Aapro M, Arends J, Bozzetti F Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol. 2014; 25:(8)1492-9

Amano K, Baracos VE, Hopkinson JB. Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members. Crit Rev Oncol Hematol. 2019; 143:117-123

Amano K, Hopkinson J, Baracos V. Psychological symptoms of illness and emotional distress in advanced cancer cachexia. Curr Opin Clin Nutr Metab Care. 2022; 25:(3)167-172

Andreyev HJN, Muls AC, Shaw C Guide to managing persistent upper gastrointestinal symptoms during and after treatment for cancer. Frontline Gastroenterol. 2017; 8:(4)295-323

Arends J, Baracos V, Bertz H ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017; 36:(5)1187-1196

Baile WF, Palmer JL, Bruera E, Parker PA. Assessment of palliative care cancer patients' most important concerns. Support Care Cancer. 2011; 19:(4)475-81

Bernhardson BM, Olson K, Baracos VE, Wismer WV. Reframing eating during chemotherapy in cancer patients with chemosensory alterations. Eur J Oncol Nurs. 2012; 16:(5)483-490

Blödt S, Kaiser M, Adam Y Understanding the role of health information in patients' experiences: secondary analysis of qualitative narrative interviews with people diagnosed with cancer in Germany. BMJ Open. 2018; 8:(3)

Bozzetti F. The oncologist as coordinator of the nutritional approach. Nutrition. 2015; 31:(4)619-620

British Dietetic Association. Primary Care Across the UK. 2020. https:// (accessed 15 November 2022)

Britton B, McCarter K, Baker A Eating As Treatment (EAT) study protocol: a stepped-wedge, randomised controlled trial of a health behaviour change intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiotherapy. BMJ Open. 2015; 5:(7)

Cooper C, Burden ST, Cheng H, Molassiotis A. Understanding and managing cancer-related weight loss and anorexia: insights from a systematic review of qualitative research. J Cachexia Sarcopenia Muscle. 2015; 6:(1)99-111

A holistic approach to nutrition in palliative care FONS study. 2016. (accessed 15 November 2022)

Deshields TL, Potter P, Olsen S, Liu J. The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year. Support Care Cancer. 2014; 22:(4)1089-1096

Supporting people who have eating and drinking difficulties. A guide to practical care and clinical assistance, particularly towards the end of life. 2021. (accessed 15 November 2022)

The ‘MUS T’ report. Nutritional screening of adults: a multidisciplinary responsibility. Development and use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. 2003. (accessed 15 November 2022)

Flynn B, Barrett M, Sui J, Halpin C, Paz G, Walsh D. Nutritional status and interventions in hospice: physician assessment of cancer patients. J Hum Nutr Diet. 2018; 31:(6)781-784

Grace EM, Shaw C, Lalji A, Mohammed K, Andreyev HJN, Whelan K. Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago-gastric cancer: a longitudinal cohort study. J Hum Nutr Diet. 2018; 31:(6)785-792

Harris PS, Payne L, Morrison L Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis. BMC Fam Pract. 2019; 20:(1)

Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr. 2014; 38:(2)196-204

Homsi J, Walsh D, Rivera N Symptom evaluation in palliative medicine: patient report vs systematic assessment. Support Care Cancer. 2006; 14:(5)444-53

Hopkinson JB, Wright DN, McDonald JW, Corner JL. The prevalence of concern about weight loss and change in eating habits in people with advanced cancer. J Pain Symptom Manage. 2006a; 32:(4)322-31

Hopkinson J, Wright D, Corner J. Exploring the experience of weight loss in people with advanced cancer. J Adv Nurs. 2006b; 54:(3)304-312

Hopkinson JB. The emotional aspects of cancer anorexia. Curr Opin Support Palliat Care. 2010; 4:(4)254-258

Hopkinson JB, Fenlon DR, Foster CL. Outcomes of a nurse-delivered psychosocial intervention for weight- and eating-related distress in family carers of patients with advanced cancer. Int J Palliat Nurs. 2013; 19:(3)

Hopkinson JB. The psychosocial components of multimodal interventions offered to people with cancer cachexia: a scoping review. Asia Pac J Oncol Nurs. 2021; 8:(5)450-461

Khorasanchi A, Nemani S, Pandey S, Del Fabbro E. Managing nutrition impact symptoms in cancer cachexia: a case series and mini review. Front Nutr. 2022; 9

Laur C, McCullough J, Davidson B, Keller H. Becoming food aware in hospital: a narrative review to advance the culture of nutrition care in hospitals. Healthcare (Basel). 2015; 3:(2)393-407

