Malnutrition in cancer patients: Causes, consequences and treatment options

Dissecting the global leadership initiative on malnutrition criteria in advanced cancer: Reduced intake vs. inflammation

BACKGROUND & AIMS

The Global Leadership Initiative on Malnutrition (GLIM) criteria have been recommended for the diagnosis of malnutrition. It requires that the patient meets at least one phenotypic criterion and at least one aetiological criterion. For the latter, the patient must either demonstrate reduced food intake or have evidence of systemic inflammation. As both are common in advanced cancer, the aim of the present study was to determine, in patients who met the GLIM phenotypical criteria, which GLIM aetiological criteria (reduced food intake or systemic inflammation) is most useful in predicting overall survival (OS).

METHODS

Data from two cancer biobanks were combined. Inclusion criteria were: ≥18 years, advanced cancer (stage III or IV) and ability to provide written consent. Weight loss (WL) was selected as the phenotypic criterion of choice, as preliminary analysis demonstrated it to be a superior predictor of OS compared to body mass index. Malnutrition type 1 was defined as >5 % WL over 6 months and a C reactive protein (CRP) ≥3 mg/l. Further analysis was performed with a CRP >10 mg/l cut-off. Malnutrition type 2 was defined as >5 % WL over 6 months and reduced food intake, as reported in the Patient Generated Subjective Global Assessment. Survival was assessed using Kaplan-Meier methodology, log-rank tests and Cox proportional hazards models, with hazard ratios (HR) and confidence intervals (CI) reported.

RESULTS

In total, 176 patients were studied, with 147 events observed. The 3-month mortality rate was 32.4 % (CI: 25.1 to 39.0) and the 1-year mortality rate was 71.8 % (CI: 63.8 to 78.0). Malnutrition type 1 and malnutrition type 2 were observed in 37.8 % (HR: 2.27 [CI: 1.54 to 3.33], p < 0.001) and 26.3 % (HR: 1.74 [CI: 1.19 to 2.54], p = 0.005) of patients respectively, with both significantly increasing the risk of death. Following adjustment for relevant confounders both malnutrition type 1 (HR: 1.92 [CI: 1.25 to 2.94], p = 0.003) and malnutrition type 2 (HR: 1.61 [CI: 1.09 to 2.38], p = 0.019) remained significant predictors of OS. Median survival for patients with malnutrition type 1 was 2.14 (CI: 1.74 to 4.90) months compared to 9.5 (6.94-13.64) months for those without (p < 0.001). For malnutrition type 2, this was 2.37 (CI: 1.64 to 5.46) vs. 7.40 months (CI: 6.08 to 10.16), p = 0.004. When the CRP threshold was increased to >10 mg/l, malnutrition type 1 was observed in fewer patients (30.4%), median survival was shorter (1.91 [CI: 1.25 to 2.99] vs. 9.86 months [CI: 7.27 to 14.7], p < 0.001) and in both univariable (HR: 2.91 [CI: 1.94 to 4.63], p < 0.001) and multivariable (HR: 2.32 [CI: 1.50 to 3.60], p < 0.001) analyses, the risk of death increased.

CONCLUSION

The results suggest that the inflammatory component of GLIM appears superior compared to reduced intake in predicting OS and notably, a higher CRP threshold correlates with shorter OS. Therefore, whilst GLIM has multiple potential combinations, all treated with equal regard, these data suggest that the inflammatory aetiological component should be hierarchical to others.

[Psychological stress and psychiatric comorbidities in the treatment of dysphagia in patients with head and neck cancer]

BACKGROUND

Dysphagia, along with dysphonia and dyspnea, is undoubtedly one of the major problems in the treatment of head and neck tumors. However, impairment of the ability to swallow has many different aspects.

OBJECTIVE

This article aims to shed light on the interactions and interdependencies between dysphagia and psychological stress and psychiatric comorbidities. This should provide the basis for improved treatment coordination.

MATERIALS AND METHODS

A literature search was carried out in the PubMed database using the search terms "dysphagia AND hnc/hnscc AND psychiatric," "dysphagia AND hnc/hnscc AND psychologic," and "dysphagia AND hnc/hnscc AND stress." In addition, the authors were able to draw on their many years of experience with the treatment of patients with dysphagia on the background of head and neck tumors.

RESULTS

Psychological stress and psychiatric comorbidities play a significant role in the treatment of dysphagia in patients with head and neck tumors, which makes an early examination and, if necessary, psycho-oncological intervention useful.

CONCLUSION

In our view, multidisciplinary patient care is recommended, e.g., as part of an oncology ward round with medical staff from the fields of otorhinolaryngology or oral and maxillofacial surgery, phoniatrics, and pediatric audiology as well as professionals from the fields of nursing, speech therapy, nutritional counseling, psycho-oncology, and social services.

A dynamic online nomogram for predicting nutritional risk in nasopharyngeal carcinoma patients after radiotherapy

PURPOSE

Malnutrition is a prevalent and detrimental complication in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. Early identification and intervention are crucial for optimizing outcomes.

METHODS

We retrospectively analyzed data from 383 patients with NPC who underwent radiotherapy. We employed logistic regression analysis to identify risk factors for malnutrition and developed a nomogram for its prediction. The nomogram was internally and externally validated using bootstrap methods and calibration curves.

RESULTS

Body mass index (BMI), chemotherapy cycles, central venous catheter (CVC), and alanine aminotransferase (ALT) were identified as independent risk factors for malnutrition. The nomogram demonstrated good discriminatory ability (AUC: 0.786 in the training set, 0.687 in the validation set) and clinical utility, with high net benefit in decision curve analysis.

CONCLUSIONS

This nomogram offers a practical tool for predicting nutritional risk in patients with NPC undergoing radiotherapy. Its application can facilitate early identification of at-risk patients and guide targeted interventions to improve clinical outcomes.

The bidirectional association of malnutrition with depression and anxiety in patients with cancer: a systematic review and meta-analysis of evidence

BACKGROUND

Anxiety and depression are common mental health problems in cancer patients. At the same time, cancer patients often suffer from disease-related catabolic dysregulation and malnutrition. Emerging evidence has suggested the potential link between mental disorders and nutritional status.

AIMS

This study summarised the evidence for the association of malnutrition with anxiety and depression in cancer patients.

METHODS

A systematic search of PubMed and EMBASE databases was performed for observational studies published up to December 2024.

RESULTS

Forty-one articles were found eligible for inclusion in the systematic review, and twenty-nine in the meta-analysis. Compared with the normally nourished cancer patients, malnourished patients had a more than threefold (relative risk (RR) = 3.23, 95% CI 2.39, 4.38) and nearly twofold (RR = 1.87, 95% CI 1.48, 2.37) increased risk of depression and anxiety, respectively. Considering the studies that identified lower emotional status as a cause rather than an effect of malnutrition, the inverse association was confirmed only for depression (RR = 2.01, 95% CI 1.62, 2.49), but not for anxiety (RR = 1.38, 95% CI 0.68, 2.80). Finally, the standardised mean differences of the psychological scores showed significantly higher values in individuals with nutritional impairment compared to those with normal nutritional status (SMD = 0.69, 95% CI 0.50, 0.88 for depression and SMD = 0.54, 95% CI 0.26, 0.82 for anxiety).

CONCLUSIONS

Mental health problems such as anxiety and depression are associated with malnutrition in cancer patients.

Impact of body mass index on D-dimer diagnostic utility for deep vein thrombosis in patients with cancer: a single-center retrospective analysis

BACKGROUND

Deep vein thrombosis (DVT) is a common complication in cancer patients associated with significant morbidity and mortality. D-dimer is a widely used screening tool for suspected DVT; however, its accuracy may be influenced by body mass index (BMI). We evaluated whether BMI modified the diagnostic utility of D-dimer levels in patients with cancer and DVT.

METHODS

We retrospectively analyzed 439 patients with newly diagnosed solid cancers suspected of having DVT between January 2013 and December 2020. DVT was confirmed or excluded by using computed tomography or echography. D-dimer was measured, and patients were classified by BMI as low- (< 18.5 kg/m2), normal- (18.5-24.9 kg/m2), or high-BMI (≥ 25.0 kg/m2). D-dimer levels, positive and negative predictive values (PPV and NPV), and overall survival (OS) were compared.

