OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press98710.17650/1818-8346-2024-19-4-188-203SUPPORTIVE THERAPY ASPECTSАСПЕКТЫ ПОДДЕРЖИВАЮЩЕЙ ТЕРАПИИMalnutrition screening and nutritional support for cancer patients. Clinical guidelines and features of their application in real practiceСкрининг нутритивной недостаточности и нутритивная поддержка онкологических больных Клинические рекомендации и особенности их применения в реальной практикеhttps://orcid.org/0000-0002-9181-7811GevorkovA. R.ГеворковА. Р.
Russian Federation

Artem Rubenovich Gevorkov,

3 2nd Botkinskiy Proezd, Moscow 125284

Артем Рубенович Геворков,

125284 Москва, 2-й Боткинский пр-д, 3

dr.gevorkov@gmail.comhttps://orcid.org/0000-0002-0170-5681SnegovoyA. V.СнеговойА. В.
Russian Federation

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

105425 Москва, 3-я Парковая ул., 51, стр. 1

P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of RussiaМосковский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииN.A. Lopatkin Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Radiological Center, Ministry of Health of RussiaНаучно-исследовательский институт урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России101220241941882031012202410122024https://oncohematology.abvpress.ru/ongm/article/view/987

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.

Нутритивная недостаточность – значимая проблема для пациентов с гемобластозами и солидными опухолями, негативный прогностический и предиктивный фактор, который снижает эффективность противоопухолевой терапии и ухудшает прогноз выживаемости.

В статье обсуждается роль нутритивной поддержки в улучшении результатов лечения, снижении осложнений и повышении качества жизни онкологических пациентов. Рассматриваются современные клинические рекомендации по применению нутритивной поддержки в онкологии и онкогематологии, подчеркивается необходимость раннего вмешательства и постоянного мониторинга для предотвращения и устранения нутритивных нарушений. Также обсуждаются различные методы нутритивной поддержки, включая пероральное, энтеральное и парентеральное питание, и важность персонализированного подхода для удовлетворения индивидуальных потребностей пациентов.

