Anyone living with a tumor knows that it is very likely to happen, because it is a very frequent problem, right from the onset of the disease. What he knows less is how important it is to face it and in what way, and above all that it can be contained. We are talking about weight loss, due to lack of appetite, nausea, difficulty swallowing, obstruction in the passage of food, gastrointestinal disorders, digestive difficulties, anxiety and depression. All symptoms that occur with the disease and during oncological therapies, and which make it difficult to eat in the right way, particularly if you suffer from certain types of cancers such as those of the head and neck tract, gastrointestinal tract, colon in an advanced phase and lung. The problem affects about 50% of cancer patients and if it is neglected it can lead to lower efficacy of therapies and greater drug toxicity, worse clinical outcomes, surgical complications, worse quality of life and higher mortality rates. And also to an increase in healthcare costs, because the patient goes back to the hospital and stays there longer.
In recent years the attention to nutrition in oncology by doctors has grown, and strategies are being developed to support the patient with the right intake of calories, proteins and minerals. Some regions, for example, are creating, or have already created, clinical nutrition networks, and introduced the possibility for cancer patients to receive oral nutritional supplementation at home from the National Health Service when needed.
Cancer, half of the patients suffer from malnutrition
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“Until recently, doctors and specialists considered weight loss in the course of treatment almost a secondary aspect. In reality, it was then understood that it could be a key factor on which to intervene to help patients tolerate the therapies – explains to Health Riccardo Caccialanza, Director of UOC Dietetics and Clinical Nutrition at the IRRCCS Policlinico San Matteo Foundation, and member of the technical tables of Pancres Unit, Clinical Nutrition and Decree on Home Artificial Nutrition (Nad) in the Lombardy Region – A factor that, while on the one hand it is not totally reversible, on the other it can be contained. With oral nutritional supports and early counseling it is in fact possible to have weight losses of no more than three and a half kilos during the whole therapy, and therefore to counteract a possible state of malnutrition and to reduce the risk of suspending therapies or decreasing their dosage “.
Detect the weight from the diagnosis to increase the therapeutic chances
Acting in time is very important because a good nutritional state corresponds to greater therapeutic opportunities: you can administer the therapies in the right doses and try different treatments. “The goal is to avoid the worsening of nutritional conditions and contain the weight and muscle loss to ensure that the patient receives cancer treatments in the most appropriate way – continues Caccialanza – Research confirms that taking care of the patient right from diagnosis , even if not frankly malnourished, by detecting the weight and monitoring it constantly, it guarantees greater effectiveness of the therapies and improves life expectancy. In metastatic advanced gastroesophageal cancer, for example, studies have shown that nutritional support can increase survival by three months. We are talking about one of the tumors with the most severe and rapid prognosis, which is about one year “.
The role of oral nutritional supplements
Oral nutritional supplements used in oncology are foods for special medical purposes and are administered to patients under the supervision of the physician. They can be liquid solutions, such as juices or milkshakes, powder or solid such as puddings, and are high-calorie or high-protein enriched with vitamins and trace elements. They serve to increase the share of calories and proteins and in many cases allow the patient not to resort to artificial feeding through a tube or vein.
In Italy their deliverability is still patchy. In Lombardy, for example, with the Nad Decree (n.14274 of 25 October 2021) it was established that the cancer patient in the active phase has the right to free oral supplementation at home when this is prescribed by specialists. “A single digital platform for prescriptions will be operational within the first months of next year – explains Caccialanza – We are working on the creation of a Clinical Nutrition Network in collaboration with the Oncology Network, establishing multidisciplinary nutritional teams in each healthcare facility to guarantee nutritional treatments. quality, from hospitalization to home care with family members “.
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The work was born by virtue of the dialogue and collaborations initiated between oncological and nutritional scientific societies and patient associations. And in addition to Lombardy, there are also other regions that are moving or have already moved in the same direction, such as Piedmont, Tuscany and the Marches. “Through Alleanza contro il Cancro we have also submitted a position paper on the subject to the Ministry of Health and the Istituto Superiore di Sanità – underlines Caccialanza – because free oral supplementation should be guaranteed to cancer patients with homogeneous criteria throughout Italy. In fact, it is no longer acceptable for a patient in therapy who cannot swallow, or suffers from other symptoms that do not allow him to eat properly, to pay 15 euros a day to buy supplements “.
The importance of home care
Nutritional support is initiated in the hospital but then continued and monitored at home. During the entire period of treatment it is in fact important to try to maintain adequate muscle mass and function, following a satisfactory diet from a caloric and protein point of view. For this, it is important that the patient is informed and educated together with the family, and followed by specialists. “The issue of continuity of care between the hospital and the patient’s home is a focal point – continues Caccialanza – and we are trying to understand how to best develop it. Following a specific diet is in fact complex because it has a cultural, social and psychological value; it means adapting one’s habits to a difficult period which, however, can make a big difference in the treatment path “.
Telemedicine, for example, lends itself a lot to this area. “Digital medicine projects are being developed through which, for example, monitoring meals – says Caccialanza – and giving the patient and family members the opportunity to be followed and to feel constantly followed, ask questions, dissolve doubts or simply be reassured”.
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No to do it yourself
At the table you can bring the most popular foods, which allow you to take calories and proteins in line with your needs. Except that in certain situations some foods could worsen the side effects of cancer treatments, or make drugs less active. For this it is necessary to find a balance. Such as? “By personalizing and balancing the daily intake of food with the support of specialists – concludes Caccialanza – based not only on the principles of a healthy diet and individual tastes, but also on symptoms and clinical conditions”.