RESULTS

Of 439 patients, 175 (39.9%) had DVT. BMI did not differ significantly between the DVT-positive and DVT-negative patients. In the normal and high BMI groups, D-dimer levels were significantly higher in patients with DVT than those without (p < 0.01), whereas patients with a low BMI did not show this difference (p = 0.12). Using a 1 µg/mL cut-off, PPV was 32% in low-, 52% in normal-, and 49% in high-BMI patients; NPV was 83%, 91%, and 97%, respectively. OS did not differ among the BMI groups, and no deaths were directly related to DVT.

CONCLUSION

Diagnostic performance of D-dimer level may diminish in underweight patients with cancer. Clinicians should carefully interpret the D-dimer levels in low-BMI populations and consider additional diagnostic strategies.

The Role of Registered Dietitians in Cancer Palliative Care: Responsibilities, Challenges, and Interdisciplinary Collaboration-A Cross-Sectional Survey

Registered dietitians (RDs) in palliative care help maintain patients' quality of life by providing personalized nutritional support that alleviates eating-related distress. This study aimed to clarify the role of RDs in palliative care by examining their responsibilities and challenges in caring for cancer patients. A nationwide mailed survey was conducted in 2022, focusing on RDs involved in cancer palliative care. One RD per facility was included from all 501 hospitals accredited by Japan's Ministry of Health, Labour and Welfare. Multivariate analysis identified factors related to collaboration with palliative care teams and challenges in cancer care. Responses from 325 RDs (63.9%) across 325 hospitals (63.9%) were analyzed. Among RDs who consistently collaborated with the palliative care team (PCT), significant associations (p < 0.05) were found with exclusive engagement in cancer/palliative care, providing nutritional counseling to inpatients, the frequency of ward rounds, and individualized meal provision. Challenges included the following: "I struggled with determining appropriate food choices for patients unable to eat", and "Metabolic complications like cachexia hindered my ability to provide adequate support". RDs play a crucial role in providing individualized meals for cancer patients through PCT collaboration and ward rounds. To ensure effective support in challenging situations, RDs must be exclusively engaged in palliative care and receive specialized education.

Predictive Value of Nutritional Status for Symptomatic Radiation Pneumonitis in Patients with Thoracic Cancer Undergoing Radiotherapy

The association between nutritional status and the risk of radiation pneumonitis (RP) in patients with thoracic cancer undergoing radiotherapy remains unclear and warrants further investigation. General clinical data between January 2021 and June 2024 were retrospectively analyzed. RP was diagnosed and graded according to the Common Terminology Criteria for Adverse Events (version 5), with symptomatic RP defined as grade ≥2. Predictive factors for RP were identified using least absolute shrinkage and selection operator and multivariate logistic regression analyses, followed by the development of a nomogram. The predictive performance of the nomogram was evaluated using the area under the curve (AUC) of receiver operating characteristic, calibration curve, and decision curve analysis. Controlling Nutritional Status (CONUT) scores and V5 were identified as independent predictors of symptomatic RP and incorporated into the predictive model. The nomogram demonstrated excellent predictive capability (AUC: 0.851; 95% confidence interval: 0.801-0.902), with good accuracy and clinical application utility. Nutritional status is associated with the development of symptomatic RP. The pre-radiotherapy CONUT score can serve as a predictor of symptomatic RP, and its incorporation into the CONUT-V5 model achieves better discriminative capacity. Improving nutritional status may be a simple way to prevent the development of symptomatic RP.

Cancer Patients' Behavior and Perception on the Use of Medical Foods and Dietary Supplements During Chemotherapy

Purpose

The emerging clinical implications of medical foods and dietary supplements in cancer patients have been recognized. This study aimed to evaluate the perception and usage of these products in cancer patients undergoing chemotherapy.

Patients and Methods

Cross-sectional descriptive research was conducted by face-to-face interviews between October 2017 and February 2018. The participants provided written informed consent before data collection.

Results

This study included 201 patients (mean age 55.9 years) with gastrointestinal, breast, gynecological, and respiratory tract cancers, primarily receiving antimetabolite or platinum-based regimens. Awareness of medical foods and dietary supplements was high, at 97% and 98%, respectively. Most patients (91.5% for medical foods, 80.1% for dietary supplements) believed these products could be used safely without side effects, and over 70% thought they could be used concurrently with chemotherapy. More than half of the patients reported receiving supplement information from friends or relatives, while 65.2% stated that healthcare providers did not ask about their uses. Notably, 69.7% and 51.2% of patients reported current use of medical foods and dietary supplements, respectively, but 61.7% did not disclose this to their healthcare providers primarily since they were not asked.

Conclusion

These findings highlight the need for healthcare professionals to actively address the use of medical foods and dietary supplements with cancer patients. Enhanced communication and guidance could ensure safe and effective integration of these products into supportive cancer care.

The Impact of Nutritional Support on Outcomes of Lung Cancer Surgery-Narrative Review

Background: Malnutrition is a prevalent yet often overlooked issue in lung cancer patients, significantly affecting surgical outcomes. This review examines the impact of nutritional status on lung cancer surgery and explores the role of nutritional assessment and intervention strategies. Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. Key studies on nutritional status assessment, preoperative nutritional support, and their impact on surgical outcomes were analyzed. Results: Malnutrition in lung cancer patients is associated with increased postoperative complications, prolonged hospital stays, and reduced survival rates. Various assessment tools, including dietary interviews, physical examinations, laboratory tests, and body composition analyses, can help identify malnourished patients. Nutritional support strategies such as high-protein diets, oral supplements, enteral and parenteral nutrition, and perioperative immunomodulation improve clinical outcomes. Conclusions: Implementing standardized nutritional assessment and support protocols is crucial for optimizing surgical outcomes in lung cancer patients. Integrating these strategies into the Enhanced Recovery After Surgery (ERAS) protocol may further enhance recovery and long-term prognosis.

Evaluation and Prognostic Impact of Nutrition in Patients with Acute Leukemia: A Narrative Review

PURPOSE OF THIS REVIEW

Acute leukemia (AL) is a hematological neoplasm with rapid progression that affects nutritional status of patients. Assessing nutrition in patients with haematological malignancies poses challenges due to the rapid progression of the disease, the variety of methods for evaluating malnutrition. In this review we will provide evidence of the need of early malnutrition diagnosis thru timely assessment and the implications of malnutrition in patients evolution in patients with AL.

RECENT FINDINGS

The prevalence of malnutrition ranging from 15 to 26.5% among patients with AL. It is well known that inflammation and cytokine production have been recognized as potential mechanisms of CCS in hematologic malignancies. Regardless of the mechanism underlying Cancer Cachexia Syndrome (CCS) in AML, patients undergoing conditioning chemotherapy and during transplant or antineoplastic treatment. In addition to this, patients with AL undergoing chemotherapy frequently face two main challenges: oral mucositis (OM) and neutropenic colitis (NC). Both conditions challenge nutrition intake and nutrients absorption which make them more susceptible to have nutritional deficits. Malnutrition in patients with acute leukemia face a higher risk of therapy failure, increased rates of relapse, and higher mortality rates. Nutritional status impact patient's prognosis in many ways, malnutrition increases risk of antineoplastic treatment toxicities, hospital stay, and cost, as well reduces quality of life and this condition worsens patient's prognosis.

Toward a Pragmatic Multidisciplinary Management of Nutritional Risk in Hospitalized Patients: Initiatives and Proposals of the Clinical Nutrition Network of Lombardy Region

Malnutrition is a widespread problem in hospitalized patients, which significantly impacts clinical outcomes, quality of life, and healthcare costs. Despite its well-documented consequences, it remains underdiagnosed and inadequately managed in many healthcare settings. Even with recent progress, key challenges remain, including inconsistent use of standardized nutritional screening tools and practices, insufficient professional training, and resource limitations. A multidisciplinary approach involving physicians, dietitians, nurses, and pharmacists is crucial for early detection, timely intervention, and prevention of malnutrition-related complications. The sustainability of a multidisciplinary model requires overcoming logistical and financial barriers, including the integration of technology for real-time monitoring, standardized screening protocols, and specific professional training. Regional initiatives, such as the establishment of the Clinical Nutrition Network of Lombardy (Italy), reported and discussed in this article, have made strides in improving nutritional care by promoting scientific networking and standardized practices across hospitals. This approach may not only improve patient outcomes but also reduce long-term healthcare costs by shortening hospital stays and preventing readmissions. For this model to be effective and sustainable, collaboration among healthcare providers, policymakers, and researchers is essential to promote an integrated, cost-effective approach to managing nutritional risk throughout the continuum of care.

