title: Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE).
abstract: Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support. We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. "Alternative hypocaloric anti-cancer diets" (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status. Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients.
authors.affiliation: 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caccialanza
authors.affiliation: 2. Division of Medical Oncology, Department of Hemato-Oncology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
authors.forename: Paolo
authors.initials: P
authors.lastname: Pedrazzoli
authors.affiliation: 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.affiliation: 3. Clinical Nutrition Unit, National Cancer Institute, Milan, Italy;
authors.forename: Cecilia
authors.initials: C
authors.lastname: Gavazzi
authors.affiliation: 4. Medical Oncology, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy;
authors.forename: Carmine
authors.initials: C
authors.lastname: Pinto
authors.affiliation: 5. Endocrinology, Metabolism and Nutrition Unit, Local Health Authority ULSS 9, Treviso, Italy;
authors.forename: Agostino
authors.initials: A
authors.lastname: Paccagnella
authors.affiliation: 6. Medical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy;
authors.forename: Giordano Domenico
authors.initials: GD
authors.lastname: Beretta
authors.affiliation: 7. Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padova, Italy;
authors.forename: Mariateresa
authors.initials: M
authors.lastname: Nardi
authors.affiliation: 8. Department of Clinical Medicine, University La Sapienza, Rome, Italy;
authors.forename: Alessandro
authors.initials: A
authors.lastname: Laviano
authors.affiliation: 9. Medical Oncology 1, Veneto Institute of Oncology-IRCCS, Padova, Italy.
authors.forename: Vittorina
authors.initials: V
authors.lastname: Zagonel
keywords: cancer; malnutrition; nutritional support
references.citation: Anticancer Agents Med Chem. 2013 Oct;13(8):1197-203
references.pmid: 23919745
references.citation: Clin Nutr. 2009 Aug;28(4):467-79
references.pmid: 19464089
references.citation: Eur J Oncol Nurs. 2005;9 Suppl 2:S51-63
references.pmid: 16437758
references.citation: Drug Resist Updat. 2012 Feb-Apr;15(1-2):114-22
references.pmid: 22391012
references.citation: JPEN J Parenter Enteral Nutr. 2012 May;36(3):292-8
references.pmid: 22045723
references.citation: Clin Nutr. 2006 Apr;25(2):245-59
references.pmid: 16697500
references.citation: Am J Clin Nutr. 2012 Dec;96(6):1346-53
references.pmid: 23134880
references.citation: JPEN J Parenter Enteral Nutr. 2014 Feb;38(2):196-204
references.pmid: 24748626
references.citation: Clin Nutr. 2012 Dec;31(6):854-61
references.pmid: 22698802
references.citation: Clin Nutr. 2012 Jun;31(3):293-312
references.pmid: 22257636
references.citation: Crit Rev Oncol Hematol. 2013 Aug;87(2):172-200
references.pmid: 23746998
references.citation: Support Care Cancer. 2008 May;16(5):447-51
references.pmid: 18196284
references.citation: Curr Opin Oncol. 2011 Jul;23 (4):322-30
references.pmid: 21552123
references.citation: Integr Cancer Ther. 2013 Sep;12(5):369-84
references.pmid: 23439656
references.citation: Am J Clin Nutr. 2010 Sep;92(3):612-9
references.pmid: 20631202
references.citation: Dig Liver Dis. 2014 Aug;46(8):667-74
references.pmid: 24794790
references.citation: Eur J Clin Nutr. 2015 Dec;69(12):1290-7
references.pmid: 26220573
references.citation: Am J Hosp Palliat Care. 2006 Oct-Nov;23(5):369-77
references.pmid: 17060304
references.citation: Nutrients. 2015 Jan 05;7(1):265-76
references.pmid: 25569622
references.citation: Clin Nutr. 2013 Oct;32(5):671-8
references.pmid: 23845384
references.citation: J Hum Nutr Diet. 2012 Jun;25(3):201-8
references.pmid: 22257023
references.citation: JPEN J Parenter Enteral Nutr. 2009 Sep-Oct;33(5):472-500
references.pmid: 19713551
references.citation: Clin Nutr. 2009 Aug;28(4):445-54
references.pmid: 19477052
references.citation: PLoS One. 2014 Feb 28;9(2):e88553
references.pmid: 24586342
references.citation: Clin Nutr. 2006 Apr;25(2):224-44
references.pmid: 16698152
references.citation: Semin Oncol Nurs. 2015 Feb;31(1):42-52
references.pmid: 25636394
references.citation: J Natl Cancer Inst. 2012 Mar 7;104(5):371-85
references.pmid: 22345712
references.citation: Am J Clin Nutr. 2007 Sep;86(3):s878-81
references.pmid: 18265482
references.citation: Clin Nutr. 2014 Oct;33(5):872-8
references.pmid: 24182767
references.citation: Br J Cancer. 2006 Aug 21;95(4):431-4
references.pmid: 16880793
references.citation: Nutrients. 2015 Mar 11;7(3):1828-40
references.pmid: 25768953