here’s what you can (and must) do – breaking latest news

Malnutrition is a very common problem in cancer patients and brings with it a series of serious consequences: prolonged and repeated hospitalizations over time, increased toxicity of anticancer therapies and their lower efficacy, worsening both of the patient’s quality of life and of the prognosis. And, finally, a great waste of resources on the part of the National Health System used to treat the effects of excessive weight loss that could instead be largely prevented or treated promptly. A problem that, although it is very clear and very present both to those directly involved and to oncologists, in our country is still too often underestimated or not addressed with adequate times and methods. For this reason, in the last five years the experts of the Italian Intersociety Working Group for Nutritional Support in Cancer Patients have been working on new guidelines, just published in the journal Journal of Cancer
updating the previous ones (which were from 2016) with the aim of providing a synthetic and usable tool to all specialists who treat cancer patients.

What’s new in the latest 2022 recommendations?

Compared to the previous document, the surgical part has been introduced because there is more and more evidence that indicates pre-operative nutritional treatment as a key factor in reducing complications and, consequently, hospitalization times and recovery times, as well as healthcare costs – he replies Riccardo Caccialanza, director of the Dietetics and Clinical Nutrition Unit at the IRCCS Policlinico San Matteo di Pavia Foundation, coordinator of the working group -. In addition, the concept has been introduced that for tumors at higher risk of developing malnutrition it is necessary to start an educational program and close monitoring from the time of diagnosis, regardless of the results of nutritional screening which can change rapidly during the course of treatments. This is because it is increasingly clear from the scientific literature that earliness in nutritional intervention is the key to guaranteeing its best efficacy.

Who are the patients at the highest risk of weight loss?

The numbers clearly frame the problem: overall about 30% of cancer patients suffer from a state of malnutrition, or at risk of being malnourished, already at the time of diagnosis – recalls Francesco De Lorenzo, president of the Italian Federation of voluntary associations in oncology (Favo ), who participated in the new guidelines -. With the passage of time and the succession of therapies, insufficient nutrition becomes a very common problem, so much so that it affects up to 60-80% of patients. Especially when you arrive in the advanced stages of cancer or if you suffer from certain types of cancers such as those of the pancreas, esophagus, stomach, head and neck. The consequences can be so serious that, according to statistics, one in four cancer patients dies from malnourishment and not directly from cancer.

When is nutritional support needed in cancer patients and why?

Nutritional support is needed as soon as the risk of malnutrition arises, which in many types of tumors (such as those of the head and neck, gastrointestinal, pancreatic, lung) already present since the diagnosis – clarifies Caccialanza -. Preventing excessive weight loss and a deterioration in nutritional status of fundamental importance to allow patients to receive treatments avoiding complications, thus being able to obtain more favorable clinical results and maintaining a better quality of life. This fundamental concept has been further emphasized in the new recommendations.

What types of support are there?

We have different types of interventions based on the degree of impairment of the ability to eat – explains Caccialanza -. Nutritional counseling aims to optimize nutrition in terms of calorie and protein intake through personalized dietary indications aimed at dealing with symptoms (such as lack of appetite, gastrointestinal problems, difficulty swallowing). If an adequate nutritional status cannot be maintained with nutrition alone, oral nutritional supplements must be used which in some regions (eg Lombardy, Piedmont) can be provided free of charge to patients on specialist prescriptions. If even these are not effective or in case of inability to feed (such as inability to swallow) or to absorb nutrients (as happens for chemotherapy diarrhea), it is necessary to resort to artificial nutrition, which consists in the administration of nutritional mixtures at the level intestinal through probes (enteral nutrition) or by venous route through catheters (parenteral nutrition).

Where to turn for help?

Patients should be referred from oncology to clinical nutrition units or services of reference – he replies Paolo Pedrazzoli, director of Oncology at the IRCCS Polyclinic S. Matteo di Pavia Foundation -. Nutritional support must in fact be prescribed and monitored by specialized medical personnel with specific skills in clinical nutrition, with the support of dieticians, and should be shared with the oncologists treating specific clinical pathways, which also include the management of home artificial nutrition.

What should patients and family members do?

Patients and caregivers should be aware of the importance of maintaining adequate nutritional support from the early stages of the disease and, if not provided, ask oncologists early for clinical references to contact for nutritional care – concludes Pedrazzoli -. It is essential to monitor the weight trend, with weekly checks and try to maintain satisfactory food intake, also on the basis of practical advice available on the official channels of the reference scientific societies or patient associations such as the specific AIMAC booklet.