The impact of malnutrition in the radiotherapy pathway in geriatric patients in the onco-surgical settings on behalf of the Turkish Society for Radiation Oncology Study Group (TROD 12-04)

AIM

This study explores the impact of age, malnutrition severity, and malnutrition risk on cancer treatment outcomes and their incidence based on cancer localization and stage, in geriatric and adult patients in Turkey. The study emphasizes the role of oral nutritional supplements (ONS) in improving nutritional status and treatment response in both age groups.

MATERIALS AND METHODS

This prospective observational cohort study involved 163 patients with solid tumors receiving radiotherapy (RT) or RT combined with chemotherapy. Malnutrition risk was assessed using the Nutritional Risk Screening (NRS) tool, and malnutrition severity was determined via body mass index (BMI). The significance of age, malnutrition severity, and risk on treatment outcomes and performance status were evaluated by the physician and the Eastern Cooperative Oncology Group Performance Status. Anthropometric measurements recorded before and after treatment were compared to evaluate ONS benefits across age and cancer groups.

RESULTS

Of the patients, 50.9 % were aged ≥70 years. A majority had stage III cancer (57.4 %) and lung cancer (38.7 %). Weight and BMI scores significantly decreased from pre-to post-treatment (P < 0.001). Malnutrition risk was higher in stage III cancer (P = 0.039), and geriatric patients had higher baseline NRS scores than adults (P = 0.049). Pre-treatment weight loss and malnutrition risk negatively affected RT response (P < 0.007). Post-treatment malnutrition risk prevalence increased significantly in head and neck cancer patients (P = 0.016).

CONCLUSIONS

Nutritional therapy is crucial alongside cancer treatment, as pre-treatment weight loss and NRS≥3 negatively affect RT response. Maintaining a healthy nutritional status correlates with better outcomes, necessitating further research to optimize interventions stabilizing weight and BMI during RT.

A Randomized Controlled 'REAL-FITNESS' Trial to Evaluate Physical Activity in Patients With Newly Diagnosed Multiple Myeloma

BACKGROUND

Multiple myeloma (MM) is the second most common haematological malignancy. The predominantly older patients often suffer from comorbidities that impair their quality of life (QoL). Physical activity (PA) can be beneficial for cancer patients, but less evidence exists in MM. This randomized controlled trial (RCT) compared an exercise group with World Health Organization (WHO)-compliant PA (150 min aerobic exercise and 2 resistance training-sessions/week) vs. activity as usual (control group).

METHODS

Thirty-four newly diagnosed consecutive MM patients were randomized 1:1 to exercise vs. control groups. Guided training (2×/week) was performed for 3 months during bortezomib-cyclophosphamide-dexamethasone (VCd) induction. PA was monitored using smartwatches and diaries. Demographics, osteolytic lesions, infections, fatigue, depression, and biomarkers (albumin, creatine kinase, C-reactive protein, high-density lipoprotein, low-density lipoprotein and pro-brain natriuretic peptide) were compared in exercise vs. control cohorts. VCd-tolerance, response, 'timed-up-and-go-test' (TUGT), Revised Myeloma Comorbidity Index (R-MCI), QoL (SF-12 questionnaire), event-free survival and trainer assignment during the training period were assessed (13 tests at baseline, during VCd and end of treatment [EOT]).

RESULTS

The exercise group was more than twice as active as the control group, with an average aerobic activity of 162 versus 68 min/week, respectively. Trainer-guided muscle-strengthening exercises were performed 2×/week in the exercise group, in line with WHO recommendations. These data were monitored via smartwatches and training diaries. PA proved to be safe: No exercise-related SAEs or accidents occurred. The study adherence was 94% (32/34). In the exercise versus control group, AEs to VCd induction (6% vs. 25%), therapy intolerance (6% vs. 25%) and hospitalization (31% vs. 50%, respectively) occurred less frequently. VCd-dose adjustments in the exercise vs. control group were significantly less needed (6.3% vs. 37.5%, respectively). At EOT, patients in the exercise group showed less fatigue (6% vs. 75%), less depression (6% vs. 44%), better TUGT (6 vs. 11 s, respectively), improved R-MCI and QoL compared to the control group. Grip strength (right hand: 73-82 lb; left hand: 68-72 lb) significantly improved from baseline to EOT in the exercise group. Biomarkers did not significantly differ in both groups, but response to VCd-induction and event-free survival were improved in the exercise group, however, without reaching statistical significance.

CONCLUSIONS

PA in MM patients during induction is feasible and can improve fatigue, depression, TUGT, grip strength, comorbidities and QoL. More sport intervention offers are warranted to advance exercising in MM.

TRIAL REGISTRATION

drks.de: DRKS00022250.

Impact of preoperative malnutrition, based on albumin level and body mass index, on operative outcomes in noncirrhosis patients with colorectal liver metastasis

Background

Serum albumin level and body mass index (BMI), acting as indicators of nutritional status, are commonly applied to predict surgical outcomes in cancer patients. This study aimed to evaluate the impact of preoperative serum albumin level and BMI on the operative outcomes of noncirrhotic patients with colorectal cancer liver metastasis who underwent hepatectomy.

Methods

This was a retrospective study of medical records from the period between January 2013 and December 2022. Preoperative malnutrition was defined as hypoalbuminemia with a serum albumin level of <35 g/L before surgery or a BMI of <18.5 kg/m2 within 30 days before surgery. Multiple statistical methods were applied to analyze the data, including the two-independent sample t-test, analysis of variance, Chi-squared test, and multivariate analysis.

Results

Among the 159 eligible patients, 42 (26.4%) were classified into the preoperative malnutrition group. The incidence of blood transfusion (45.24% vs. 18.80%, P = 0.040) was significantly higher in the malnutrition group. The drainage volume was significantly higher on the first day [65 (115) vs. 60 (80), P < 0.05] and the second day [50 (95) vs. 40 (79) P < 0.05] in the malnutrition group than that in the nonmalnutrition group. Postoperative hemoglobin levels were significantly lower in the malnutrition group (101.20 ± 2.43 vs. 108.76 ± 1.61, P = 0.015). Therefore, the incidence of grade Ⅱ or Ⅲ/Ⅳ complications was significantly higher in the malnutrition group (16.67% vs. 5.31% or 11.9% vs. 3.42%, P = 0.001), and the length of hospital stay was significantly extended [18 (12) vs. 15 (8), P = 0.002]. In the multivariate analysis, preoperative malnutrition [odds ratio (OR) = 5.548, 95% CI 1.508-20.413, p = 0.010] and operation time (OR = 1.009, 95% CI 1.002-1.016, P = 0.0011) were identified as independent predictors of postoperative complications.

Conclusion

Preoperative malnutrition in patients who underwent hepatectomy for colorectal cancer liver metastasis was associated with worse surgical outcomes, especially aggrandizing the emergence of postoperative complications.

Mean Platelet Volume-to-Albumin Ratio as a Predictor of Mortality in Patients with Febrile Neutropenia: An Observational Study

Background and Objectives: Febrile neutropenia (FN) is a life-threatening complication in cancer patients, necessitating early risk stratification for optimal management. While the Multinational Association for Supportive Care in Cancer (MASCC) risk index is commonly used for mortality prediction, novel biomarkers that integrate inflammatory and nutritional status may improve prognostic accuracy. This study evaluates the mean platelet volume (MPV)-to-albumin (ALB) ratio as a predictor of mortality in patients with febrile neutropenia. Materials and Methods: A prospective study was conducted on patients diagnosed with febrile neutropenia. The MPV/ALB ratio was calculated at admission, and its predictive value for mortality was assessed using receiver operating characteristic (ROC) curve analysis. The results were compared with the MASCC risk index for predicting mortality both during the FN episode and within 28 days. Statistical analysis included sensitivity, specificity, and negative predictive value assessments. Results: The MPV/ALB ratio was significantly lower in non-survivors compared to survivors. A threshold of 0.245 effectively stratified patients at high risk, demonstrating strong specificity and high negative predictive value. The MPV/ALB ratio outperformed the MASCC risk index in predicting mortality during febrile neutropenia, whereas the MASCC index showed slightly better performance for 28-day mortality prediction. Conclusions: The MPV/ALB ratio is a promising biomarker for mortality prediction in febrile neutropenia, offering a simple and accessible tool for early risk assessment. Its superior performance in predicting mortality during FN highlights its potential clinical utility. Further prospective studies are needed to validate these findings and explore the integration of the MPV/ALB ratio into existing risk assessment models.

