REVIEWCancer wasting and quality of life react to early individualized nutritional counselling!☆
Introduction
Cancer-related weight loss is known to worsen patients well-being,1, 2 tolerance to antineoplastic therapies3 and prognosis.4, 5 Specifically, weight loss seems to reduce immunological competence6 and resistance to infection,7, 8 enhances susceptibility to postoperative complications,5, 9, 10 and increases disability and overall cost of care.11
Although a few studies were undertaken in the early 20th century,12, 13, 14 malnutrition remained a bewildering syndrome even in relatively recent publications. Indeed, estimates of the prevalence of malnutrition in cancer patients range from 8% to 84%15 apparently associated with the cancer site, e.g. 80% in patients with gastrointestinal cancer16, 17 and 70% in patients with head and neck cancer.18 Despite the fact that nutritional deterioration has been associated with patients’ functional impairment,19 neither potential interactions between cancer location and stage, treatments, nutrition, morbidity and quality of life (QoL) nor the impact of individualized nutritional counselling on patients’ nutritional, clinical and QoL outcomes have ever been thoroughly explored.20, 21 In fact, there is remarkably little information about the effect of oral nutrition on functional outcome measures and QoL.15 Innovative and consistent evidence to support integrated nutritional counselling as a major topic in oncology will be illustrated in this overview, which results from the collision of data from prospective studies in cancer patients conducted by our group.22, 23, 24, 25, 26
Section snippets
Nutritional deterioration, intake deficits and tumour burden
In order to tackle nutritional deterioration, gathering objective data on nutritional status and its evolution throughout the disease course is an absolute necessity. There are indeed studies reporting cancer-related weight loss as the most frequent presenting symptom27 or potentially associated with advanced disease.28 Nonetheless, previous data have been inconsistent regarding nutritional status assessment and cancer/treatment-related variables even when addressing similar cancer locations.29
Nutrition: a key determinant of cancer patients QoL
Multifactorial cancer-related malnutrition22 is also swayed by experienced symptoms, e.g. anorexia, taste changes, odynophagia, dysphagia, nausea, vomiting, diarrhoea, often subsequent to antineoplastic therapies, may further compromise nutrition and functional ability.48, 49, 50, 51 Thus, the interaction between the reported symptoms and/or disease/treatment-related factors, as well as nutritional status and intake, add up to a complex combination potentially capable of dictating patients’ QoL.
Nutrition intervention improves patients outcomes and QoL
Cancer location and its progression are central to nutritional decline.22 Notwithstanding, nutritional deterioration and intake deficits were shown to be the 2nd most relevant factor (Table 1).22, 24 Our studies were conducted in outpatients referred for radiotherapy and radiation injury is known to aggravate symptoms with nutritional consequences.61, 62 Thus, such patients were suitable to test whether nutritional therapy would influence outcomes. Therefore, a pilot prospective intervention
Conclusions
Nutritional deterioration in cancer is a highly complex end-result of multiple interactions which are most likely individual to each patient and the tumour.22, 62, 74, 75 In what concerns nutrition and its impact on the patients’ QoL, cancer location and stage are the major determinants; nutritional aspects are equally important for QoL functional scores, in which the impact of nutritional deterioration combined with deficiencies in nutritional intake may be from a clinical perspective as
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Cited by (76)
Unmet needs in cancer patients: Creating recommendations to overcome geographical disparities in economic growth
2023, Clinical Nutrition ESPENManagement of orphan symptoms: ESMO Clinical Practice Guidelines for diagnosis and treatment †
2020, ESMO OpenCitation Excerpt :Bethanechol has been shown to stimulate saliva production but it was not effective in reducing the incidence of taste alteration when taken with RT.55 Regarding the use of acupuncture in the treatment of idiopathic dysgeusia, very low-quality evidence was insufficient to conclude that acupuncture improves taste discrimination in cases of idiopathic dysgeusia and hypogeusia.56 Two RCTs investigated the role of dietary counselling and educational videos: both studies showed that dietary counselling had a minor impact on acute dysgeusia but a more significant impact on long-term dysgeusia; additionally, it may enhance QoL.57 58 For additional treatment recommendations for dysgeusia, see online supplemental material.
Nutritional Aspect of Cancer Care in Medical Oncology Patients
2019, Clinical TherapeuticsCitation Excerpt :Identifying the particular needs of each patient and provision of nutritional support in accordance with an individualized nutritional plan developed by professional health care teams (including oncology physicians, nurses, and dietitians) is believed to be crucial for improving the nutritional status of cancer patients.46 Counseling is an effective and inexpensive intervention in combination with other nutritional interventions,46,55 leading to improved nutritional intake in patients undergoing chemotherapy and improved quality of life in patients undergoing radiotherapy.46,56,57 To detect nutritional disturbances at an early stage, ESPEN recommends that nutritional intake, weight changes, and BMI be evaluated regularly, beginning at the time of initial cancer diagnosis.
Ten years of Croatian national guidelines for use of eicosapentaenoic acid and megestrol acetate in cancer cachexia syndrome – Evaluation of awareness and implementation among Croatian oncologists
2019, Clinical Nutrition ESPENCitation Excerpt :That is why the combination of EPA (2.2 mg/day) and MA (400 mg/day) for a minimum duration of 8 weeks is a desirable therapeutic approach in patients with different stages of CC syndrome [26]. Another important thing we want to stress out, is that the first step in the nutritional therapy of oncological patients is dietetic advice regarding types of acceptable food, which can diminish the stage of anorexia or gastrointestinal symptoms connected to chemotherapy or radiotherapy [27,28]. This is followed by a oral nutrition supplements.
Closing the Gap in Nutrition Care at Outpatient Cancer Centers: Ongoing Initiatives of the Oncology Nutrition Dietetic Practice Group
2018, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :Patients receiving multimodal treatments are especially vulnerable while often experiencing multiple side effects that result in inadequate nutrient intake and subsequent weight loss leading to treatment interruptions, unplanned hospital admissions, lengthier hospitalizations, greater and more severe treatment side effects, dose-limiting toxicities, and reduced functional performance.37-44 Evidence shows that MNT improves treatment tolerance, reduces treatment breaks, decreases unintentional weight and lean body mass losses, increases QOL, decreases unplanned hospitalizations by >50%, reduces length of hospital stay (LOS), and improves overall survival.23,33,34,45-55 Yet despite data documenting a high prevalence of malnutrition in cancer patients during treatment, fewer than 60% of at-risk individuals received any nutrition interventions.56
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This paper is based on the presentation given at the III Cachexia Conference (Rome, 8–10 December 2005). During the conference, experts in wasting diseases, both basic scientists and clinical researchers, discussed relevant topics in the anorexia-cachexia field, including pathogenic mechanisms, diagnostic tools, current therapeutic strategies and future options. More details can be found at www.cachexia.org.