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Nutrition in Survivors with Advanced Cancer: The Role of Appetite, Muscle Wasting, Obesity, and Altered Body Composition

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 31 July 2026 | Viewed by 3752

Special Issue Editor

Prof. Dr. Egidio Del Fabbro

E-Mail Website
Guest Editor
Medical College of Georgia, Augusta University, Augusta, GA, USA
Interests: palliative medicine; advanced cancer

Special Issue Information

Dear Colleagues,

The aim of this Special issue is to address the most important facets of nutrition encountered by patients (survivors) with advanced cancer, their families, and clinicians. The scope of this Special Issue includes clinical and translational research that is patient-centered and clinically relevant. Patients with advanced cancer experience multiple challenges with regard to nutrition, including decreased appetite, high symptom burden leading to decreased oral intake, wasting of muscle or fat, and alterations in body composition such as sarcopenic obesity. While the dominant issue surrounding nutrition in oncology is related to weight loss, in particular, muscle wasting, the rise in obesity and development of anti-obesity drugs has presented additional management challenges. An interdisciplinary approach including dieticians, nurses, physical therapists, psychologists, and physicians is likely to be most effective in improving clinical outcomes for patients with solid and hematological malignancies. In addition to non-pharmacological therapy, advances in new promising medications suggest that successful management is becoming a reality for patients. In spite of progress, there are continued questions regarding nutrient composition, optimal assessment of daily clinical practice, and the necessary resources for multimodal management.  

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  1. Nutrition content in patients with advanced cancer, including both macro and micronutrients.
  2. The role of interdisciplinary team members in managing nutritional issues, including dieticians, physical therapists, psychologists, and nurses.
  3. Exercise for preventing muscle wasting and weakness in patients with advanced cancer.
  4. New therapeutic agents and their anticipated role in patients with advanced cancer.
  5. Clinical challenges in managing patients with advanced cancer that are on anti-obesity (GLP-1) drugs.
  6. The microbiome and its impact on symptom burden and wasting in patients with advanced cancer.
  7. Nutrition and older patients with advanced cancer.
  8. Critical knowledge gaps and education needs among health care providers regarding nutrition and cancer.

I look forward to receiving your contributions.

Prof. Dr. Egidio Del Fabbro
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • advanced cancer
  • nutrition
  • wasting
  • body composition
  • multimodal

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Published Papers (3 papers)