Association between CONUT scores and survival outcomes in patients with non-small cell lung cancer: meta-analysis from 4973 Asian cases

Background

The controlling nutritional status (CONUT) score is associated with cancer prognosis. However, a consensus on its prognostic value in patients with non-small cell lung cancer(NSCLC) is lacking. The present study aims to investigate the relationship between the CONUT score and prognostic and clinicopathological features of NSCLC.

Methods

The PubMed, Embase, Web of Science and Cochrane Library were searched up to July 2024. Two researchers used the Newcastle Ottawa Scale (NOS) score to evaluate the quality of the included studies and extracted data. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), and the hazard ratio (HR) and 95% confidence interval (CI) were pooled for meta-analysis. The pooled odds ratio (OR) and 95% CI were used to estimate the correlation between the CONUT score and clinical characteristics. Subgroup analysis and sensitivity analysis were performed during the pooled analysis.Funnel plots as well as Begg's and Egger's tests were used to assess publication bias.

Results

Fifteen high-quality studies with 4973 patients were included. The results indicated that a high CONUT score was associated with poor OS (HR = 1.84, 95%CI: 1.55-2.18; P < 0.0001) and DFS (HR=2.40, 95%CI: 1.73-3.34; P < 0.0001).In addition, a high CONUT score was significantly related to male, advanced age, high CEA, and later TNM stage.

Conclusion

The results of our meta-analysis suggest that a high CONUT score predicts a poor prognosis of NSCLC patients. In clinical practice, the CONUT score could act as an valuable tool to predict clinical outcomes in patients with NSCLC.

Systematic Review Registration

https://inplasy.com, identifier INPLASY202408280100.

Knowledge, attitudes, and practices of gastric cancer patients toward nutritional therapy

Background

To investigate the knowledge, attitude, and practice (KAP) of patients with gastric cancer (GC) toward nutritional therapy.

Methods

This cross-sectional study was conducted from January to March 2024 at the Affiliated Hospital of Jiangnan University (Wuxi, China) and enrolled patients with GC. Questionnaires (Cronbach's α = 0.923) were used to collect data on demographics and KAP dimensions. Scores >75% were considered good. Multivariable analyses were performed to examine the factors associated with KAP. A structural equation modeling (SEM) analysis was performed to examine the relationships among KAP dimensions.

Results

The analysis included 486 valid questionnaires. The median knowledge, attitude, and practice scores were 6.0 (0-16; 37.5%), 26.0 (7-35; 74.3%), and 28.7 (8-40; 71.7%) indicating poor KAP. Only agricultural, forestry, animal husbandry, fishery, and water conservancy production personnel (OR = 0.09, 95%CI: 0.02-0.49, p = 0.006) were independently associated with knowledge. Knowledge (OR = 1.11, 95%CI: 1.05-1.18, p < 0.001) and a monthly income of 10,000-20,000 (OR = 3.85, 95%CI: 1.23-12.06, p = 0.021) were independently associated with attitude. Knowledge (OR = 1.22, 95%CI: 1.15-1.30, p < 0.001), attitude (OR = 1.21, 95%CI: 1.11-1.32, p < 0.001), personnel other than leading cadres of state organs and enterprises (all OR < 1 and all p < 0.05), and a monthly income of 10,000-20,000 yuan (OR = 3.02, 95%CI: 1.15-7.96, p = 0.025) were independently associated with practice. Knowledge had a direct positive influence on attitude (β = 0.350, p < 0.001) and practice (β = 0.460, p < 0.001) and an indirect positive influence on practice (β = 0.146, p < 0.001). Attitude had a direct positive influence on practice (β = 0.417, p < 0.001).

Conclusion

Patients with GC in Wuxi partly had poor KAP toward nutritional support.

The effects of enteral tube feeding on nutrition, survival, and quality of life outcomes in advanced upper gastrointestinal cancers: a systematic literature review

PURPOSE

Despite guidelines, enteral tube feeding is not routinely provided to advanced upper gastrointestinal (UGI) cancer patients who cannot consume adequate nutrition and who have an expected survival of at least 3 months. This review examined its effect on nutrition status, survival, and quality of life (QOL) in these patients.

METHODS

Five databases (CINAHL, Cochrane, Embase, Ovid, Web of Science) were searched for original research on nutrition, survival, and/or QOL outcomes in adults with inoperable UGI cancers receiving enteral tube feeding. Quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist: Primary Research, and a narrative synthesis was conducted.

RESULTS

Five studies were eligible for inclusion, most participants were male (n = 205), with low sample sizes across all studies (n = 16-131). Enteral tube feeding resulted in a similar proportion of participants with weight loss above or below 5% (baseline to 12 weeks) compared to a control group [p > 0.05] (1 study), and a significant increase in mean lean body mass [+1.3 (± 4.0) kg, p = 0.01] (1 study). There was variability in survival outcomes, statistical modelling, and comparators in five studies, with subsequently contradictory results. Only one study reported on QOL. Study quality was assessed as neutral (4 studies) or negative (1 study), reflecting methodological/analytical issues across the studies.

CONCLUSIONS

This systematic literature review highlights a significant knowledge gap, with no high-quality randomised controlled trial-based evidence available on enteral nutrition efficacy, limiting its use in dietetic practice in this sub-population. Despite treatment developments prolonging survival, research investigating feeding and its impact on QOL remains inadequate. Further research is needed to promote change and influence practice, policy, and guidelines, alongside high-quality intervention studies with defined nutrition outcomes, regimens, and robust statistical analyses to determine the benefits of enteral tube feeding in this vulnerable population.

Percutaneous Endoscopic Gastrostomy in the 21st Century-An Overview of 1415 Consecutive Dysphagic Adult Patients

Background/Objectives: Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition in dysphagic patients. This study aims to characterize conditions motivating PEG, assess nutritional status on the gastrostomy day, evaluate survival and search for survival predictors. Methods: Retrospective study of adult patients who underwent PEG in a tertiary hospital from 2001 to 2023. Data collected included demographics, underlying disorders, nutritional status (anthropometry/laboratory evaluation) on the day of PEG and survival recorded until death or December 2023. Multivariable analysis was performed with Cox regression to search for survival predictors. Results: A total of 1415 patients were included (61.8% males, mean age 66.9 years); 66.4% presented a neurological disorder and 31.3% head and neck or esophageal cancers (HNC/EC). The mean BMI was 20.9 kg/m2, with 49.8% underweight. Albumin, transferrin and total cholesterol were low at 43.2%, 62.2% and 50%, respectively. Median overall survival was 11.1 months; 14.1% of deaths occurred within 4 weeks. HNC/EC patients showed lower survival than neurological patients. Potentially regressive neurological conditions presented longer survival than progressive ones. Predictors of increased survival included female gender, younger age, higher albumin and higher BMI. The protective effect of BMI and albumin was more pronounced in males than in females. Conclusions: Neurological disorders were the most frequent underlying conditions. Nearly half of the patients displayed malnutrition before PEG feeding. Although PEG-fed patients displayed a considerable median survival time, some died early without benefit from PEG. Patients with potentially regressive neurological conditions presented better outcomes. Female gender, younger age, higher albumin and higher BMI were associated with longer survival.

Effect of Hemoglobin, Albumin, Lymphocyte Count, and Platelet (HALP) Score on Survival of Patients with Metastatic Thyroid Cancer Treated with Tyrosine Kinase Inhibitors

Tyrosine kinase inhibitors (TKIs) are crucial for improving the survival rates of individuals with metastatic thyroid cancer. Moreover, systemic inflammation and malnutrition are known to negatively affect metastatic thyroid cancer prognosis. Evaluating nutritional status at the start of treatment can improve survival rates. Purpose: This study investigated the correlation between the hemoglobin, albumin, lymphocyte count, and platelet (HALP) score and prognosis of patients with metastatic thyroid cancer undergoing first-line TKI therapy. Methods: We retrospectively analyzed data from 44 patients between January 2010 and June 2024. The primary outcomes evaluated in the study were time to treatment failure (TTF) and overall survival (OS); HALP scores were categorized as low (≤29.21) and high (>29.21) based on receiver operating characteristic analysis. Results: The 1-year survival rate was significantly lower in the low HALP score group compared to the high HALP score group (50% vs. 96.3%). Multivariate Cox regression analysis revealed that low HALP scores, elevated leukocyte counts, and lymphopenia were independent predictors of shorter TTF (HR = 0.272, p = 0.011) and OS (HR = 0.208, p = 0.028). Conclusions: The results obtained in the present study demonstrate that the HALP score has prognostic significance for patients with metastatic thyroid cancer who are undergoing first-line TKI treatment. In metastatic thyroid cancer patients, interventions focused on improving nutritional status at the start, during initiation, and throughout the TKI treatment may enhance treatment effectiveness. However, further prospective studies involving larger patient cohorts are necessary to validate our results.

