.5; 5.3 and 9.6 kg, respectively. Also, full clinical nutrition contributed to an increase in the level of total protein in patients with cancer of the upper gastrointestinal tract and colon and rectum by 4.0 and 3.7 g/l, respectively, at the level of statistical trend. The level of albumin significantly increased (by 6.6 g/l) only in patients with lung cancer.Improved nutritional status of patients during their systemic therapy ensured a 6 % reduction in the frequency of intercycle periods, a 0.2–3.4 % reduction in the need for dosage correction, and a 2.9–11.1 % increase in the completeness of cancer therapy stages (trend).Conclusion. Our findings suggest that additional specialized (oral or enteral) nutritional support during chemotherapy stabilizes body weight and its index, resulting, first of all, in improved tolerability of treatment.

Nutritional Support in Cancer patients: update of the Italian Intersociety Working Group practical recommendations.

Malnutrition is a frequent problem in cancer patients, which leads to prolonged and repeated hospitalizations, increased treatment-related toxicity, reduced response to cancer treatment, impaired quality of life, a worse overall prognosis and the avoidable waste of health care resources.Despite being perceived as a limiting factor in oncologic treatments by both oncologists and patients, there is still a considerable gap between need and actual delivery of nutrition care, and attitudes still vary considerably among health care professionals.In the last 5 years, the Italian Intersociety Working Group for Nutritional Support in Cancer Patients (WG), has repeatedly revisited this issue and has concluded that some improvement in nutritional care in Italy has occurred, at least with regard to awareness and institutional activities. In the same period, new international guidelines for the management of malnutrition and cachexia have been released.Despite these valuable initiatives, effective structural strategies and concrete actions aimed at facing the challenging issues of nutritional care in oncology are still needed, requiring the active participation of scientific societies and health authorities.As a continuation of the WG's work, we have reviewed available data present in the literature from January 2016 to September 2021, together with the most recent guidelines issued by scientific societies and health authorities, thus providing an update of the 2016 WG practical recommendations, with suggestions for new areas/issues for possible improvement and implementation.

Патофізіологічне обґрунтування і перспективи використання ксиліту в нутритивній підтримці онкологічних пацієнтів

У літературному огляді розглядається перспектива застосування п’ятиатомного спирту ксиліту як цукрозамінника, що є альтернативою надмірному споживанню рафінованих вуглеводів. Установлено, що використання ксиліту приводить до підвищення толерантності до глюкози, стабілізує метаболічну ситуацію в пацієнтів із нестабільним перебігом цукрового діабету. Він має антикетогенні властивості й забезпечує повільну, але стійку енергопродукцію. Використання ксиліту в парентеральному харчуванні сприяє підвищенню в печінці вмісту АТФ та інших аденілнуклеотидів, стимулює синтез білків і виділення жовчі, знижує кількість вільних жирних кислот у крові і продукцію кетонових тіл. Здатність ксиліту пригнічувати ефект Варбурга відкриває нові можливості для потенційного покращення результатів лікування хворих із злоякісними новоутвореннями.

Cost-effectiveness analysis of oral nutritional supplements with nutritional counselling in head and neck cancer patients undergoing radiotherapy

ObjectiveThere is limited evidence regarding the economic effects of nutrition support in cancer patients. This study aims at investigating the cost-effectiveness profile of systematic oral nutritional supplementation (ONS) in head and neck cancer (HNC) patients undergoing radiotherapy (RT) and receiving nutritional counseling.MethodsA cost-effectiveness analysis based on a RCT was performed to estimate direct medical costs, life years gained (LYG) and Quality-Adjusted Life Years (QALY) for nutritional counseling with or without ONS at 5-month and 6-year follow up time. Value of information analysis was performed to value the expected gain from reducing uncertainty through further data collection.ResultsONS with nutritional counseling produced higher QALY than nutritional counseling alone (0.291 ± 0.087 vs 0.288 ± 0.087), however the difference was not significant (0.0027, P = 0.84). Mean costs were €987.60 vs €996.09, respectively in the treatment and control group (-€8.96, P = 0.98). The Incremental Cost Effectiveness Ratio (ICER) was -€3,277/QALY, with 55.4% probabilities of being cost-effective at a cost-effectiveness threshold of €30,000/QALY. The Expected Incremental Benefit was €95.16 and the Population Expected Value of Perfect Information was €8.6 million, implying that additional research is likely to be worthwhile. At a median 6-year follow up, the treatment group had a significantly better survival rate when adjusting for late effect (P = 0.039).ConclusionOur findings provide the first evidence to inform decisions about funding and reimbursement of ONS in combination with nutritional counseling in HNC patients undergoing RT. ONS may improve quality of cancer care at no additional costs, however further research on the cost-effectiveness of nutritional supplementation is recommended.Trial Registration: ClinicalTrials.gov: NCT02055833. Registered 5th February 2014 https://clinicaltrials.gov/ct2/show/NCT02055833

