Nutritional Aspect of Cancer Care in Medical Oncology Patients

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Cancer survivorship has become a long-term experience worldwide.1x1Muscaritoli, M., Molfino, A., Lucia, S., and Rossi Fanelli, F. Cachexia: a preventable comorbidity of cancer. A T.A.R.G.E.T. approach. Crit Rev Oncol Hematol. 2015;
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Progressive deterioration of nutritional status is a common feature of patients with cancer. Accordingly, >50% of hospitalized patients with cancer and up to 30% of cancer outpatients are estimated to be malnourished. Cancer-related malnutrition (CRM) is almost universal and occurs in 50%–80% of patients with cancer.5x5Fearon, K.C. Cancer cachexia: developing multimodal therapy for a multidimensional problem. Eur J Cancer. 2008;
44: 1124–1132
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,6x6Sánchez-Lara, K., Turcott, J.G., Juárez-Hernández, E. et al. Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomised trial. Clin Nutr. 2014;
33: 1017–1023
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,7x7Nixon, D.W., Heymsfield, S.B., Cohen, A.E. et al. Protein-calorie undernutrition in hospitalized cancer patients. Am J Med. 1980;
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,8x8Fearon, K.C., Glass, D.J., and Guttridge, D.C. Cancer cachexia: mediators, signaling, and metabolic pathways. Cell Metab. 2012;
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CRM is estimated to be the immediate cause of death in 20%–40% of patients with cancer. Furthermore, CRM is not merely synonymous with weight loss; it is a multilayered, multifaceted process of complex etiology and involves weight loss as one of the clearly visible components.9x9Fearon, K.C. and Moses, A.G. Cancer cachexia. Int J Cardiol. 2002;
85: 73–81
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Currently, in general oncology practice, nutritional support is provided only for the 30%–60% of patients with cancer who were already identified to be at risk of malnutrition,4x4Arends, J., Baracos, V., Bertz, H. et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017;
36: 1187–1196
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However, despite the improved understanding of the importance of CRM over the past decade,16x16Argilés, J.M., López-Soriano, F.J., and Busquets, S. Mechanisms to explain wasting of muscle and fat in cancer cachexia. Curr Opin Support Palliat Care. 2007;
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CRM has been addressed in the recently published, evidence-based guidelines for nutrition care in cancer patients by the European Society for Clinical Nutrition and Metabolism (ESPEN),2x2Arends, J., Bachmann, P., Baracos, V. et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;
36: 11–48
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Currently, the majority of medical oncologists consider weight loss and muscle loss to be an inevitable consequence of progressive tumor growth and thus focus on better control of tumor growth; a small minority consider the potential of nutritional intervention to improve the quality of life and life expectancy and await evidence-based data to enact a change in their clinical practice.5x5Fearon, K.C. Cancer cachexia: developing multimodal therapy for a multidimensional problem. Eur J Cancer. 2008;
44: 1124–1132
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The present consensus statement by a panel of medical oncologists thus aimed to provide a practical and implementable guidance document and a comprehensive framework for addressing nutritional aspects of cancer care from the medical oncologist’s perspective in terms of definition, epidemiology, pathophysiology, adverse outcomes, and treatment (nutritional support, exercise, pharmacological interventions, and multimodal combined strategy) of CRM and the role of oncologists in the nutritional aspects of cancer care.

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