Low body mass index demonstrates satisfactory specificity for diagnosing malnutrition and is associated with longer hospitalization in patients with gastrointestinal or head and neck cancer: a prospective cohort study

Background

The main causes of malnutrition in patients with gastrointestinal and head and neck cancers include metabolic alterations determined by the tumour and its stage, as well as low food intake caused by the disease itself and the effects of antineoplastic treatment. In the hospital environment, nutritional markers, such as body mass index (BMI), handgrip strength (HGS) and calf circumference (CC), can be used to identify malnutrition early, ensuring individualized and specific nutritional intervention. However, few studies have evaluated the individual performance of nutritional indicators in diagnosing malnutrition in a cancer setting. We aimed to assess the ability of these nutritional indicators to accurately diagnose malnutrition and their association with length of hospital stay (LOS) in patients with cancer.

Methods

This cohort study prospectively evaluated 171 patients with gastrointestinal or head and neck cancer. Nutritional status was assessed within 48 hours of hospital admission using BMI, CC and HGS as well as two reference standards: subjective global assessment (SGA) and patient-generated SGA (PG-SGA). The accuracy of each nutritional indicator was measured by the area under the receiver operating characteristic curve (AUC) compared with the reference standards. Multiple logistic regression analysis, adjusted for confounders, was used to determine whether malnutrition was associated with LOS.

Results

Of 171 patients, 59.1% had low CC, 46.2% had low HGS and 13.5% had low BMI. The SGA and PG-SGA scores indicated malnutrition in 57.4% and 87.2% of patients, respectively. All nutritional indicators had poor accuracy in diagnosing malnutrition (AUC < 0.70). However, compared with SGA and PG-SGA, low BMI had satisfactory specificity (>80%) and was associated with 1.79 times higher odds of LOS ≥ 6 days. Malnutrition diagnosed by SGA and PG-SGA increased the odds of LOS ≥ 6 days by 3.60-fold and 2.78-fold, respectively.

Conclusion

Low BMI showed adequate specificity for diagnosing malnutrition and was associated with longer LOS in patients with gastrointestinal or head and neck cancer. Further research is needed to explore how improved screening, interventions and nutritional support could reduce malnutrition rates in cancer patients.

Optimisation of the patient having oncological surgical through prehabilitation: a narrative review

INTRODUCTION

Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery.

METHODS

We searched databases of peer-reviewed research to identify appropriate papers. Keywords comprised 'prehabilitation', 'cancer surgery' and associated synonyms (prehab; pre-operative rehabilitation; cancer). The results were combined with articles identified by reviewing the references of key papers and the use of the grey literature to develop our discussion.

RESULTS

We detail the different elements of prehabilitation (exercise, nutrition, psychological support) relevant to patients with cancer undergoing surgery, focusing on the recent evidence base and ongoing challenges. Within this, we consider the role of behaviour change in enabling patients to undertake prehabilitation interventions and reflect on the different models of prehabilitation that have been utilised. Facilitators and barriers to implementation of prehabilitation are explored. Key findings include positioning prehabilitation as an integral part of the oncological surgical pathway which includes, but is discrete from, medical optimisation.

DISCUSSION

Prehabilitation has the potential to improve surgical outcomes for patients undergoing cancer surgery. Further evidence is needed to understand how and what we provide to patients as optimal exercise, nutrition and psychological interventions as part of their surgical care, and how we improve long-term lifestyle using behaviour change methodology. Digital technology offers the opportunity for scaling and greater personalisation of prehabilitation but needs to be deliberately fashioned to ensure equitable access.

Effect of Whey Protein Supplementation on Postoperative Outcomes After Gynecological Cancer Surgery: A Randomized Controlled Trial

Background

Whey protein's biochemical properties make it an ideal nutritional supplement for patients with cancer, especially in perioperative care. Thus, the present study aims to assess the efficacy of whey protein supplementation (WPS) compared to standard care in enhancing postoperative outcomes for patients undergoing comprehensive surgical staging for gynecological cancer.

Methods

In an open-label, randomized controlled trial conducted at Rajavithi Hospital between November 28, 2023 and July 8, 2024, 61 patients scheduled for comprehensive surgical staging were enrolled. Participants were randomized in a 1:1 ratio to either the WPS group (n = 30) or the control group (n = 31). The WPS group received isolated whey protein powder (20 g of protein per serving), administered at 6 pm before surgery and 6 am on the first postoperative day. The control group received standard postoperative care. The primary endpoint was the length of hospital stay (LOHS), with secondary outcomes including gastrointestinal function recovery, postoperative analgesic use, complications, and potential WPS-related adverse events such as transaminitis, acute kidney injury, and electrolyte imbalances.

Results

The WPS group had a significantly shorter LOHS than the control group (79.0 ± 6.7 vs. 93.3 ± 28.4 h, P = 0.021). Additionally, the WPS group demonstrated significant improvements in gastrointestinal function, with shorter times to first flatus (P < 0.001), first defecation (P = 0.013), and first ambulation (P = 0.043). No significant differences were observed between the groups regarding postoperative analgesic use or complications, including fever, nausea/vomiting, wound infection, and readmission (P > 0.05). Furthermore, no WPS-related adverse events were reported.

Conclusion

The use of WPS in the perioperative operative management of gynecological cancer surgery yields promising results by significantly reducing the LOHS and accelerating the recovery of gastrointestinal function while maintaining a favorable safety profile.

Nutritional Status and Information Provided to Polish Cancer Patients Assessed Using the EORTC QLQ-INFO25 Questionnaire

Background/Objectives: Malnutrition in cancer patients may significantly affect various aspects of the quality of life, outcomes, and prognosis, while satisfaction with the information provided may also influence these aspects. This study aims to assess the nutritional status of Polish cancer patients and its association with the level of information received, their potential need for more information, and the resultant quality of life. Methods: A cross-sectional study was conducted in 104 cancer patients. Validated European Organization for Research and Treatment of Cancer questionnaires EORTC QLQ-C30 and EORTC QLQ-INFO25 were used, and nutritional assessment was conducted using Subjective Global Assessment (SGA). Results: Male patients reported receiving more information than females about the disease, treatment, and care options, as well as greater satisfaction, and a higher overall score. Patients receiving enteral nutrition were more satisfied compared to those not receiving it, even if the scores for the information obtained within the specific areas did not differ, but they still wished to receive more information. Older patients reported higher scores than younger patients, indicating a higher level of information received regarding medical tests and higher satisfaction. The EORTC QLQ-INFO25 global score showed strong or moderate positive correlations with the majority of modules, and the level of information provided significantly influenced satisfaction. Conclusions: Female patients, those not receiving enteral nutrition, and young patients were less satisfied with the information received, which may negatively influence their quality of life. Effective communication with patients highlights the need for personalized informational support to enhance quality of life.

High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies

Introduction: Pancreaticoduodenectomy (PD) is a major surgery associated with significant morbidity and mortality, especially in older adult patients. Malnutrition is a common complication in these patients and is linked to poorer outcomes. This study aimed to investigate the associations between preoperative nutritional status using the Geriatric Nutritional Risk Index (GNRI) and postoperative outcomes in older adult patients who underwent PD. Methods: A retrospective cohort study was conducted on 363 older adult patients who underwent PD. The preoperative GNRI was calculated based on serum albumin levels and body mass index. GNRI ≤ 82, GNRI 83 to ≤98, and GNRI > 98 were classified as severely malnourished, moderately/mildly malnourished, and no malnourishment, respectively. Perioperative data, including demographics, comorbidities, and postoperative complications, were collected. Univariate and multivariate analyses were performed to assess the associations between the GNRI and outcomes such as length of hospital stay, postoperative complications, and overall survival. Results: Patients with a higher GNRI were more likely to experience Clavien-Dindo grade ≥ 3b postoperative complications (42.1% vs. 22.0% vs. 14.1%; p = 0.027) and pulmonary complications (26.3% vs. 11.9% vs. 4.2%; p = 0.016). These patients also stayed at the hospital for a longer duration (17.0% vs. 16.0% vs. 11.0%; p < 0.001). Multivariate analysis confirmed that the GNRI was an independent predictor of adverse outcomes, even after adjusting for other confounding factors. Conclusions: Our findings highlight the importance of preoperative nutritional assessment in older adult patients undergoing PD. Patients with low GNRI scores are at increased risk of postoperative complications and prolonged recovery. These results underscore the need for targeted nutritional interventions and regular monitoring of these patients. Future studies should focus on interventions to improve nutritional status in older adult patients undergoing PD.