malnutritiononcohematologynutritional supportchemotherapyнутритивная недостаточностьонкогематологиянутритивная поддержкахимиотерапияPressoir 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.6605578Laviano A., Meguid M.M. Nutritional issues in cancer management. Nutrition 1996;12(5):358–71. DOI: 10.1016/s08999007(96)80061xDel 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.2011.0098Baracos V.E., Martin L., Korc M. et al. Cancerassociated cachexia. Nat Rev Dis Primers 2018;4:17105. DOI: 10.1038/nrdp.2017.105Ryan 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.2019.06.020Baracos V.E. Cancer-associated malnutrition. Eur J Clin Nutr 2018;72(9):1255–9. DOI: 10.1038/s4143001802454Muscaritoli M., Arends J., Bachmann P. ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr 2021;40(5): 2898–913. DOI: 10.1016/j.clnu.2021.02.005Muscaritoli 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.20168Arends 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.2021.100092Yavuzsen 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/s0052000906235Detsky 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: 10.1177/014860718701100108Capuano 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.20737Handbook of EvidenceBased Radiation Oncology. 2nd edn. Eds.: E.K. Hansen, M. Roach. Springer, 2010. 786 p.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.30950ESMO Handbook of Nutrition and Cancer. 2nd edn. Eds.: A. Jatoi, S. Kaasa, M. Strijbos. 2023.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.2011.12.008Gorbunova 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.).Горбунова В.А., Бредер В.В. Качество жизни онкологических больных. Материалы 4й Российской онкологической конференции. М., 2000. С. 125–7.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.).Луфт В.М., Луфт А.В. Нутриционная поддержка онкологических больных: возможности и противоречия. Вестник интенсивной терапии 2008;2:43–50.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/s12032021014607Campos 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.2014.253Epstein 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.21157Supportive 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.).Сопроводительная терапия в онкологии: практическое руководство. Под ред. С.Ю. Мооркрафта, Д.Л.Ю. Ли, Д. Каннингэма; пер. с англ. под ред. А.Д. Каприна. М.: ГЭОТАРМедиа, 2019. 440 с.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/mdx018Weimann 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.2017.02.013Dort 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.2016.2981Bargetzi 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.2021.05.793Radiation oncology: an evidencebased approach. Eds.: J.J. Lu, L.W. Brady. New York: Springer, 2008. 657 p.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.2013.824609Van 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.33501Langius 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: 10.1080/01635581.2013.741749Ballesteros-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.2022.11.013BallesterosPomar 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.2022.11.013Cereda 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.2017.10.015Jiang 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: 10.1080/01635581.2018.1557222GonzálezRodríguez 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/s41430020007861Bensinger 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.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.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.2013.06.012Cereda 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/cam4.2517Kim 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/nu11051145Kabata 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/s0052001423634Maňásek 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.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: 10.1080/01635581.2019.1653473Obukhova O.A. Is nutritional support necessary for patients with cancer? Klinicheskaya onkogematologiya = Clinical Oncohematology 2009;2(4):343–8. (In Russ.).Обухова О.А. Необходима ли питательная поддержка больным с онкологическими заболеваниями? Клиническая онкогематология 2009;2(4):343–8.Nutritional support for cancer patients: a pocket guide. Moscow: ABVPress; Society of Supportive Care in Oncology, 2017. 94 p. (In Russ.).Нутритивная поддержка при онкологических заболеваниях. Карманный справочник. М.: АБВпресс; Общество специалистов поддерживающей терапии в онкологии, 2017. 94 с.Protocols of clinical guidelines for supporting therapy in oncology. 7th edn., revised. Moscow: ABVpress, 2023. 320 p. (In Russ.).Протоколы клинических рекомендаций поддерживающей терапии в онкологии. 7е изд., перераб. и доп. М.: АБВпресс, 2023. 320 с.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.2013.06.007Kondrup 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)000980Ligibel 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.22.00687Association of Oncologists of Russia. Clinical Guidelines. 2020– 2024. Available at: https://oncologyassociation.ru (In Russ.).Ассоциация онкологов России. Клинические рекомендации. 2020–2024. Доступно по: https://oncologyassociation.ruSytov 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: 10.18027/222450572020103s243Сытов А.В., Зузов С.А., Лейдерман И.Н., Хотеев А.Ж. Практические рекомендации по нутритивной поддержке онкологических больных. Злокачественные опухоли: практические рекомендации RUSSCO 2020;10(3s2):117–25. DOI: 10.18027/222450572020103s243Cederholm 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.2018.08.002Jobim 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.2022.10.022Zhang 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.S244910Boyko 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: 10.17650/222214682017715060Бойко А.В., Геворков А.Р., Волкова Е.Э., Шашков С.В. Нутритивная поддержка как обязательный компонент терапии сопровождения при лучевом и химиолучевом лечении больных с опухолями головы и шеи. Опухоли головы и шеи 2017;7(1):50–60. DOI: 10.17650/222214682017715060Bozzetti F., Bozzetti V. Efficacy of enteral and parenteral nutrition in cancer patients. Nestle Nutr Workshop Ser Clin Perform Programme 2005;10:127–42. DOI: 10.1159/000083302Elia 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.28.1.5Sánchez 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].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.).Снеговой А.В., Лейдерман И.Н., Салтанов А.И., Стрельчук В.Ю. Основные принципы и технологии клинического питания в онкологии: методическое руководство для врачей. М., 2006. 35 с.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.).Приказ Министерства здравоохранения Российской Федерации от 05.08.2003 № 330 (ред. от 19.02.2024) «О мерах по совершенствованию лечебного питания в лечебнопрофилактических учреждениях Российской Федерации». Приложение № 5.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.2006.12.010Bernhardson 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/s0052000703197De 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.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.2009.11.008Gamper 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.2011.11.011Kershaw 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.2018.02.006Nishijima 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.2013.09.015Steinbach 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/s0040401223075Steinbach 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.2008.19.2690Yarom 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/s00520019052564Paleri 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.23251Pauloski 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.2008.05.010Payakachat 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.23035Brady 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/S0029665111003685Kang 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.0000000000003403Sullivan 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