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J Cancer 2016; 7(2):131-135. doi:10.7150/jca.13818 This issue Cite

Review

Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE)

Riccardo Caccialanza^1✉, Paolo Pedrazzoli², Emanuele Cereda¹, Cecilia Gavazzi³, Carmine Pinto⁴, Agostino Paccagnella⁵, Giordano Domenico Beretta⁶, Mariateresa Nardi⁷, Alessandro Laviano⁸, Vittorina Zagonel⁹

1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
2. Division of Medical Oncology, Department of Hemato-Oncology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
3. Clinical Nutrition Unit, National Cancer Institute, Milan, Italy;
4. Medical Oncology, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy;
5. Endocrinology, Metabolism and Nutrition Unit, Local Health Authority ULSS 9, Treviso, Italy;
6. Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy;
7. Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padova, Italy;
8. Department of Clinical Medicine, University La Sapienza, Rome, Italy;
9. Medical Oncology 1, Veneto Institute of Oncology-IRCCS, Padova, Italy.

✉ Corresponding author: Dr. Riccardo Caccialanza, Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. Tel.: +39 0382 501615; fax: + 39 0382 502801. E-mail: r.caccialanzapv.it

Abstract

Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support.

We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. “Alternative hypocaloric anti-cancer diets” (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status.

Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients.

Keywords: malnutrition, cancer, nutritional support

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