Near-Death Quality of Life in Cancer Patients on Home Parenteral Nutrition

Background: The impact of home parenteral nutrition (HPN) on the quality of life (QoL) of cancer patients has been previously investigated. However, scarce data are available regarding near-death QoL in patients with cancer receiving HPN. This study aims to investigate the changes of QoL in these patients in the last two months before death. Methods: This is a secondary analysis of a previous, prospective, longitudinal, observational study. QoL was assessed using the EORTC QLQ-C30 questionnaire. Results: Eighty-four adult cancer patients who died on HPN and had filled out the questionnaire between 31 and 60 days (M2) and within 30 days prior (M1) to death were included in this analysis. The questionnaires filled out at M2 and M1 were compared with those filled out by the same patients at HPN start (T0). At M2, there was a significant improvement in both the global QoL and symptoms scales (p < 0.001 and p < 0.033, respectively), while at M1, a significant improvement in the global QoL scale persisted (p < 0.035) compared with T0. Conclusions: Our study first reports that HPN, if started early and according to European guidelines, is associated with an improvement in the QoL of patients with cancer even in the last two months before death.

Cancer knocks you out by fasting: Cachexia as a consequence of metabolic alterations in cancer

Neoplastic transformation reprograms tumor and surrounding host cell metabolism, increasing nutrient consumption and depletion in the tumor microenvironment. Tumors uptake nutrients from neighboring normal tissues or the bloodstream to meet energy and anabolic demands. Tumor-induced chronic inflammation, a high-energy process, also consumes nutrients to sustain its dysfunctional activities. These tumor-related metabolic and physiological changes, including chronic inflammation, negatively impact systemic metabolism and physiology. Furthermore, the adverse effects of antitumor therapy and tumor obstruction impair the endocrine, neural, and gastrointestinal systems, thereby confounding the systemic status of patients. These alterations result in decreased appetite, impaired nutrient absorption, inflammation, and shift from anabolic to catabolic metabolism. Consequently, cancer patients often suffer from malnutrition, which worsens prognosis and increases susceptibility to secondary adverse events. This review explores how neoplastic transformation affects tumor and microenvironment metabolism and inflammation, leading to poor prognosis, and discusses potential strategies and clinical interventions to improve patient outcomes.

Phase Angle and Ultrasound Assessment of the Rectus Femoris for Predicting Malnutrition and Sarcopenia in Patients with Esophagogastric Cancer: A Cross-Sectional Pilot Study

BACKGROUND

Disease-related malnutrition (DRM) and sarcopenia are prevalent conditions in gastrointestinal cancer patients, whose early diagnosis is essential to establish a nutritional treatment that contributes to optimizing adverse outcomes and improving prognosis. Phase angle (PhA) and rectus femoris ultrasound measurements are considered effort-independent markers of muscle wasting, which remains unrecognized in oncology patients.

OBJECTIVE

This study aimed to evaluate the potential utility of PhA, rectus femoris cross-sectional area (RFCSA), and rectus femoris thickness (RF-Y-axis) in predicting malnutrition and sarcopenia in patients with esophagogastric cancer (EGC).

METHODS

This was a cross-sectional study of patients diagnosed with EGC. PhA was obtained using bioelectrical impedance vector analysis (BIVA) along with ASMMI. The RFCSA and RF-Y-axis were measured using nutritional ultrasound (NU®). Muscle capacity was assessed using handgrip strength (HGS), and functionality by applying the Short Physical Performance Battery (SPPB). Malnutrition and sarcopenia were determined according to the GLIM and EWGSOP2 criteria, respectively.

RESULTS

Out of the 35 patients evaluated, 82.8% had malnutrition and 51.4% had sarcopenia. The RFCSA (r = 0.582) and RF-Y-axis (r = 0.602) showed significant, moderate correlations with ASMMI, unlike PhA (r = 0.439), which displayed a weak correlation with this parameter. However, PhA (OR = 0.167, CI 95%: 0.047-0.591, p = 0.006), RFCSA (OR = 0.212, CI 95%: 0.074-0.605, p = 0.004), and RF-Y-axis (OR = 0.002, CI 95%: 0.000-0.143, p = 0.004) all showed good predicting ability for sarcopenia in the crude models, but only the RF-Y-axis was able to explain malnutrition in the regression model (OR = 0.002, CI 95%: 0.000-0.418, p = 0.023).

CONCLUSIONS

The RF-Y-axis emerged as the only independent predictor of both malnutrition and sarcopenia in this study, likely due to its stronger correlation with ASMMI compared to PhA and RFCSA.

Biological Effect of Food for Special Medical Purposes (NutramilTM Complex) on Melanoma Cells in In Vitro Study

BACKGROUND/OBJECTIVES

Melanoma malignum is considered the most dangerous form of skin cancer, characterized by the exceptional resistance to many conventional chemotherapies. The aim of this study was to evaluate the effect of NutramilTM Complex (NC)-Food for Special Medical Purpose (FSMP), on two types of melanoma cell lines, primary WM115 and malignant WM266-4.

METHODS

At 24 h after seeding, growth medium was replaced with a medium containing encoded treatments of NC or NC-CC (NutramilTM Complex without calcium caseinate) at various concentrations. Cells were treated for 24, 48, and 72 h.

RESULTS

Our results showed that NutramilTM Complex reduces proliferation of malignant melanoma WM266-4 cells but did not affect the proliferation of WM115 primary melanoma. This was followed by measured down-regulation of selected pro-survival proteins expression in WM266-4 cells, specifically ERK1/2, AKT-1, HSP27, Survivin, and TAK1. Interestingly, our results showed elevated levels of some pro-apoptotic proteins in both cell lines, including Bad, Smad2, p38MAPK, cleaved forms of Caspase-3/7, as well as cleaved PARP.

CONCLUSIONS

Taken together, our results indicate that various melanoma cancer cell lines may respond in a different way to the same compound. They also suggest induction of apoptotic pathway by NutramilTM Complex as the most likely mechanism of its anticarcinogenic activity.

Prognostic Nutritional Index and the Survival of Patients with Endometrial cancer: A Meta-analysis

The prognostic nutritional index (PNI) has emerged as a potential predictor of clinical outcomes in various cancers. However, a quantativetily analysis of its role in endometrial cancer (EC) remains lacking. This meta-analysis aims to evaluate the prognostic value of PNI on the survival outcomes of patients with EC. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Wanfang, and CNKI to identify relevant cohort studies. Studies were included if they provided sufficient data to calculate hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) based on PNI levels. Data extraction and quality assessment were performed independently by two reviewers. Pooled HRs with 95% confidence intervals (CIs) were calculated using a random-effects model to account for heterogeneity. A total of 10 studies, encompassing 3656 patients, met the inclusion criteria. The meta-analysis revealed that a low PNI was significantly associated with poorer OS (HR = 2.01, 95% CI = 1.62-2.49, p < 0.05; I2 = 54%) and PFS (HR = 2.75, 95% CI = 1.74-4.33, p < 0.05; I2 = 78%) in patients with EC. Subgroup analyses indicated that the prognostic impact of PNI was consistent in studies from Asian and non-Asian countries, and across studies with different ages of the patients, cutoff values of PNI, and follow-up duration (p for subgroup difference all > 0.05). In conclusion, the PNI is a prognostic marker for survival in patients with EC.

The Importance of Nutrition in Cancer Care: A Narrative Review

PURPOSE OF REVIEW

Cancer, a complex disease affecting millions globally, presents considerable challenges for both patients and health care providers. Within the broad spectrum of cancer care, nutrition plays a key role in supporting patients throughout their journey. This narrative review examines the role of nutrition in cancer care, exploring its impact on treatment outcomes, nutritional status, current dietary recommendations, physical activity, palliative care, and finally, as a nutritional encouragement for cancer survivors.

