Cancers are the second leading cause of death in the world.
Although there are many advances in science, unfortunately the incidence of this disease is continuously increasing and some authors predict that it could double by 2030.
The cancer patient in the various stages of the disease undergoes many changes in their diet, at diagnosis, which, creating strong psychological stress, could lead to lack of appetite, during the therapies, which could cause diarrhea, constipation, nausea, vomiting and other situations in which it is necessary to remodel the diet, before and after surgery and in case of ostomy.
Very often there is an alteration in nutritional status and malnutrition by default is considered a “disease within a disease”, with which an estimated 33 million people in Europe live and a social cost of about 120 billion euros.
Unfortunately, the lack of attention to the nutritional status of cancer patients, widely documented in the scientific literature worldwide, has serious consequences on the quality and length of life of patients, on the course of the disease and on the response and tolerance to proposed treatments, resulting in a worse prognosis.
The nutritional therapy assessment becomes an essential element in the approach to the patient since the diagnosis.
Malnutrition by default (excessive thinness) is a true independent predictor of increased morbidity and mortality and is associated with an increased risk of toxicity due to cancer therapies.
Among neoplastic patients who lose body weight, approximately 25% die from the direct or indirect consequences of malnutrition.
Frequency and severity of weight loss vary depending on the type of tumor (mainly this phenomenon affects neoplasms of the gastrointestinal tract, lung, head and neck district and non-Hodgkin’s lymphoma).
On the contrary, some anticancer therapies (especially hormonal ones) and the use of anti-inflammatory drugs can lead to weight gain (malnutrition by excess) and metabolic alterations, both risk factors for metabolic syndrome and disease recurrence.
Proper nutritional management of neoplastic patients would not only have a positive impact on the quality and length of life of the patient, but also on the simplification of patient management and health care spending.
It is no coincidence that the Ministry of Health has drawn up a document entitled “Guidelines for nutritional pathways in cancer patients”, aimed at the nutritional management of the patient (screening and nutritional assessment).
The document also takes into account the “Charter of the Rights of the Oncology Patient to Appropriate and Timely Nutritional Support”, signed in 2017 by AIOM, FAVO and SINPE, and the contribution of the Scientific Societies ADI, SINUC and SISA and patient associations.
The objectives of this document consist of the following points:
- to define screening and specific needs in nutrition at diagnosis, during the therapeutic pathway, at follow up and for tertiary prevention;
- present an organizational model that provides an integrated pathway, which allows the implementation of a personalized nutritional program based on the type of cancer treatment, which also makes use of innovative approaches such as the analysis of the relationship between intestinal microbiota, disease and cancer therapies;
- structuring training and information paths for healthcare professionals.
The expected effects of these recommendations are to reduce medical complications resulting from malnutrition and to facilitate the recovery of a suitable nutritional status and physical health, which are essential steps in the healing process.
Cancer patients should always have a nutritional assessment and an adequate diet, at any stage of the disease, and this path should be an integral and essential part of the diagnostic-therapeutic-assistance path, which constitutes the whole oncological care, and should be personalized and dynamic, considering the evolution and the needs of the cancer patient.
Unfortunately, the state of malnutrition, sometimes inapparent to a superficial evaluation, can change the patient’s clinical history.
Even in subjects who have overcome the disease it is important to monitor the nutritional and metabolic status and it is essential to educate them to a correct and conscious nutrition, a fundamental element for prevention in the medium and long term and for the management of any problems secondary to cancer therapies.
Even in the case of an initial absence of changes in nutritional status, it is important to carefully monitor the condition because it can be modified by the secondary effects of therapies and/or the evolution of the disease.
The assessment of the nutritional status is a multimodal process, based on the clinical history, the treatments carried out and in progress, the presence of uncontrolled symptoms, the detection of anthropometric parameters and laboratory tests.
Validated tests (e.g. PG-SGA; SGA; MST; MNA®) can also be used.
The assessment of possible reasons for inadequate nutrition (eg, oral cavity mycosis, nausea) are essential to determine any deficiencies of macronutrients and micronutrients and undertake a targeted therapeutic intervention.
For each patient there should be a personalized and integrated path, managed by interdisciplinary and multi-professional teams, in which the various figures work together in synergy, each for its own competence. It should be built a multidisciplinary organizational model capable of ensuring the patient adequate, timely, effective, efficient and safe therapeutic interventions, in which nutrition is considered “therapy” within the therapeutic protocol.
Finally, it should be considered how the change in the patient’s eating habits can impact within the family, where nutrition becomes a central topic of discussion, sometimes to the point of inducing in the patient and family a state of anxiety and depression.
“Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study”; M. Muscaritoli et al.; Oncotarget 2017.