Special Issue "Individualized Care for Malnourished Cancer Patients"

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 December 2020) | Viewed by 14718

Special Issue Editors

Prof. Dr. Paolo Pedrazzoli
E-Mail Website
Guest Editor
1. Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
2. Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
Interests: medical Oncology; immunotherapy; nutrition in oncology; malnutrition; clinical trials; nutritional support
Special Issues, Collections and Topics in MDPI journals
Dr. Riccardo Caccialanza
E-Mail Website
Guest Editor
Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
Interests: Nutrition; Metabolism; Nutrition Assessment; Clinical Nutrition; Malnutrition Nutritional Medicine; Dietetics; Nutritional Status; Nutritional Biochemistry; Nutritional Requirements; Nutrition Performance
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Malnutrition is a frequent critical problem for a considerable proportion of cancer patients following diagnosis, which impairs quality of life (QoL) and clinical outcomes, and requires appropriate and well-timed multidisciplinary management by professionals with specific skills and training. Despite the robust evidence showing an association between nutritional status and clinical outcomes, the attitude towards nutrition care varies considerably among oncologists, and a significant proportion of patients do not receive adequate nutritional assessment and support.

The recognition of the importance of nutrition in cancer rehabilitation has been suggested among the key objectives for a global core curriculum in medical oncology, and emphasis has been placed on the need to start treating cachexia in the precachexia phase, which is when oncologists predominantly see their patients. However, this would require increased awareness and knowledge of nutritional issues among health care professionals involved in cancer care, which is still far from being the case. As an example, the management of home artificial nutrition, which can improve the prognosis and QoL of many advanced cancer patients, is often not consistent. Due to its organizational complexity, the possible development of potentially serious complications, and the need of periodic outcomes assessment, it is vital that nutritional support should be prescribed and monitored by clinical nutrition specialists or professionals with specific skills in clinical nutrition, who should be part of the multidisciplinary teams providing early palliative care.

The purpose of this Special Issue is to provide health care professionals involved in cancer patient care with a comprehensive overview of the aims and current evidence about nutrition in oncology, together with updated practical and concise recommendations on the application of nutritional therapy in cancer patients.

Prof. Dr. Paolo Pedrazzoli
Dr. Riccardo Caccialanza
Guest Editor

Manuscript Submission Information

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Keywords

  • Malnutrition
  • Cancer patients
  • Sarcopenia
  • Nutritional care

Published Papers (8 papers)

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Research

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Article
Differential Diagnosis of Cachexia and Refractory Cachexia and the Impact of Appropriate Nutritional Intervention for Cachexia on Survival in Terminal Cancer Patients
Nutrients 2021, 13(3), 915; https://doi.org/10.3390/nu13030915 - 12 Mar 2021
Cited by 2 | Viewed by 1140
Abstract
Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of [...] Read more.
Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of nutritional intervention for them. Study subjects were terminal cancer patients admitted for palliative care and were judged refractory cachexia in the last five years. We retrospectively examined to find useful indices for identifying such cachectic patients and for evaluating the effect of nutritional intervention. Out of 223 patients in refractory cachexia, 26 were diagnosed cachexia with starvation after symptom management. Comparing before and one week after this management, Palliative Performance Scale (PPS) and transthyretin significantly improved (p < 0.0001, p = 0.0002, respectively) Then, we started nutritional intervention for these cachectic patients and divided into effective group (n = 17) and non-effective group (n = 9) using the criteria for cachexia. Comparing between the two groups, PPS significantly improved2 weeks after intervention in effective group (p = 0.006). Survival time was significantly longer in effective group (p = 0.008). PPS and transthyretin were useful for differential diagnosis of cachexia and refractory cachexia. PPS was useful for evaluating nutritional intervention for cachectic patients. Appropriate nutritional intervention improved survival. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
Article
Survival of Patients with Multi-Level Malignant Bowel Obstruction on Total Parenteral Nutrition at Home
Nutrients 2021, 13(3), 889; https://doi.org/10.3390/nu13030889 - 10 Mar 2021
Cited by 1 | Viewed by 890
Abstract
Home parenteral nutrition (HPN) may improve the survival in selected patients with malignant bowel obstruction. This retrospective, medical registry-based study aimed to identify clinical and laboratory markers predicting short survival, which would allow a more accurate selection of patients that would benefit from [...] Read more.
Home parenteral nutrition (HPN) may improve the survival in selected patients with malignant bowel obstruction. This retrospective, medical registry-based study aimed to identify clinical and laboratory markers predicting short survival, which would allow a more accurate selection of patients that would benefit from HPN in inoperative bowel obstruction. In a retrospective analysis of 114 patients receiving HPN, the median survival was 89 days after discharge home, and the three and six-month survival probability was 48% and 26%, respectively. Parenteral nutrition was provided during 98% of overall survival time and ended on a median of one day before the patient’s death. Discontinuing chemotherapy, anemia, severe hypoalbuminemia, and water retention appeared correlated with survival shorter than three months. In these cases, routine initiation of HPN should be discouraged, as it may not bring any benefits to the patient. The decision on the initiation of HPN should be made along with continuing or initiating chemotherapy. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
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Review

