Here’s what you can (and should) do –

From Vera Martinella

There are many risks to patients who lose a lot of weight, especially for those with tumors of the pancreas, esophagus, stomach, head and neck. With the help of a nutritionist, you can live better and longer

Malnutrition is a very common problem among cancer patients It brings with it a series of serious consequences: prolonged and repeated hospitalizations over time, increased toxicity and decreased efficacy of anticancer therapies, which leads to a deterioration in the patient’s quality of life and prognosis. Finally, there is a significant waste of resources on the part of the National Health System used to treat the effects of excessive weight loss that can instead be prevented or immediately treated. A problem, although it is very clear and very present to both those directly concerned and oncologists, in our country it is still often underestimated or not dealt with in appropriate times and methods. That’s why, in the past five years, experts from the Italian Inter-Society Working Group on Nutritional Support for Cancer Patients have worked on new guidelines, just published in the journal. Cancer Magazine
and updating its predecessors (which were from 2016) with the aim of providing a synthetic and usable tool for all specialists treating cancer patients.

What’s new in the latest recommendations of 2022?

Compared to the previous document, the surgical part was introduced as there is more and more evidence pointing to preoperative nutritional therapy as a major factor in reducing complications and, consequently, hospitalization and recovery times, as well as healthcare costs – responses Ricardo Catzialanza, Director of the Nutrition and Clinical Nutrition Unit at IRCCS Policlinico San Matteo di Pavia Foundation, Working Group Coordinator -. In addition, the concept was introduced that for tumors at risk for malnutrition, it is necessary to initiate an education and close monitoring program from the time of diagnosis, regardless of nutritional screening results that can change rapidly during treatment. This is because it is increasingly clear from the scientific literature that early dietary intervention is key to ensuring its best efficacy.

Who are the patients most at risk of losing weight?

The numbers illustrate the problem: in general about 30% of cancer patients are malnourished, or at risk of developing malnutrition, already at the time of diagnosis – recalls Francesco Di Lorenzo, president of the Italian Federation of Voluntary Societies in Oncology (FAVO) who was involved in New directives -. With the passage of time and succession of treatments, inadequate nutrition becomes a very common problem, to the point that it affects up to 60-80% of patients. Especially when you reach advanced stages of cancer or if you suffer from certain types of cancers such as pancreatic, esophageal, stomach, head and neck. The consequences can be so dire that, according to statistics, one in four cancer patients dies from malnutrition and not directly from cancer.

When do cancer patients need nutritional support and why?

Nutritional support is needed as soon as the risk of malnutrition appears, which is already present in many types of tumors (eg, head and neck, gastrointestinal, pancreatic and lung tumors) since diagnosis – explains Caccialanza -. Preventing excessive weight loss and deterioration in nutritional status is of primary importance to allow patients to receive treatment to avoid complications, and thus to be able to obtain better clinical outcomes and maintain a better quality of life. This basic concept is emphasized in the new recommendations.

What types of support are available?

We have different types of interventions based on the degree of impaired ability to eat, explains Caccialanza. Nutritional counseling aims to improve nutrition in terms of calorie and protein intake through personalized nutritional indicators aimed at managing symptoms (eg lack of appetite, digestive problems, difficulty swallowing). If proper nutritional status cannot be maintained by nutrition alone, oral nutritional supplements should be used which in some regions (eg Lombardy, Piedmont) can be given free of charge to patients according to specialized prescriptions. If these drugs are not effective or in the event of inability to eat (eg inability to swallow) or absorb nutrients (as occurs in the treatment of chemical diarrhea), it is necessary to resort to artificial feeding, which consists in giving nutritional mixtures at the intestinal level Through probes (enteral nutrition) or intravenously through a catheter (parenteral nutrition).

Where do you go for help?

Patients should be referred from the oncology department to clinical feeding units or reference services – answers Paolo Pedrazuli, Director of the Department of Oncology at the S. Matteo di Pavia Clinic at IRCCS Polyclinic -. In fact, nutritional support should be prescribed and monitored by specialized medical personnel with specific skills in clinical nutrition, with the support of dieticians, and should be shared with oncologists treating specific clinical pathways, which also include the administration of artificial feeding in the home.

What should patients and family members do?

Patients and caregivers should be aware of the importance of maintaining adequate nutritional support from the early stages of the disease, and if not provided, ask their oncologists ahead of time for clinical references to contact nutritional care – Pedrazuli concludes -. It is necessary to monitor the trend of weight, through weekly checks and try to maintain a satisfactory eating, also on the basis of practical advice available on the official channels of reference scientific societies or associations of patients such as the specific AIMAC handbook.

Jun 15 2022 (change on Jun 15, 2022 | 19:08)

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