RECENT FINDINGS

Evidence indicates that cancer and anticancer treatments frequently cause malnutrition and loss of muscle mass, which can exacerbate symptoms, impair immune function, and hamper recovery. Therefore, adequate nutritional support is crucial for maintaining strength, controlling symptoms, and optimizing treatment tolerance in patients with cancer. Several factors influence nutritional needs and dietary recommendations, including cancer type, treatment, and individual patient characteristics. Nutritional care aims not only to ensure sufficient energy and protein intake, but also to manage specific symptoms such as dysgeusia, nausea, and dysphagia. Registered dietitians play a crucial role in providing personalized nutritional guidance, monitoring nutritional status, and implementing interventions to address emerging challenges in cancer care. Furthermore, recent research has underscored the benefits of dietary interventions in cancer treatment. From targeted nutritional supplements to more invasive nutritional support, interest in how nutrition can affect cancer risk and treatment outcomes is increasing. Overall, this review highlights the critical role of nutritional care in comprehensive cancer treatment. By recognizing and meeting dietary demands throughout the entire cancer journey, health care professionals can improve patients' well-being, response to treatment, and long-term prognosis.

Gender-Specific Malnutrition and Muscle Depletion in Gastric and Colorectal Cancer: Role of Dietary Intake in a Jordanian Cohort

OBJECTIVES

This study aimed to assess malnutrition and muscle mass depletion risk in gastrointestinal cancer patients, exploring the differences between gastric and colorectal cancer, with a focus on gender0specific variations and dietary intake. It also examined whether muscle depletion mediates the relationship between dietary intake and malnutrition risk.

METHODS

A sample of 100 Jordanian pre-operative gastrointestinal cancer patients (60 male, 40 female) with gastric or colorectal cancer were assessed for malnutrition risk using the malnutrition universal screening tool (MUST) and for muscle depletion using fat-free mass index (FFMI) and mid-upper arm muscle area (MUAMA).

RESULTS

The study found that 80% (95% CI: 0.708-0.873) of patients were at high risk of malnutrition, with over 60% experiencing severe muscle loss. Gastric cancer patients showed higher, though not statistically significant, malnutrition risk (90.2% vs. 72.9%) and muscle depletion compared to colorectal cancer patients. Advanced cancer stages were associated with significantly higher risk of malnutrition and muscle depletion. Significant gender-specific differences in muscle depletion via FFMI (p = 0.012) and via MUAMA (p = 0.028) were also noted, especially in females with gastric cancer. Additionally, males exhibited a significantly higher malnutrition risk (p < 0.001) based on cancer stage. Patients' dietary intake was significantly (p < 0.001) below the recommended levels for energy, protein, carbohydrates, fiber, and essential fatty acids, which was associated with higher malnutrition risk, muscle depletion, low BMI (<18.5 kg/m2), and significant weight loss (>10%). Low dietary intake was strongly linked to increased malnutrition risk and muscle depletion, with muscle loss partially mediating (b = 0.4972, p < 0.0001) the relationship between poor dietary intake and malnutrition risk. Additionally, higher muscle mass was protective against malnutrition (OR = 16.0, 95% CI: 1.706-150.507), and cancer type was a significant predictor of malnutrition risk (OR = 14.4, 95% CI: 1.583-130.867).

CONCLUSIONS

Malnutrition risk and significant muscle loss are common in GI cancer patients, highlighting the urgent need for tailored nutrition care plans and lifestyle modifications.

Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations

BACKGROUND

Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use.

METHODS

Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients?

RESULTS

Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8).

CONCLUSION

Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.

European Association for the Study of Obesity (EASO) Position Statement on Medical Nutrition Therapy for the Management of Individuals with Overweight or Obesity and Cancer

Obesity, a prevalent and multifactorial disease, is linked to a range of metabolic abnormalities, including insulin resistance, dyslipidemia, and chronic inflammation. These imbalances not only contribute to cardiometabolic diseases but also play a significant role in cancer pathogenesis. The rising prevalence of obesity underscores the need to investigate dietary strategies for effective weight management for individuals with overweight or obesity and cancer. This European Society for the Study of Obesity (EASO) position statement aimed to summarize current evidence on the role of obesity in cancer and to provide insights on the major nutritional interventions, including the Mediterranean diet (MedDiet), the ketogenic diet (KD), and the intermittent fasting (IF), that should be adopted to manage individuals with overweight or obesity and cancer. The MedDiet, characterized by high consumption of plant-based foods and moderate intake of olive oil, fish, and nuts, has been associated with a reduced cancer risk. The KD and the IF are emerging dietary interventions with potential benefits for weight loss and metabolic health. KD, by inducing ketosis, and IF, through periodic fasting cycles, may offer anticancer effects by modifying tumor metabolism and improving insulin sensitivity. Despite the promising results, current evidence on these dietary approaches in cancer management in individuals with overweight or obesity is limited and inconsistent, with challenges including variability in adherence and the need for personalized dietary plans.

Serum Albumin as a Prognostic Biomarker for Febrile Neutropenia Outcome and Complications: A Prospective Observational Trial

Background

Febrile neutropenia (FN) poses a significant challenge in cancer treatment, with a high incidence among patients undergoing standard therapies. Predicting FN complications and outcomes remains crucial for improving patient management strategies. Biomarkers, including procalcitonin and albumin, have garnered attention for their potential prognostic value in FN.

Methods

We conducted a prospective observational study at a tertiary hospital, enrolling 185 adult cancer patients experiencing FN episodes. We assessed serum albumin levels and incorporated them into the Multinational Association for Supportive Care in Cancer (MASCC) risk index to enhance risk stratification.

Results

Serum albumin levels displayed promising prognostic utility in febrile neutropenia (FN). They exhibited moderate specificity and sensitivity in predicting mortality during FN and 28-day mortality. Serum albumin levels were significantly associated with gastrointestinal infections, serving as an independent predictor. Integrating serum albumin into the MASCC risk index improved predictive accuracy for FN mortality by 50%, 28-day mortality by 66.67%, and respiratory tract infections by 62.50%, enhancing in this way risk stratification for FN-related complications.

Conclusion

Serum albumin emerges as a promising biomarker for prognostication in FN, complementing existing risk assessment frameworks. Its incorporation into the MASCC risk index enhances predictive capabilities, aiding clinicians in identifying high-risk patients promptly. While albumin shows potential in predicting mortality and complications, further research is warranted to optimize sensitivity and specificity, ensuring its clinical utility.

Dietary Counseling Outcomes in Patients with Lung Cancer in an Upper-Middle-Income Country: An Open-Label Randomized Controlled Trial

Background: Malnutrition harms treatment outcomes, QoL, and survival in lung cancer patients. Effective dietary counseling can improve nutrition, but few randomized controlled trials have focused on lung cancer patients. The objective of this study was to determine if dietary counseling improves nutritional and treatment outcomes when compared to routine care. Methods: This open-label parallel RCT was conducted at Maharaj Nakorn Chiang Mai Hospital in Thailand. The investigators used computer-generated blocked randomization to assign patients to dietary counseling by a nutritionist or routine care. The nutritionist sessions occurred before treatment, with follow-ups at 3-4 weeks and 12 weeks. The primary outcome was the mean percentage change in the body weight of patients at 12 weeks. Secondary outcomes included changes in the BMI, nutrition score, QoL, serum albumin level, lymphocyte count, energy and protein intake, treatment response, PFS, and OS. Results: Between April 2020 and May 2022, after completing recruitment, 80 lung cancer patients were randomized: 43 to dietary counseling and 37 to routine care. The dietary counseling group showed significant benefits, with smaller decreases in body weight at 3-4 weeks (-0.8% vs. -2.6%, p = 0.05) and 12 weeks (-1.1% vs. -4.3%, p = 0.05). They also had higher energy and protein intake levels and better treatment response rates. The secondary outcomes and significant adverse events did not differ significantly between the groups. Conclusions: Dietary counseling helps to maintain body weight, maintain dietary intake, and enhance treatment responses in lung cancer patients. Although not all nutritional markers or survival outcomes were affected, these findings highlight the importance of early nutritional interventions.

Nutritional care in older adults: are we doing everything? An expert opinion review

Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality-of-life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.

