Managing malnutrition in Oncology

Chemotherapy

“During intensive chemotherapy and after stem cell transplantation ESPEN recommends to maintain physical activity and to ensure adequate nutritional intake. This may require enteral and/or parenteral.” ^2,3

Radiotherapy

“During radiotherapy with special attention to radiotherapy of the head and neck, thorax and gastrointestinal tract, an adequate intake should be ensured primary by, individualised nutritional counselling and/or oral nutritional supplements (ONS), in order to avoid nutritional deterioration, maintain intake and avoid radiotherapy interruptions.” ^2,3

Surgery

“For all cancer patients undergoing either curative or palliative surgery, ESPEN recommends management within an enhanced recovery after surgery (ERAS) program; within this program every patients should be screened for malnutrition and if deemed at risk, given additional nutritional support.” ^2,3

“For those at risk of malnutrition or already malnourished, appropriate nutritional support  is recommended during hospital stay and post discharge.” ³

Palliative Care

“ESPEN recommends implementing nutritional interventions in patients with advanced cancer only after considering together with the patient the prognosis of the malignant disease and both the expected benefit on quality of life and potentially survival as well as the burden associated with nutritional care.” ^2,3

Screening and effective management of malnutrition can be incorporated into current practice with the Managing Adult Malnutrition in the Community pathway.⁸

• A practical guide developed by a multi-disciplinary team (MDT) to support Health Care Professionals (HCPs) to identify and manage malnutrition in the community

• Offers clear guidance on screening and first line management and includes a pathway for the appropriate use of ONS, which type of ONS to prescribe, appropriate doses and when to stop the prescription

1. NICE. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical Guideline CG32. https://www.nice.org.uk/Guidance/CG32 [Accessed October 2020].
2. Arends et al. Clin Nutr. 2016;36(1):11-48
3. Muscaritoli, Arends, Bachmann et al. Clin Nutr. 2021; 40: 2898-2913
4. Baldwin et al. J Natl Cancer Inst. 2012, 104(5): 371-385
5. Kabata et al. Support Care Cancer. 2015; 23: 365-370.
6. Maňásek et al. Klin Onkol. 2016; 29: 351-357.
7. Trestini et al. Eur J Clin Nutr. 2018;72:772-779
8. Malnutrition Pathway: A Guide to Managing Adult Malnutrition in the Community. 2017. [Online]. Available from: http://www.malnutritionpathway.co.uk/. [Accessed on: 13.01.21].