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Research

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24 pages, 1488 KB  
Article
Investigating the Prognostic Value of Pretreatment Body Composition in Women with Ovarian Cancer: Impact on Clinical Outcomes
by Sarah Benna-Doyle, Erin Laing, Brenton J. Baguley, Nicholas Hardcastle, Gavin Abbott and Nicole Kiss
Cancers 2026, 18(9), 1478; https://doi.org/10.3390/cancers18091478 - 4 May 2026
Viewed by 742
Abstract
Background/Objectives: In ovarian cancer, the association between low muscle mass and outcomes is unclear, despite well-established evidence in other cancer diagnoses. Overall body composition may have greater prognostic value. This study aimed to investigate associations between body composition and clinical outcomes. Methods: Retrospective [...] Read more.
Background/Objectives: In ovarian cancer, the association between low muscle mass and outcomes is unclear, despite well-established evidence in other cancer diagnoses. Overall body composition may have greater prognostic value. This study aimed to investigate associations between body composition and clinical outcomes. Methods: Retrospective study of women diagnosed with ovarian cancer between August 2020 and March 2024. Clinical characteristics were extracted from medical records. Body composition phenotypes (low skeletal muscle index [SMI], low skeletal muscle density [SMD], high subcutaneous [SATI], visceral [VATI] and total adipose tissue index [TATI]) were assessed from pre-treatment CT images. Logistic regression, chi-squared, Fisher’s exact tests, and Mann–Whitney U tests were used to assess associations between body composition phenotypes, patient characteristics and study outcomes. Cox proportional hazards models were fitted to examine associations with survival. Results: Ninety-nine patients [mean (SD) age 61 (12.7) years, 80% stage III/IV] were included. Overall, 67 (67%) women had low SMI, 57 (57%) low SMD, and 49 (49%) high TATI. Thirty-seven (37%) women had low SMI and low SMD, 23 (23%) low SMI with high TATI, and 33 (33%) low SMD with high TATI. Post-menopausal status was associated with higher VAT (p = 0.004). Low SMI or low SMD co-occurring with high adiposity was associated with a 1.91–2.03 and 2.15–2.49 higher hazard mortality. There was insufficient or weak evidence of an association between body composition and other treatment outcomes. Conclusion: These findings suggest additive effects when phenotypes co-occur. In ovarian cancer, singular assessments may be an oversimplification. Future studies should continue to consider co-occurring phenotypes to adequately capture risk. Full article
(This article belongs to the Special Issue Nutrition in Survivors with Advanced Cancer: The Role of Appetite, Muscle Wasting, Obesity, and Altered Body Composition)
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11 pages, 674 KB  
Article
Impact of Body Composition Changes on Treatment-Related Toxicities and Clinical Outcomes in HER2-Positive Metastatic Breast Cancer Patients Receiving Trastuzumab Deruxtecan
by Alessio Molfino, Giovanni Imbimbo, Simona Pisegna, Simone Scagnoli, Claudia Alabiso, Massimiliano Ardovino, Carmen Gallicchio, Veronica Rizzo and Andrea Botticelli
Cancers 2025, 17(18), 3063; https://doi.org/10.3390/cancers17183063 - 19 Sep 2025
Cited by 1 | Viewed by 1336
Abstract
Background/Objectives: Breast cancer remains a significant global health concern, with HER2-positive metastatic breast cancer continuing to present persistent challenges despite advancements in targeted therapies, including trastuzumab deruxtecan (T-DXd). This study aimed to verify the impact of body composition changes on treatment-related toxicities, dose [...] Read more.
Background/Objectives: Breast cancer remains a significant global health concern, with HER2-positive metastatic breast cancer continuing to present persistent challenges despite advancements in targeted therapies, including trastuzumab deruxtecan (T-DXd). This study aimed to verify the impact of body composition changes on treatment-related toxicities, dose modifications, and clinical outcomes in patients receiving T-DXd. Methods: A retrospective analysis on 35 patients with HER2-positive metastatic breast cancer was conducted, analyzing body composition parameters such as subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), skeletal muscle area (SMA), and skeletal muscle index (SMI)—assessed using CT scans at baseline (T0) and after a median follow-up of 4 months (T1)—and calculating ΔT0–T1% of each parameter. Results: Significant reductions over time were observed in SAT (mean ΔSAT% = −5.7%, p = 0.023) and SMA (mean ΔSMA% = −4.9%, p = 0.001). Treatment-related adverse events (AEs) were common, with 31% of patients experiencing severe (Grade 3–4) toxicities. Patients with higher ΔSAT% (above the median value) experienced Grade 3–4 toxicities more frequently compared to those with lower ΔSAT% (below the median) (p < 0.05). Among patients without toxicities, a significant decrease in SAT was observed between T0 and T1 (p = 0.003), while no significant change was detected in patients with Grade 3–4 toxicities (p = 0.929). Greater reductions in SMA were associated with increased rates of treatment discontinuation (75% vs. 29%, p = 0.009). Kaplan–Meier analysis confirmed that greater reductions in SMA significantly increased the risk of mortality (HR 5.1, 95% CI: 1.05–24.79; p = 0.025) and showed a trend toward higher risk of disease progression (HR 2.58, 95% CI: 0.89–7.49; p = 0.063). Conclusions: Changes in body composition, particularly reductions in SMA, were associated with increased treatment discontinuation and mortality in HER2-positive metastatic breast cancer receiving T-DXd. Increase in SAT was associated with higher rates of severe toxicities, highlighting its potential role in predicting treatment-related complications, and the clinical relevance of nutritional changes on outcomes in this setting. Full article
(This article belongs to the Special Issue Nutrition in Survivors with Advanced Cancer: The Role of Appetite, Muscle Wasting, Obesity, and Altered Body Composition)
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Review

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15 pages, 583 KB  
Review
The Role of New Agents and Supportive Care in a Multimodal Approach to Cancer Cachexia
by Egidio Del Fabbro and Sudeep Pandey
Cancers 2026, 18(4), 649; https://doi.org/10.3390/cancers18040649 - 17 Feb 2026
Viewed by 1230
Abstract
Given the multi-faceted nature of cancer cachexia, a combination of pharmacologic and supportive measures such as exercise and nutrition seems intuitive to most clinicians. Clinical trials have also suggested that a multimodal approach to cancer cachexia (CC) is feasible and potentially effective. However, [...] Read more.
Given the multi-faceted nature of cancer cachexia, a combination of pharmacologic and supportive measures such as exercise and nutrition seems intuitive to most clinicians. Clinical trials have also suggested that a multimodal approach to cancer cachexia (CC) is feasible and potentially effective. However, past trials have been limited by medications that were partially effective or had the potential for serious adverse events such as thromboembolism. We review new agents that have demonstrated efficacy in phase II trials or are involved in multi-center phase III studies. The advent of several recent phase II studies indicate that consistently effective, well-tolerated medications may soon be available for CC. These new agents target several mechanisms involved in CC, including food aversion, catabolism, and decreased anabolism. Several multi-center studies are expected to be actively recruiting this year. If these agents prove to be effective, individualized treatment may be possible, guided by individuals’ phenotype and/or clinical biomarkers. Future research should also determine whether combination therapy (pharmacologic and/or non-pharmacologic) produces additive or synergistic benefits. Full article
(This article belongs to the Special Issue Nutrition in Survivors with Advanced Cancer: The Role of Appetite, Muscle Wasting, Obesity, and Altered Body Composition)
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