Macmillan Cancer Support. Macmillan Durham Cachexia Pack. 2008. (accessed 15 November 2022)

Practice development in nursing and healthcare, 2nd edn. In: McCormack B, Manley K, Tinchen A (eds). Oxford: Wiley-Blackwell; 2013

Muscaritoli M, Arends J, Bachmann P ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021; 40:(5)2898-2913

National Institute of Health and Care Excellence. Improving supportive and palliative care for adults with cancer. Cancer service guideline CSG4. 2004. (accessed 15 November 2020)

National Institute of Health and Care Excellence. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical guideline CG32. 2017. (accessed 15 November 2022)

NHS website. What end of life care involves. 2022. (accessed 15 November 2022)

The dietitian's role in palliative care: a qualitative study exploring the scope and emerging competencies for dietitians in palliative care. 2016. (accessed 15 November 2022)

Planas M, Álvarez-Hernández J, León-Sanz M, Celaya-Pérez S, Araujo K, García de Lorenzo A Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study. Support Care Cancer. 2016; 24:(1)429-435

Ravasco P. Nutrition in Cancer Patients. J Clin Med. 2019; 8:(8)

Royal College of Occupational Therapy. How to conserve your energy. Practical advice for people during and after having COVID-19. 2021. (accessed 15 November 2022)

Shaw C, Eldridge L. Nutritional considerations for the palliative care patient. Int J Palliat Nurs. 2015; 21:(1)7-15

Souter J. Loss of appetite: a poetic exploration of cancer patients' and their carers' experiences. Int J Palliat Nurs. 2005; 11:(10)524-532

Holdoway A. P-114 A holistic approach to nutrition and diet in palliative care. 2016. (accessed 15 November 2022)

Shragge JE, Wismer WV, Olson KL, Baracos VE. Shifting to conscious control: psychosocial and dietary management of anorexia by patients with advanced cancer. Palliat Med. 2007; 21:(3)227-233

Sullivan ES, Rice N, Kingston E A national survey of oncology survivors examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey. Clin Nutr ESPEN. 2021; 41:331-339

Tong H, Isenring E, Yates P. The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer. 2009; 17:(1)83-90

World Health Organization. Palliative care (fact sheet). 2020. (accessed 15 November 2022)

Yin RK. Case study research. Design and methods, 5th edn. Thousand Oaks (CA): Sage; 2014

Nutrition in palliative care: issues, perceptions and opportunities to improve care for patients

24 November 2022
Volume 31 · Issue 21


Dietary advice, the provision of timely nutritional support and the alleviation of diet-related issues, should be an essential component of a holistic approach to palliative and end-of-life care, adjusted to account for the stage in the patient's journey, including prognosis. With an ageing population and increasing numbers of people living with not just one life-limiting disease but several, the dietary management of these patients is becoming more complex. This article considers the issues patients and families experience, how nurses can play a key role in identifying and alleviating nutrition- and diet-related issues in palliative care, including the use of tools to screen, assess and guide nutrition conversations and interventions. The content of the article is mostly drawn from the literature relating to palliative cancer care, knowledge derived from stakeholder engagement, clinical observations in a dietetic role in a hospice setting and qualitative research on the role of diet in palliative care as perceived by patients, carers, and health professionals.

In palliative and end-of-life care, the management of symptoms and the provision of psychological, social, and spiritual support are paramount (World Health Organization (WHO), 2020). In addition to the common symptoms of pain, breathlessness and fatigue, all of which can adversely affect dietary intake, a range of physical and metabolic effects associated with the underlying disease and its treatment, can also negatively impact on an individual's ability to eat and drink, predisposing them to an increased risk of malnutrition along with its associated consequences, such as infections, poor wound healing and reduced activity (Hébuterne et al, 2014; Khorasanchi et al, 2022).

With the reduced ability to eat and drink secondary to physiological and metabolic issues (cachexia – muscle wasting secondary to disease-related inflammation), and loss of enjoyment and desire to eat, diet frequently becomes a source of psychological stress and anxiety (Hopkinson, 2006a; 2006b; Amano et al, 2022). If feasible and acceptable to patients and carers, there exists a sound clinical rationale for the use of timely interventions to modify diet to alleviate symptoms and maintain nutritional status to optimise quality of life, physical functioning, immunity, and wellbeing (Shaw and Eldridge, 2015; Arends et al, 2017; Amano et al, 2019; Hopkinson, 2021).

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