2023-07-06 14:27:00
Fewer than 40% of cancer patients have a nutritional assessment at diagnosis. Malnutrition – estimated to be up to 80% in these patients, with less than 30% adequately treated – is correlated with longer hospital stays, increased morbidity and readmission, as well as higher mortality rates. Malnourished cancer patients may experience reduced tolerance to chemotherapy, lower quality of life, and reduced overall survival. However, attitudes towards this issue vary greatly among oncologists, surgeons and radiation oncologists due to the lack of structured collaboration between healthcare professionals. This is what emerges from the first national survey on the awareness of nutritional problems among health professionals who provide anticancer treatments, published in the journal ‘Frontiers Nutrition’, created with the young sections of Aiom (Italian Association of Medical Oncology), Airo (Italian Association of radiotherapy and clinical oncology) and Sico (Italian Society of Oncological Surgery) merged into the NutriOnc research group and with the non-conditioning support of Nhsc (Nestlé Health Science).
Precisely to implement multidisciplinary strategies aimed at improving the quality of life of patients – explains a note – in 2020 the young sections of Aiom, Sico and Airo planned common research objectives and founded NutriOnc, a multidisciplinary group made up not only of medical oncologists, surgeons and radiotherapists but also by nutritionists and pharmacists, which aims to carry out translational research and deepen the theme of malnutrition and clinical nutrition in cancer patients. From the investigation, mainly focused on oesophagogastric, hepato-bilio-pancreatic and colorectal cancers, the need also emerges to replace the traditional ‘one-size-fits-all’ approach (the same for all) with a patient-centred vision, which aims to minimize adverse events thereby improving the therapeutic impact of new treatments.
Going into the details of the results of the study – in which 215 Italian health workers under 40 took part – it turns out that, according to 57% of the interviewees, cancer patients were regularly subjected to nutritional screening. Timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). As regards the management of the nutritional status of cancer patients, 49.3% of the doctors declared that they adopted the ERAS program (Enhanced Recovery After Surgery), but 41.8% did not follow a specific protocol due to the lack of educational courses (14.5%), financial support (15.3%) and understanding (13%).
Almost all institutions – details the note – had a multidisciplinary team (92%) to finalize the treatment decision-making process and, in the absence of the dietitian, the evaluation was managed by doctors with clinical experience in nutritional evaluation (35.6%) , surgeons (34.3%), physician/radiation oncologists (36.8%) and nurse case managers (6.8%). After hospital discharge, prescription nutritional support was provided by dietitians (59.5%), medical oncologists (20%), surgeons (15.3%) and radiation oncologists (5.12%).
And again: in cases of malnutrition (for example, more than 5% of weight loss in the last 3 months), the doctor’s choices were directed towards nutritional advice (34.8%), oral nutritional supplement (28.8% ), enteral nutrition (2.8%), parental nutrition (3.3%) and no treatment (0.9%). During radiotherapy, 95% of physicians stated that patients needed supplemental nutrition and immunonutrition (Imn) was prescribed perioperatively (54.5%), before surgery (36.3%) and during neoadjuvant radiochemotherapy (22.3%).
Healthcare providers providing cancer care still have a long way to go in making nutritional care a standardized component of cancer management, but the positive signals from this cross-society, multidisciplinary national survey should encourage and improve nutritional screening. systematic and management of cancer patients. Moreover, the theme of nutrition is also at the center of the debate at an institutional level and the 2023 Guideline Act of the Ministry of Health underlines, among other things, the importance for cancer patients of foods for special medical purposes defined as supplements oral nutrition (Ons), considered an important tool to combat malnutrition, increase life expectancy and also contribute to a decrease in the impact on the National Health Service as a whole.
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