Nutrition and oncology: best practice and the development of a traffic light system
Malnutrition is common in oncology patients, with age, disease stage and tumour type all influencing malnutrition risk. There are several detrimental effects of malnutrition in oncology patients, including weight loss, which is associated with negative oncological outcomes, and reduced survival. The causes of malnutrition in this group may be multifactorial and include effects from the tumour itself, altered metabolism, increased nutritional requirements, and cancer treatments and their associated side effects, which can impact on an individual's ability and desire to eat. Nutritional screening to identify early nutritional risk is essential and should involve the use of a validated screening tool, with commonly used tools usually assessing nutritional risk and weight loss over a period of months, for example a 3- to 6-month period. It is also important to consider weight changes over a shorter time period to identify rapid weight changes. Multidisciplinary teamworking is essential in tackling malnutrition, with collaborative working between the dietitians and the nutrition nurses shown to be beneficial in the authors' practice to develop community pathways and improve their service and manage increasing patient numbers. Malnutrition within oncology can often be managed with additional supplementation with oral nutritional supplements or enteral nutrition, where indicated. A low-volume, energy-dense, high-protein supplement can help to meet nutritional needs and to achieve dietetic aims, with compliance improved by the use of a low-volume product.
The term malnutrition can refer to either over- or under-nutrition, and for the purposes of this article will focus specifically on under-nutrition. Under-nutrition can be defined as a deficiency of energy, protein and other nutrients that causes adverse effects on the body and clinical outcome (Holdoway et al, 2017; National Institute for Health and Care Excellence (NICE), 2017).
Oncology patients have one of the highest prevalence of malnutrition (Agarwal et al 2012; Marshall et al 2019), occurring in the majority of cancer patients (Van Cutsem and Arends, 2005). Such patients are more likely to be malnourished compared to any other patient group (Ryan et al, 2016). Worldwide prevalence of malnutrition in cancer patients is estimated to range from 20% to over 70% (Arends et al, 2017a), with cancer cachexia affecting 50-80% and sarcopenia present in 20-70% of cancer patients (Ryan et al, 2016). In the UK and Ireland, estimates show that, annually, 34% of patients may experience weight loss of over 5% body weight depending on tumour site; with an additional 18.5% experiencing weight loss over 10%, and a further 35% of patients experiencing sarcopenia (Sullivan et al, 2020). Older age and disease stage, as well as tumour type, can influence malnutrition risk, with malnutrition and nutritional risk increased in oesophageal and/or gastric and pancreatic cancers, and weight loss increased in upper gastrointestinal tumours and advanced disease (Bozzetti, 2009; Hébuterne et al, 2014).
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