Nutritional Intervention for the Elderly during Chemotherapy: A Systematic Review

This study aims to review existing literature on the effect of oral nutritional supplements (ONSs) during chemotherapy in older cancer patients. Electronic databases were searched for relevant studies up to March 2024. The risk of bias in the included studies was evaluated using the Cochrane tool. Eligible studies included randomized, prospective, and retrospective studies evaluating the effect of ONSs in elderly (median age > 65 years) cancer patients during chemotherapy. Data regarding chemotherapy adherence, toxicity, overall survival, and nutritional status were extracted. A total of ten studies, involving 1123 patients, were included. A meta-analysis of the results was not conducted due to the scarcity and heterogeneity of results. Some ONSs were associated with reduced incidence of chemotherapy side-effects, particularly oral mucositis, and improved nutritional status. There was limited or no evidence regarding the impact of ONSs on chemotherapy adherence or overall survival. Various types of ONS were investigated, including multimodal intervention with tailored nutritional counseling, whey protein supplements, amino acids supplements (including immune nutrition supplements), and fish oil omega-3-enriched supplements. ONSs showed promise in reducing chemotherapy side-effects and improving nutritional status in older cancer patients, but further studies are needed to explore their efficacy on chemotherapy adherence and overall survival. Future research should consider both chronological age and frailty criteria, account for dietary habits, and use specific nutritional assessment like Bioelectrical Impedance Analysis.

Obesity and overweight are associated with worse survival in early-onset colorectal cancer

BACKGROUND

Obesity and its associated lifestyle are known risk factors for early-onset colorectal cancer and are associated with poor postoperative and survival outcomes in older patients. We aimed to investigate the impact of obesity on the outcomes of early-onset colorectal cancers.

METHODS

Retrospective review of all patients undergoing primary resection of colon or rectal adenocarcinoma at our institution between 2015-2022. Patients who had palliative resections, resections performed at another institution, appendiceal tumors, and were underweight were excluded. The primary endpoint was survival according to the patient's body mass index: normal weight (18-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (≥30 kg/m2). Patient and tumor characteristics and survival were compared between the three groups.

RESULTS

A total of 279 patients aged <50 years with colorectal cancer were treated at our hospital; 120 were excluded from the analysis for the following reasons: main treatment or primary resection performed at another hospital (n = 97), no resection/palliative resection (n = 23), or body mass index <18 kg/m2 (n = 2). Of these, 157 patients were included in the analysis; 61 (38.9%) were overweight and 45 (28.7%) had obesity. Except for a higher frequency of hypertension in the overweight (P = .062) and obese (P = .001) groups, no differences in patient or tumor characteristics were observed. Mean overall survival was 89 months with normal weight, 92 months with overweight, and 65 months with obesity (P = .032). Mean cancer-specific survival was 95 months with normal weight, 94 months with overweight, and 68 months with obesity (P = .018). No statistically significant difference in disease-free survival (75 vs 70 vs 59 months, P = .844) was seen.

CONCLUSION

Individuals with early-onset colorectal cancer who are overweight or obese present with similar tumor characteristics and postoperative morbidity to patients with normal weight. However, obesity may have a detrimental impact on their survival. Addressing obesity as a modifiable risk factor might improve early-onset colorectal cancer prognosis.

Anticancer restrictive diets and the risk of psychological distress: Review and perspectives

INTRODUCTION

The most studied anticancer restrictive diets include fasting, fasting-mimicking diets (FMDs) and ketogenic diets (KDs). Besides the current lack of established clinical benefit and the significant risk of malnutrition and micronutrient deficiencies, dietary restrictions in cancer patients might have relevant psychological effects.

MATERIALS AND METHODS

We reviewed the randomized and non-randomized controlled clinical trials (CCTs) reporting data on the psychological impact of fasting, FMDs and KDs in cancer patients. We excluded trials on restrictive diets performed for weight reduction in obese or overweight patients, studies on dietary restrictions lasting less than 24 h, and studies on fasting related to cultural or religious beliefs.

RESULTS

Three CCTs on fasting or FMDs and eight CCTs on KDs in cancer patients were included. In terms of diet-related distress, emotional, social, and family well-being, none of these studies showed a detrimental impact of fasting, FMDs and KDs. However, clinical trials specifically assessing the psychological aspects in the long term are lacking.

CONCLUSIONS AND PERSPECTIVES

In the absence of a conclusive evidence on the clinical benefits of restrictive diets, which carry significant risks especially if unsupervised, further studies are needed to clarify their psychological impact in cancer patients. Multidisciplinary approaches including psychological evaluations should be used to ameliorate patient selection for clinical trials, identify early distress symptoms, and increase patient compliance to dietary recommendations.

Current Oncology Nutrition Care Practice in Southeast Asia: A Scoping Review

Although evidence-based nutrition care is recommended for patients with cancer, current nutrition care practices provided by nutritionists and dietitians in Southeast Asian countries are not clearly reported. The aim of this scoping review was to describe nutritionists' and dietitians' current oncology nutrition care practice within Southeast Asia by identifying access to dietetic services, tools or strategies used in providing care, and barriers and enablers to implementing nutrition care practices. Five databases (Ovid MEDLINE, Global Health, Embase, Cochrane Central Register of Controlled Trials, and Proquest) were searched through structured search strategies, in addition to strategic searching of grey literature. A total of 4261 sources of evidence were retrieved. After full-text screening, 18 studies from Southeast Asian countries met the inclusion criteria and were included in this review. The provision and reporting of nutrition care practices provided by nutritionists and dietitians were limited. Access to dietetic services, including nutritional screening tools and reason to be referred, were varied within studies. Barriers and enablers to nutrition care provision were unique and related to each country's specific resources and guidelines. In summary, there was varied reporting of nutrition care practices provided to patients with cancer in Southeast Asia and a lack of clarity on the actual standardized processes. Future research is warranted to further explore the barriers and enablers to providing nutrition care by local nutritionists and dietitians in Southeast Asia.

An evaluation of nutritional impact symptoms and their association with reduced dietary intake in patients with solid tumors at tertiary care hospitals: a multicenter, cross-sectional study from palestine

BACKGROUND

Nutritional impact symptoms (NISs) are proposed to be a key indicator of decreased dietary intake in patients with solid cancer. Cancer patients frequently experience NIS from the disease itself and from disease treatment side effects that impact oral and gastrointestinal health. Thus, this study aimed to investigate the association between NIS and dietary intake among cancer patients in the Nablus district, one of the largest districts in Palestine. This study also sought to identify the types of treatment and other factors related to dietary intake for solid cancer patients.

METHODS

A cross-sectional study was conducted between October 15, 2021, and October 15, 2022. The convenience sampling technique was used to recruit participants from two primary hospital campuses for cancer treatment in the entire region of Nablus Governorate in northern Palestine. To assess the patients, structured questionnaires completed by interviewers during face-to-face interviews with patients were used. The NIS was assessed using a checklist developed based on a literature review and clinical experience. Univariate and multivariate analyses were used to evaluate the correlations between sociodemographic variables and clinical variables and between the NIS and dietary intake. Multiple binary logistic regression analyses were also performed to determine the most influential variables, sociodemographic, clinical, and NIS, on dietary intake.

RESULTS

Data were collected from 290 patients with solid malignancies. The mean age of the participants was 55.04 ± 12.76 years. Multiple binary logistic regressions revealed that dry mouth (odds ratio (OR) = 3.742; 95% confidence interval (CI) = 1.800-7.780; p < 0.001), constipation (OR = 2.707; 95% CI = 1.113-6.581; p = 0.028), taste alteration (OR = 3.620; 95% CI = 1.752-7.481; p = 0.001), and feeling fullness (OR = 8.879; 95% CI = 2.982-26.441; p < 0.001) were significantly related to decreased dietary intake. Biological and hormonal treatments had an inverse association with dietary intake (OR = 0.372; 95% CI = 0.177-0.782; p = 0.009 and OR = 0.383; 95% CI = 0.168-0.874; p = 0.023, respectively).

CONCLUSIONS

This study revealed that many solid cancer patients have reduced food intake due to NIS, such as dry mouth and taste changes. These patients may be at risk of malnutrition. Healthcare professionals should consider these NISs to improve dietary plans and decide whether extra feeding support is needed. The results obtained indicate the need for further research focused on removing limitations in food consumption as an effect of treatment and appropriate nutritional strategies to prevent patient malnutrition.