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J Cancer 2019; 10(18):4318-4325. doi:10.7150/jca.31611 This issue Cite

Review

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

Paolo Cotogni^1✉, Paolo Pedrazzoli², Elisabeth De Waele³, Giuseppe Aprile⁴, Gabriella Farina⁵, Silvia Stragliotto⁶, Francesco De Lorenzo⁷, Riccardo Caccialanza⁸ for the AIOM-SINPE-FAVO-Fondazione AIOM Working Group

1. Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, Turin, Italy
2. Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
3. Intensive Care Unit and Department of Nutrition, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
4. Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
5. Department of Oncology, ASST Fatebenefratelli Sacco, Milan, Italy
6. Medical Oncology 1, Veneto Institute of Oncology-IRCCS, Padova, Italy
7. FAVO Italian Federation of Volunteer-based Cancer Organizations, Rome, Italy
8. Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

✉ Corresponding author: Paolo Cotogni, MD, MSc, Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, C.so Bramante 88/90, 10126 Turin, Italy. Tel.: +39 338 7018496; fax: +39 011 5171634. E-mail: paolo.cotogniit More

Abstract

One of the challenges during chemotherapy and radiotherapy is to complete the planned cycles and doses without dose-limiting toxicity. Growing evidence clearly demonstrates the relationship between dose-limiting toxicity and low muscle mass. Moreover, malnutrition leads to low performance status, impaired quality of life, unplanned hospital admissions, and reduced survival.

In the past, the lack of clear and authoritative recommendations and guidelines has meant that oncologists have not always fully appreciated the importance of nutritional therapy in patients receiving anticancer treatments. Therefore, collaboration between oncologists and clinical nutrition specialists needs to be urgently improved.

Recent guidelines from scientific societies and practical recommendations by inter-society consensus documents can be summarized as follows: 1) timely nutritional therapy should be carefully considered if patients undergoing anticancer treatments are malnourished or at risk of malnutrition due to inadequate oral intake; 2) if oral intake is inadequate despite counseling and oral nutritional supplements, supplemental enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition should be considered; 3) home artificial nutrition should be prescribed and regularly monitored using defined protocols developed between oncologists and clinical nutrition specialists; 4) appropriate nutritional management in the context of simultaneous care should become a guaranteed right for all patients with cancer.

The purpose of this review is to provide oncologists with an overview of the aims and current evidence about nutrition in oncology, together with updated practical and concise recommendations on the application of nutritional therapy in cancer patients receiving chemoradiotherapy.

Keywords: malnutrition, dose-limiting toxicity, nutritional support, artificial nutrition, guidelines

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