The importance of a healthy diet is being promoted through many media channels, with recommendations regarding the quality, quantity and the food composition, as well as its influence in promoting a normal growth and development of human body, but also in preventing diseases and maintaining a good health condition and quality of life. Nutritional recommendations must be tailored according to age category, anthropometric and biologically individual status, as well as possible associated pathologies. The medical nutritional therapy is an individual medical approach for different pathologies, through a specific nutrition plan, developed and monitored by a nutritionist.

The medical nutritional therapy –a principle of antitumor treatment

The dietary therapy implies qualitative and quantitative changes in the existing food intake, for therapeutic purposes, being a fundamental therapeutic element in different pathologies. This has a major role for patients diagnosed with cancer, the medical nutritional therapy being regarded as a principle of antitumor therapy, as it is a well-known fact that nutrition can change the tumoral process in any stage, and that nutrition and diet could contribute as causing factors in approximatively 35% of all malignancies(1).

Antitumor therapies are evolving continuously, becoming more specific and targeted, and although the majority of advanced cancers are not curable, they can be now seen as a “chronic condition”. Nevertheless, these advances we are referring to need a good patient performance status. The performance status can be influenced by both the adverse events induced by chemotherapy or radiotherapy and the nutrition disorders, which can occur in approximately 85-90% of all gastrointestinal cancers and up to 60% of other types of malignancies(2).

Which are the nutrition disorders that can occur in oncologic patients?

The cancer-induced adverse effects on the performance status can be severe, as a direct effect of chemo­therapy, as well as a psychological disease impact. The qualitative and quantitative dietary deficiencies (malnutrition), anorexia (appetite lost) and weight loss represent issues that patients with neoplasia are facing frequently, starting from the diagnosis. In these conditions, the reduction of food intake in combination with metabolic disorders resulting from the host-tumour competition for caloric resources contribute to the onset of protein-calorie malnourishment called tumor cachexia.

Anorexia-cachexia tumoral syndrome is characterized by reduced food intake, progressive weight loss, hypoalbuminemia, changes in the energy metabolism, muscle and fat tissue losses, emaciation and weakness(2). The oncologic patient develops anorexia due to both the tumoral disease and adverse effects of oncological therapies (chemotherapy, radiotherapy).

How does malnutrition affect the oncological patient’s evolution?

Since 1980, it has been demonstrated that a weight loss of only 5% can reduce response to therapy and general survival(3). Malnutrition can also lead to a decreased quality of life, increase in complication rates, increased discontinuation rates of anti-tumor treatment, altering of the cardiac function, reduction of glomerular filtration etc.(4)

Additionally, malnutrition can be the main cause of death for up to 20% of the cancer-diagnosed patients, as opposed to direct effect of the oncological disease(5).

What are the criteria for assessing malnutrition?

Of the investigated nutritional variables, three seem to best reflect malnutrition: unintentional weight loss, decrease of BMI (Body Mass Index) and decrease of FFMI (Fat Free Mass Index). In order to diagnose malnutrition either all three variables or BMI alone can be used(6).

In addition, multiple validated screening instruments exist, which are recommended for the nutritional status assessment; these are MUST (Malnutrition Universal Screening Tools), NRS 2002 (Nutritional Risk Screening) and MNA (Mini Nutritional Assessment), GNRI (Geriatric Nutrition Risk Index)(6).

Nutritional assesment consultation should be performed at diagnosis

Each stage in the oncology patient’s progression, from diagnosis to treatment, recovery and survival, is associated with specific nutritional challenges. Integrating medical nutritional therapy into the oncological treatment can lead to a more effective management of adverse effects, lower complication rates, lower discontinuation rates and improved patient outcomes in overall survival and quality of life(2).

Also, as in any pathology, prevention is essential; for this reason, all oncologic patients should benefit from a nutritional consultation at diagnosis(2).

Unfortunately, a too small number of oncology treatment centres benefit from the presence of a nutritionist dedicated to oncologic patients and onco-nutrition is still too seldom discussed currently in Romania.

What is nutritional counselling?

It is a continuous process that involves close collaboration between patient and nutritionist, who utilizes information from the evaluation of the current nutritional status of the patient, its goal being the identification of patient preferences, barriers in changing nutritional habits and ultimately finding specific solutions(7).

Nutritional treatment includes firstly enteral feeding, and only in specific cases can include parenteral feeding or dietary supplements(6).

In most cases, the prevention of malnutrition is not very complicated, but it is very important that the patients receive the correct information from specialized sources.

Concluding, a good collaboration between oncologist and nutritionist is mandatory because NUTRITION IS A FUNDAMENTAL PRINCIPLE OF ONCOLOGICAL TREATMENT! 

Article published with the support of Lilly Oncology