Preview

Oncohematology

Advanced search

Malnutrition screening and nutritional support for cancer patients. Clinical guidelines and features of their application in real practice

https://doi.org/10.17650/1818-8346-2024-19-4-188-203

Abstract

Malnutrition is a significant problem for patients with hematological neoplasms and solid tumors, serving as a negative prognostic and predictive factor that reduces the effectiveness of anticancer therapy and worsens survival outcomes.

The article discusses the role of nutritional support in improving treatment outcomes, reducing complications, and enhancing the quality of life for cancer patients. It reviews current clinical guidelines for the implementation of nutritional support in oncology and oncohematology, underscoring the necessity of early intervention and continuous monitoring to prevent and address nutritional deficiencies. Various methods of nutritional support, including oral, enteral, and parenteral nutrition, are also discussed, with an emphasis on the importance of a personalized approach to meet the individual needs of patients.

About the Authors

A. R. Gevorkov
P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia
Russian Federation

Artem Rubenovich Gevorkov,

3 2nd Botkinskiy Proezd, Moscow 125284



A. V. Snegovoy
N.A. Lopatkin Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Radiological Center, Ministry of Health of Russia
Russian Federation

Build. 1, 51 3rd Parkovaya St., Moscow 105425



References

1. Pressoir M., Desné S., Berchery D. et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 2010;102(6):966–71. DOI: 10.1038/sj.bjc.6605578

2. Laviano A., Meguid M.M. Nutritional issues in cancer management. Nutrition 1996;12(5):358–71. DOI: 10.1016/s08999007(96)80061x

3. Del Fabbro E., Hui D., Dalal S. et al. Clinical outcomes and contributors to weight loss in a cancer cachexia clinic [published correction appears in J Palliat Med 2011;14(12):1361]. J Palliat Med 2011;14:1004–8. DOI: 10.1089/jpm.2011.0098

4. Baracos V.E., Martin L., Korc M. et al. Cancerassociated cachexia. Nat Rev Dis Primers 2018;4:17105. DOI: 10.1038/nrdp.2017.105

5. Ryan A.M., Prado C.M., Sullivan E.S. et al. Effects of weight loss and sarcopenia on response to chemotherapy, quality of life, and survival. Nutrition 2019;67–8:110539. DOI: 10.1016/j.nut.2019.06.020

6. Baracos V.E. Cancer-associated malnutrition. Eur J Clin Nutr 2018;72(9):1255–9. DOI: 10.1038/s4143001802454

7. Muscaritoli M., Arends J., Bachmann P. ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr 2021;40(5): 2898–913. DOI: 10.1016/j.clnu.2021.02.005

8. Muscaritoli M., Lucia S., Farcomeni A. et al. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget 2017;8(45):79884–96. DOI: 10.18632/oncotarget.20168

9. Arends J., Strasser F., Gonella S. et al. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines. ESMO Open 2021;6(3):100092. DOI: 10.1016/j.esmoop.2021.100092

10. Yavuzsen T., Walsh D., Davis M.P. et al. Components of the anorexiacachexia syndrome: gastrointestinal symptom correlates of cancer anorexia. Support Care Cancer 2009;17(12):1531–41. DOI: 10.1007/s0052000906235

11. Detsky A.S., McLaughlin J.R., Baker J.P. et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987;11(1):8–13. DOI: 10.1177/014860718701100108

12. Capuano G., Grosso A., Gentile P.C. et al. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck 2008;30(4):503–8. DOI: 10.1002/hed.20737

13. Handbook of EvidenceBased Radiation Oncology. 2nd edn. Eds.: E.K. Hansen, M. Roach. Springer, 2010. 786 p.

14. Cespedes Feliciano E.M., Lee V.S., Prado C.M. et al. Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: the CSCANS study. Cancer 2017;123(24):4868–77. DOI: 10.1002/cncr.30950

15. ESMO Handbook of Nutrition and Cancer. 2nd edn. Eds.: A. Jatoi, S. Kaasa, M. Strijbos. 2023.

16. Cawood A.L., Elia M., Stratton R.J. Systematic review and meta analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev 2012;11(2):278–96. DOI: 10.1016/j.arr.2011.12.008

17. Gorbunova V.A., Breder V.V. Quality of life of cancer patients. Proceedings of the 4th Russian Oncology Conference. Moscow, 2000. Pp. 125–7. (In Russ.).

18. V.M., Luft A.V. Nutritional support of oncological patients: possibilities and challenges. Vestnik intensivnoy terapii = Intensive Care Herald 2008;2:43–50. (In Russ.).

