By: Talking Nutrition Editors
Cancer remains the world’s second-leading cause of death with more than 10 million people dying of the disease each year.1 Although there are many non-modifiable risk factors that impact the incidence of this disease group, more than 40% of cancer-related deaths could be preventable.1 World Cancer Day was inaugurated to raise awareness of how suitable strategies for cancer risk reduction, early detection and treatment could save lives. This year, we’re spotlighting how integrating medical nutrition with cancer therapies can better support patients and improve outcomes.
Cancer and its treatment may increase the risk of malnutrition by reducing food intake, nutrient absorption and shifting metabolic demands. This causes substantial weight loss, body composition changes, decreased physical and mental function and tissue degradation.2 Studies demonstrate that between 20-80% of individuals with cancer suffer from malnutrition, with its prevalence varying depending on diverse factors such as age, cancer stage and therapy methods.3,4,5,6,7,8 What’s more, as many as 20% of cancer deaths are associated with malnutrition.3,9,10 Malnutrition potentially increases the toxicity of pharmaceutical drugs and accelerates drug catabolism, resulting in a reduced efficacy of oncology treatments and increasing adverse symptoms.11,12 Despite the negative impact disease-related malnutrition has on patient health and wellbeing, clinical outcomes, cost of care and quality of life,13,14,15 only 30-60% of cancer patients receive the medical nutrition support they need.3,16
Medical nutrition supports patients to address disease-related nutritional deficiencies and improve outcomes with a range of specialized nutritional therapy products including oral nutritional supplements (ONS), enteral (tube) and parenteral (intravenous) feeding methods to provide adequate nutrition. There’s mounting evidence to suggest that tailored medical nutrition solutions embedded in multimodal cancer cachexia care could make a significant difference to the lives of patients with cancer.17,18 Multimodal cancer care in this context refers to holistic treatment which addresses different aspects of patient health and wellbeing, including psychological support, physical mobilization and exercise, sleep and lifestyle management.17
Research indicates that some of the advantages of integrating medical nutrition into multimodal therapeutic care plans include a reduction or reversal of malnutrition’s negative effects, advance healthy immune system function, increase the efficacy of drug therapies, improve patient outcomes, quality of life and prognosis – reducing healthcare costs and hospital readmissions as a result. One trial found that early medical nutrition intervention was effective at both significantly improving the quality of life of cancer patients and significantly improving survival rates of patients, when combined with anticancer treatments.19 Another meta-analysis demonstrated that targeted nutrition improved the body weight of patients receiving chemoradiotherapy.20
Our latest survey assessed the attitudes and behaviors of healthcare professionals towards screening and management of disease-related malnutrition. The three concepts we assessed were cancer cachexia, stroke rehabilitation and/or cognitive disorder and diabetes. The survey found that only 46% of participating healthcare professionals routinely screen patients for malnutrition.
Barriers to nutritional screening included a lack of resources like staff time and training on screening tools. There is a clear need for further education on existing screening protocols and nutritional guidelines to improve patient access to medical nutrition.
Of those interviewed, 90% of screening professionals will prescribe medical nutrition. However, only 1 in 3 malnourished patients actually receive it.
The survey results show a consensus among healthcare professionals that cancer patients are among the prime candidates for screening for disease-related malnutrition. This aligns with the finding that 95% of surveyed physicians agreed that screening is important for cancer patients undergoing treatment.
Guideline adherence is lower among oncologists, with 40% reporting they do not follow nutritional recommendations when managing their cancer patients. This aligns with previous market research which suggests that oncologists are hesitant to subscribe cachexia prevention products because they require more evidence in support of the benefits of oral nutritional product descriptions, and also anticipate patients will perhaps not be able to afford treatment or comply.21 However, 59% of oncologists say that they are positive toward the idea of a product that provided targeted nutritional support as an element of multimodal cancer cachexia care.20 The survey further suggests that oncologists require more details on the clinical efficacy to make decisions about prescribing cancer cachexia-related medical nutrition solutions, considering cost and details on calories and other cancer specific nutrients like EPA as must have information prior to purchasing.
While the importance of paying special attention to the nutritional status of cancer patients through screening is clear, additional work is still needed to promote standards of nutritional care in oncology settings. To gain buy-in, access to robust evidence and data on clinical outcomes, cost-effectiveness, and quality of life, impact is needed, when discussing medical nutrition products and services.
29 January 2024
6 min read
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1. World Cancer Day. To learn more about "What is Cancer?" click here. [Accessed 19/01/2024].
2. Cederholm et al. ESPEN guidelines on definitions and terminology of clinical nutrition, Clin Nutr., vol. 36, no.1, pg. 49-64, 2017.
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21. Ipsos. DSM Medical Nutritional Product Concepts Research 2022.
