Research suggests that malnutrition may affect 30% to 85% of cancer patients, and it may account for 10% to 20% of deaths in these patients.1
Malnutrition in cancer has been associated with fewer treatment options, reduced response to treatment, greater treatment-related toxicity, longer hospitalization, and worse prognosis.2
“Malnutrition is a major concern for our patients, especially those undergoing intense treatments,” said Katie Roberts, MPH, RD, CSO, LD, clinical dietitian at The University of Texas MD Anderson Cancer Center in Houston.
The highest prevalence of malnutrition occurs with upper gastrointestinal, head and neck, lung, hematologic, gynecologic, and colorectal cancers, added Edelina “Ede” Bustamante Cohen, MS, RD, CDN, CDCES, clinical nutrition manager at NYU Langone’s Perlmutter Cancer Center in New York, New York.3
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Screening for Malnutrition in Cancer Patients
The National Cancer Institute (NCI) recommends that cancer patients undergo standard nutrition screening and assessment.1 Screening tools that have been validated for use in cancer patients include the Malnutrition Screening Tool, Patient-Generated Subjective Global Assessment, and NUTRISCORE tool.
The NCI recommends assessing patients’ nutrition status before they start cancer treatment and continuing assessments throughout treatment.
Research has shown that even minimal weight loss before the start of cancer treatment is associated with worse prognosis, said Ginger Carney, MPH, RDN, LDN, IBCLC, RLC, FILCA, FAND, director of clinical nutrition at St Jude Children’s Research Hospital in Memphis, Tennessee.4,5
During cancer treatment, patients may experience a wide range of issues that can contribute to malnutrition and sarcopenia, Cohen added. This includes treatment-related side effects such as nausea, vomiting, diarrhea, altered taste, and loss of appetite.
Patients who are at risk of malnutrition should be referred to a registered dietician (RD) or registered dietitian nutritionist (RDN) for “a comprehensive nutrition assessment, including a nutrition-focused physical exam,” advised Kerry McMillen, MS, RD, CSO, FAND, manager of medical nutrition therapy services at Fred Hutchinson Cancer Center in Seattle.
This exam involves evaluation of muscle mass and subcutaneous fat, fluid accumulation, and nutritional deficiencies.1
Treating and Preventing Malnutrition
Nutrition support has important implications for the success of cancer treatment and the effects of cancer therapies on patients’ overall health, said Julie Bosworth, RD, LDN, senior dietitian on the Nutrition Services Team at Dana-Farber Cancer Institute in Boston.
“While chemotherapy, radiation therapy, and many medications used in cancer care result in side effects that are catabolic to the body, food and fluids rebuild the body, readying it to receive the next step of treatment,” Bosworth explained.
Studies have linked nutritional interventions to a range of benefits for cancer patients.1,2,6 Nutritional interventions have been shown to help patients complete cancer treatment, reduce treatment-related toxicity, decrease the duration of hospitalization, and improve survival, quality of life, and physical function.
In the oncology setting, RDs or RDNs provide medical nutrition therapy to help “manage treatment-related symptoms, proactively support patients in maintaining strength and healthy body tissue, maintain or improve energy and protein intake, reduce the risk of treatment intolerance, mitigate metabolic perturbations, and improve quality of life for patients,” McMillen explained.
“Loss of skeletal muscle — with or without fat loss — is the main aspect of malnutrition that predicts the risk of physical impairment, postoperative complications, treatment toxicity, and mortality in individuals with cancer,” McMillen said. “For these reasons, it’s important to ensure that the patient’s lean body mass is preserved and to collaborate with RD and rehab professionals to prevent and treat sarcopenia.”
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