19. SonnebornPapakostopoulos M., Dubois C., Mathies V. et al. Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: a crosssectional study. Med Oncol 2021;38(2):20. DOI: 10.1007/s12032021014607

20. Campos M.I., Campos C.N., Aarestrup F.M., Aarestrup B.J. Oral mucositis in cancer treatment: natural history, prevention and treatment. Mol Clin Oncol 2014;2:337–40. DOI: 10.3892/mco.2014.253

21. Epstein J.B., Thariat J., Bensadoun R.J. Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA Cancer J Clin 2012;62(6):400–22. DOI: 10.3322/caac.21157

22. Supportive care in oncology: a practical guide. Eds.: S.Yu. Moorkraft, D.L.Yu. Li, D. Kanninhem; trans. from English edited by A.D. Kaprin. Moscow: GEOTARMedia, 2019. 440 p. (In Russ.).

23. Spotten L.E., Corish C.A., Lorton C.M. et al. Subjective and objective taste and smell changes in cancer. Ann Oncol 2017;28(5):969–84. DOI: 10.1093/annonc/mdx018

24. Weimann A., Braga M., Carli F. et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr 2017;36(3):623–50. DOI: 10.1016/j.clnu.2017.02.013

25. Dort J.C., Farwell D.G., Findlay M. et al. Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol Head Neck Surg 2017;143(3):292–303. DOI: 10.1001/jamaoto.2016.2981

26. Bargetzi L., Brack C., Herrmann J. et al. Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial. Ann Oncol 2021;32(8):1025–33. DOI: 10.1016/j.annonc.2021.05.793

27. Radiation oncology: an evidencebased approach. Eds.: J.J. Lu, L.W. Brady. New York: Springer, 2008. 657 p.

28. Mortensen H.R., Overgaard J., Jensen K. et al. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer. Acta Oncol 2013;52(7):1535–42. DOI: 10.3109/0284186X.2013.824609

29. Van Dijk L.V., Mohamed A.S.R., Ferrarotto R. et al. The impact of induction and/or concurrent chemoradiotherapy on acute and late patientreported symptoms in oropharyngeal cancer: application of a mixedmodel analysis of a prospective observational cohort registry. Cancer 2021;127(14):2453–64. DOI: 10.1002/cncr.33501

30. Langius J.A., van Dijk A.M., Doornaert P. et al. More than 10 % weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutr Cancer 2013;65(1):76–83. DOI: 10.1080/01635581.2013.741749

31. Ballesteros-Pomar M.D., Blay Cortés G., Botella Romero F. et al. Continuity of care in diseaserelated malnutrition and nutritional medical treatment. Endocrinol Diabetes Nutr (Engl Ed) 2022;69(10):897–909. DOI: 10.1016/j.endien.2022.11.013

32. Cereda E., Cappello S., Colombo S. et al. Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy. Radiother Oncol 2018;126(1):81–8. DOI: 10.1016/j.radonc.2017.10.015

33. Jiang W., Ding H., Li W. et al. Benefits of oral nutritional supplements in patients with locally advanced nasopharyngeal cancer during concurrent chemoradiotherapy: an exploratory prospective randomized trial. Nutr Cancer 2018;70(8):1299–307. DOI: 10.1080/01635581.2018.1557222

34. GonzálezRodríguez M., VillarTaibo R., FernándezPombo A. et al. Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fasttrack circuit. Eur J Clin Nutr 2021;75(5):748–53. DOI: 10.1038/s41430020007861

35. Bensinger W., Schubert M., Ang K.K. et al. NCCN Task Force Report. Prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 2008;6 Suppl 1:S1–24.

36. Galloway T., Amdur R. Management and prevention of complications during initial treatment of head and neck cancer. In: UpToDate. Eds.: M. Posner, B. Brockstein, D. Brizel, D. Deschler. 2014.

37. Langius J.A., Zandbergen M.C., Eerenstein S.E. et al. Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr 2013;32(5):671–8. DOI: 10.1016/j.clnu.2013.06.012

38. Cereda E., Turri A., Klersy C. et al. Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy. Cancer Med 2019;8(16):6923–32. DOI: 10.1002/cam4.2517

39. Kim S.H., Lee S.M., Jeung H.C. et al. The effect of nutrition intervention with oral nutritional supplements on pancreatic and bile duct cancer patients undergoing chemotherapy. Nutrients 2019;11(5):1145. DOI: 10.3390/nu11051145

40. Kabata P., Jastrzębski T., Kąkol M. et al. Preoperative nutritional support in cancer patients with no clinical signs of malnutrition – prospective randomized controlled trial. Support Care Cancer 2015;23(2):365–70. DOI: 10.1007/s0052001423634

41. Maňásek V., Bezděk K., Foltys A. et al. The impact of high protein nutritional support on clinical outcomes and treatment costs of patients with colorectal cancer. Klin Onkol 2016;29(5):351–7.