Nutritional care in cancer patients: Initiatives and perspectives of the Italian Intersociety Working Group for Nutritional Support in Cancer Patients

Malnutrition is a frequent comorbidity in people with cancer, associated with poor tolerance of anticancer treatments, prognosis, and quality of life. Despite the abundance of scientific literature supporting this evidence and the availability of international guidelines for managing nutritional care in people with cancer, attitudes about this issue still vary considerably among oncologists, to the point that many patients who are malnourished do not receive adequate nutritional support. In view of this, the Italian Association of Medical Oncology, the Italian Society of Artificial Nutrition and Metabolism, and the Italian Federation of Volunteer-based Cancer Organizations implemented in 2016 a collaborative working group and initiated a structured project called Integrating Nutritional Therapy in Oncology, with the aim of increasing oncologists’ awareness of nutritional issues and consequently improving the nutritional care of cancer patients in Italy. In 2019, the Italian Society of Oncological Surgery and the Technical Scientific Association of Food, Nutrition and Dietetics joined the working group. In this article, we present the updated initiatives and the perspectives of this intersociety project.

Awareness of Cancer-Related Malnutrition and Its Management: Analysis of the Results From a Survey Conducted Among Medical Oncologists.

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.

Nutritional nutrition in rehabilitation of cancer patients

The article provides a brief overview of the issues of nutritional therapy in the rehabilitation of cancer patients. Excess sugar in food and drink, fatty and high-calorie foods, processed meat, trans fatty acids, preservatives and dyes are risk factors for the formation of malignant tumors. Patients should be informed about adherence to a healthy lifestyle and exclusion from the diet of foods containing carcinogens to reduce the recurrence of the disease. Chemotherapy courses and radiation sessions are accompanied by a number of side effects that lead to a decrease in the body's defense systems. For the recovery of cancer patients, protein, vitamins and minerals must be present in the diet. All nutrients are better obtained from the natural foods. To maintain a healthy diet, the World Cancer Research Foundation (WCRF) and the American Institute for Cancer Research (AICR) recommends you toinclude vegetables, fruits, whole grains and legumes in your daily diet. The article focuses on mare's milk, its multicomponent composition, which has immunomodulatory, antiviral, antibacterial properties. To increase the effectiveness of rehabilitation measures in patients after antitumor treatment, it is advisable to include mare's milk in medical nutrition, which has therapeutic and health-improving properties, and it is also possible to use it in patients undergoing antitumor cytostatic therapy. Further comprehensive study of the therapeutic and rehabilitation potential of mare's milk would make it possible to use this product more widely as an important component of nutritional support for cancer patients during specific therapy courses, which will have a positive effect on their survival rates and quality of life. In the treatment of malignant tumors, the main emphasis is on the development of strategies, new treatment options, and medical nutrition and a healthy lifestyle are an integral part of their complex rehabilitation.

New perspective toward nutritional support for malnourished cancer patients: Role of lipids.

To improve the difficulties related to malnutrition, nutritional support has become an essential part of multidisciplinary comprehensive treatment for cancer. Lipids are essential nutrient source for the human body, and nowadays in clinical practices, it has a positive interventional effect on patients suffering from cancer. However, contribution of lipids in nutritional support of cancer patients is still poorly understood. Moreover, the sensory and physicochemical properties of lipids can severely restrict their applications in lipid-rich formula foods. In this review article, for the first time, we have presented a summary of the existing studies which were related to the associations between different lipids and improved malnutrition in cancer patients and discussed possible mechanisms. Subsequently, we discussed the challenges and effective solutions during processing of lipids into formula foods. Further, by considering existing problems in current lipid nutritional support, we proposed a novel method for the treatment of malnutrition, including developing individualized lipid nutrition for different patients depending on the individual's genotype and enterotype. Nonetheless, this review study provides a new direction for future research on nutritional support and the development of lipid-rich formula foods for cancer patients, and probably will help to improve the efficacy of lipids in the treatment of cancer malnutrition.