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Review
The Clinical Value of Nutritional Care before and during Active Cancer Treatment
Nutrients 2021, 13(4), 1196; https://doi.org/10.3390/nu13041196 - 05 Apr 2021
Cited by 8 | Viewed by 1404
Abstract
Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher [...] Read more.
Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients’ overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients’ nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
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Review
Sarcopenia, Malnutrition, and Cachexia: Adapting Definitions and Terminology of Nutritional Disorders in Older People with Cancer
Nutrients 2021, 13(3), 761; https://doi.org/10.3390/nu13030761 - 26 Feb 2021
Cited by 11 | Viewed by 2985
Abstract
The recent publication of the revised Consensus on definition and diagnosis of sarcopenia (EWGSOP2) and the Global Leadership Initiative on Malnutrition (GLIM) criteria changed the approach to research on sarcopenia and malnutrition. Whilst sarcopenia is a nutrition-related disease, malnutrition and cachexia are nutritional [...] Read more.
The recent publication of the revised Consensus on definition and diagnosis of sarcopenia (EWGSOP2) and the Global Leadership Initiative on Malnutrition (GLIM) criteria changed the approach to research on sarcopenia and malnutrition. Whilst sarcopenia is a nutrition-related disease, malnutrition and cachexia are nutritional disorders sharing the common feature of low fat-free mass. However, they have differential characteristics and etiologies, as well as specific therapeutic approaches. Applying the current definitions in clinical practice is still a challenge for health professionals and the potential for misdiagnosis is high. This is of special concern in the subgroup of older people with cancer, in which sarcopenia, malnutrition, and cancer cachexia are highly prevalent and can overlap or occur separately. The purpose of this review is to provide an updated overview of the latest research and consensus definitions of sarcopenia, malnutrition, and cachexia and to discuss their implications for clinical practice in older patients with cancer. The overall aim is to improve the quality of nutritional care in light of the latest findings. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
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Review
The Role of Nutritional Support for Cancer Patients in Palliative Care
Nutrients 2021, 13(2), 306; https://doi.org/10.3390/nu13020306 - 22 Jan 2021
Cited by 11 | Viewed by 3414
Abstract
The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. [...] Read more.
The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
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Review
Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status
Nutrients 2021, 13(1), 57; https://doi.org/10.3390/nu13010057 - 27 Dec 2020
Cited by 4 | Viewed by 1600
Abstract
Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the [...] Read more.
Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
Review
Impact of Early Incorporation of Nutrition Interventions as a Component of Cancer Therapy in Adults: A Review
Nutrients 2020, 12(11), 3403; https://doi.org/10.3390/nu12113403 - 05 Nov 2020
Cited by 4 | Viewed by 1759
Abstract
Malnutrition is prevalent among oncology patients and can adversely affect clinical outcomes, prognosis, quality of life, and survival. This review evaluates current trends in the literature and reported evidence around the timing and impact of specific nutrition interventions in oncology patients undergoing active [...] Read more.
Malnutrition is prevalent among oncology patients and can adversely affect clinical outcomes, prognosis, quality of life, and survival. This review evaluates current trends in the literature and reported evidence around the timing and impact of specific nutrition interventions in oncology patients undergoing active cancer treatment. Previous research studies (published 1 January 2010–1 April 2020) were identified and selected using predefined search strategy and selection criteria. In total, 15 articles met inclusion criteria and 12/15 articles provided an early nutrition intervention. Identified studies examined the impacts of nutrition interventions (nutrition counseling, oral nutrition supplements, or combination of both) on a variety of cancer diagnoses. Nutrition interventions were found to improve body weight and body mass index, nutrition status, protein and energy intake, quality of life, and response to cancer treatments. However, the impacts of nutrition interventions on body composition, functional status, complications, unplanned hospital readmissions, and mortality and survival were inconclusive, mainly due to the limited number of studies evaluating these outcomes. Early nutrition interventions were found to improve health and nutrition outcomes in oncology patients. Future research is needed to further evaluate the impacts of early nutrition interventions on patients’ outcomes and explore the optimal duration and timing of nutrition interventions. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
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Review
The Role of Nutritional Support in Cured/Chronic Patients
Nutrients 2020, 12(10), 3167; https://doi.org/10.3390/nu12103167 - 16 Oct 2020
Cited by 1 | Viewed by 923
Abstract
Improvements in Clinical Oncology, due to earlier diagnoses and more efficient therapeutic strategies, have led to increased numbers of long-term survivors, albeit many with chronic diseases. Dealing with the complex care needs of these survivors is now an important part of Medical Oncology. [...] Read more.
Improvements in Clinical Oncology, due to earlier diagnoses and more efficient therapeutic strategies, have led to increased numbers of long-term survivors, albeit many with chronic diseases. Dealing with the complex care needs of these survivors is now an important part of Medical Oncology. Suitable diet and physical activity regimes will be important in maintaining their health. This paper will review what we know and what we can do in the near future for these patients. Full article
(This article belongs to the Special Issue Individualized Care for Malnourished Cancer Patients)
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