42. Mudarra García N., Naranjo Peña I., Olivares Pizarro S.P. et al. Presurgical nutrition support reduces the incidence of surgical wound complications in oncological patients. Nutr Cancer 2020;72(5):801–7. DOI: 10.1080/01635581.2019.1653473

43. Obukhova O.A. Is nutritional support necessary for patients with cancer? Klinicheskaya onkogematologiya = Clinical Oncohematology 2009;2(4):343–8. (In Russ.).

44. Nutritional support for cancer patients: a pocket guide. Moscow: ABVPress; Society of Supportive Care in Oncology, 2017. 94 p. (In Russ.).

45. Protocols of clinical guidelines for supporting therapy in oncology. 7th edn., revised. Moscow: ABVpress, 2023. 320 p. (In Russ.).

46. Prevost V., Joubert C., Heutte N., Babin E. Assessment of nutritional status and quality of life in patients treated for head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2014;131(2):113–20. DOI: 10.1016/j.anorl.2013.06.007

47. Kondrup J., Allison S.P., Elia M. et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22(4):415–21. DOI: 10.1016/s02615614(03)000980

48. Ligibel J.A., Bohlke K., May A.M. et al. Exercise, diet, and weight management during cancer treatment: ASCO Guideline. J Clin Oncol 2022;40(22):2491–507. DOI: 10.1200/JCO.22.00687

49. Association of Oncologists of Russia. Clinical Guidelines. 2020– 2024. Available at: https://oncologyassociation.ru (In Russ.).

50. Sytov A.V., Zuzov S.A., Leyderman I.N., Khoteev A.Zh. Practical guidelines for nutritional support in cancer patients. Zlokachestvennye opukholi: prakticheskie rekommendatsii RUSSCO = Malignant Tumors: RUSSCO Practical Guidelines 2020;10(3s2):117–25. (In Russ.). DOI: 10.18027/222450572020103s243

51. Cederholm T., Jensen G.L., Correia M.I.T.D. et al. GLIM criteria for the diagnosis of malnutrition – a consensus report from the global clinical nutrition community. Clin Nutr 2019;38(1):1–9. DOI: 10.1016/j.clnu.2018.08.002

52. Jobim Milanez D.S., Razzera E.L., da Silveira Knobloch I. et al. A scoping review on the GLIM criteria for malnutrition diagnosis: understanding how and for which purpose it has been applied in studies on hospital settings. Clin Nutr 2023;42(1):29–44. DOI: 10.1016/j.clnu.2022.10.022

53. Zhang X., Zhang X., Zhu Y. et al. Predictive value of nutritional risk screening 2002 and mini nutritional assessment short form in mortality in Chinese hospitalized geriatric patients. Clin Interv Aging 2020;15:441–9. DOI: 10.2147/CIA.S244910

54. Boyko A.V., Gevorkov A.R., Volkova E.E., Shashkov S.V. Nutritional support as an obligatory component of accompanying therapy for head and neck tumors during radiotherapy and chemoradiotherapy. Opukholi golovy i shei = Head and Neck Tumors 2017;7(1):50–60. (In Russ.). DOI: 10.17650/222214682017715060

55. Bozzetti F., Bozzetti V. Efficacy of enteral and parenteral nutrition in cancer patients. Nestle Nutr Workshop Ser Clin Perform Programme 2005;10:127–42. DOI: 10.1159/000083302

56. Elia M., Van Bokhorstde van der Schueren M.A., Garvey J. et al. Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: a systematic review. Int J Oncol 2006;28(1):5–23. DOI: 10.3892/ijo.28.1.5

57. Sánchez Alvarez C., Nuñez Ruiz R., Morán García V. Soporte nutricional en el paciente con neoplasia digestiva [Nutritional support in the patient with GI malignancy]. Nutr Hosp 2005;20(2):38–40. [In Spanish].

58. Snegovoy A.V., Leyderman I.N., Saltanov A.I., Strelchuk V.Yu. Basic principles and technologies of clinical nutrition in oncology: a methodological guide for doctors. Moscow, 2006. 35 p. (In Russ.).

59. Order of the Ministry of Health of the Russian Federation of 05.08.2003 No. 330 (as amended on 19.02.2024) “On measures to improve therapeutic nutrition in medical and preventive institutions of the Russian Federation”. Appendix No. 5. (In Russ.).

60. Bernhardson B.M., Tishelman C., Rutqvist L.E. Chemosensory changes experienced by patients undergoing cancer chemotherapy: a qualitative interview study. J Pain Symptom Manage 2007;34(4):403–12. DOI: 10.1016/j.jpainsymman.2006.12.010

61. Bernhardson B.M., Tishelman C., Rutqvist L.E. Selfreported taste and smell changes during cancer chemotherapy. Support Care Cancer 2008;16(3):275–83. DOI: 10.1007/s0052000703197

62. De Haan J.J., Moshage Y., Kluifhooft D. et al. Impact of taste alterations during systemic antitumour therapy on the liking of oral nutritional supplements with adapted flavours. Ann Oncol 2018;29(Suppl 8):viii620.

63. Epstein J.B., Barasch A. Taste disorders in cancer patients: pathogenesis, and approach to assessment and management. Oral Oncol 2010;46(2):77–81. DOI: 10.1016/j.oraloncology.2009.11.008

64. Gamper E.M., Zabernigg A., Wintner L.M. et al. Coming to your senses: detecting taste and smell alterations in chemotherapy patients. A systematic review. J Pain Symptom Manage 2012;44(6):880–95. DOI: 10.1016/j.jpainsymman.2011.11.011

65. Kershaw J.C., Mattes R.D. Nutrition and taste and smell dysfunction. World J Otorhinolaryngol Head Neck Surg 2018;4(1):3–10. DOI: 10.1016/j.wjorl.2018.02.006

66. Nishijima S., Yanase T., Tsuneki I. et al. Examination of the taste disorder associated with gynecological cancer chemotherapy. Gynecol Oncol 2013;131(3):674–8. DOI: 10.1016/j.ygyno.2013.09.015

67. Steinbach S., Hundt W., Schmalfeldt B. et al. Effect of platinum containing chemotherapy on olfactory, gustatory, and hearing function in ovarian cancer patients. Arch Gynecol Obstet 2012;286(2):473–80. DOI: 10.1007/s0040401223075

68. Steinbach S., Hummel T., Böhner C. et al. Qualitative and quantitative assessment of taste and smell changes in patients undergoing chemotherapy for breast cancer or gynecologic malignancies. J Clin Oncol 2009;27(11):1899–905. DOI: 10.1200/JCO.2008.19.2690

69. Yarom N., Hovan A., Bossi P. et al. Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines – part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents. Support Care Cancer 2020;28(5):2457–72. DOI: 10.1007/s00520019052564

70. Paleri V., Roe J.W., Strojan P. et al. Strategies to reduce longterm postchemoradiation dysphagia in patients with head and neck cancer: an evidencebased review. Head Neck 2014;36(3):431–43. DOI: 10.1002/hed.23251

71. Pauloski B.R. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am 2008;19(4):889–928. DOI: 10.1016/j.pmr.2008.05.010

72. Payakachat N., Ounpraseuth S., Suen J.Y. Late complications and longterm quality of life for survivors (>5 years) with history of head and neck cancer. Head Neck 2013;35(6):819–25. DOI: 10.1002/hed.23035

73. Brady O., Donnelly M., Horgan A., Maher M. Postradiotherapy side effects for head and neck cancer – the patient’s perspective. Proc Nutr Soc 2011;70(OCE5):E283. DOI: 10.1017/S0029665111003685

74. Kang H.S., Roh J.L., Kim S.B. Noncancerrelated health events and mortality in head and neck cancer patients after definitive radiotherapy: a prospective study [published correction appears in Medicine (Baltimore) 2016;95(24):e8157]. Medicine (Baltimore) 2016;95(19):e3403. DOI: 10.1097/MD.0000000000003403

75. Sullivan E.S., Rice N., Kingston E. et al. 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;41:331–9. DOI: 10.1016/j.clnesp.2020.10.023


Review

For citations:


Gevorkov A.R., Snegovoy A.V. Malnutrition screening and nutritional support for cancer patients. Clinical guidelines and features of their application in real practice. Oncohematology. 2024;19(4):188-203. (In Russ.) https://doi.org/10.17650/1818-8346-2024-19-4-188-203

Views: 267


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1818-8346 (Print)
ISSN 2413-4023 (Online)