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Integral nutritional approach to the care of cancer patients: results from a Delphi panel

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Abstract

Introduction

Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level.

Methods

A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted.

Results

Regarding the presence of malnutrition, 57.7% of the participants stated that < 30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31–50% had malnutrition during cancer treatment, and 26.9% that > 50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium–low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in < 30% of patients.

Conclusions

There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan.

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References

  1. Virizuela JA, Camblor-Álvarez M, Luengo-Pérez LM, Grande E, Álvarez-Hernández J, Sendrós-Madroño MJ, et al. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report. Clin Transl Oncol. 2017. https://doi.org/10.1007/s12094-017-1757-4.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Argilés JM. Cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9(Suppl 2):S39–50.

    Article  PubMed  Google Scholar 

  3. Omlin A, Blum D, Wierecky J, Haile SR, Ottery FD, Strasser F. Nutrition impact symptoms in advanced cancer patients: frequency and specific interventions, a case–control study. J Cachexia Sarcopenia Muscle. 2013;4(1):55–61.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gagnon B, Murphy J, Eades M, Lemoignan J, Jelowicki M, Carney S, et al. A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer. Curr Oncol. 2013;20(6):310–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Uster A, Ruehlin M, Mey S, Gisi D, Knols R, Imoberdorf R, et al. Effects of nutrition and physical exercise intervention in palliative cancer patients: a randomized controlled trial. Clin Nutr. 2017. https://doi.org/10.1016/j.clnu.2017.05.027.

    Article  PubMed  Google Scholar 

  6. Balstad TR, Solheim TS, Strasser F, Kaasa S, Bye A. Dietary treatment of weight loss in patients with advanced cancer and cachexia: a systematic literature review. Crit Rev Oncol Hematol. 2014;91(2):210–21.

    Article  PubMed  Google Scholar 

  7. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9(Suppl 2):S51–63.

    Article  PubMed  Google Scholar 

  8. Marín Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007;26(3):289–301.

    Article  PubMed  Google Scholar 

  9. Rubin H. Cancer cachexia: its correlations and causes. Proc Natl Acad Sci USA. 2003;100(9):5384–9.

    Article  PubMed  CAS  Google Scholar 

  10. Heber D, Li Z. Nutrition intervention in cancer. Med Clin N Am. 2016;100(6):1329–40.

    Article  PubMed  Google Scholar 

  11. Schatzkin A, Subar AF, Moore S, Park Y, Potischman N, Thompson FE, et al. Observational epidemiologic studies of nutrition and cancer: the next generation (with better observation). Cancer Epidemiol Biomark Prev. 2009;18(4):1026–32.

    Article  Google Scholar 

  12. Tchekmedyian NS. Pharmacoeconomics of nutritional support in cancer. Semin Oncol. 1998;25(2 Suppl 6):62–9.

    PubMed  CAS  Google Scholar 

  13. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48.

    Article  PubMed  Google Scholar 

  14. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017;36(5):1187–96.

    Article  PubMed  CAS  Google Scholar 

  15. Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M. ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clin Nutr. 2009;28(4):445–54.

    Article  PubMed  CAS  Google Scholar 

  16. Cotogni P. Enteral versus parenteral nutrition in cancer patients: evidences and controversies. Ann Palliat Med. 2016;5(1):42–9.

    PubMed  Google Scholar 

  17. Chow R, Bruera E, Chiu L, Chow S, Chiu N, Lam H, et al. Enteral and parenteral nutrition in cancer patients: a systematic review and meta-analysis. Ann Palliat Med. 2016;5(1):30–41.

    PubMed  Google Scholar 

  18. Muscaritoli M, Molfino A, Laviano A, Rasio D, Rossi Fanelli F. Parenteral nutrition in advanced cancer patients. Crit Rev Oncol Hematol. 2012;84(1):26–36.

    Article  PubMed  Google Scholar 

  19. Senesse P, Tadmouri A, Culine S, Dufour PR, Seys P, Radji A, et al. A prospective observational study assessing home parenteral nutrition in patients with gastrointestinal cancer: benefits for quality of life. J Pain Symptom Manag. 2015;49(2):183.e2–191.e2.

    Article  Google Scholar 

  20. Vashi PG, Dahlk S, Popiel B, Lammersfeld CA, Ireton-Jones C, Gupta D. A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition. BMC Cancer. 2014;14:593. https://doi.org/10.1186/1471-2407-14-593.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Graham B, Regehr G, Wright JG. Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol. 2003;56:1150–6.

    Article  PubMed  Google Scholar 

  22. Mansell G, Shapley M, van der Windt D, Sanders T, Little P. Critical items for assessing risk of lung and colorectal cancer in primary care: a Delphi study. Br J Gen Pract. 2014;64(625):e509–15.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, et al. Nutritional support in cancer patients: a position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer. 2016;7(2):131–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Caccialanza R, Cereda E, Pinto C, Cotogni P, Farina G, Gavazzi C, et al. Awareness and consideration of malnutrition among oncologists: insights from an exploratory survey. Nutrition. 2016;32(9):1028–32.

    Article  PubMed  Google Scholar 

  25. Spiro A, Baldwin C, Patterson A, Thomas J, Andreyev HJ. The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br J Cancer. 2006;95(4):431–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Akbulut G. New perspective for nutritional support of cancer patients: enteral/parenteral nutrition. Exp Ther Med. 2011;2(4):675–84.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Puts MT, Tu HA, Tourangeau A, Howell D, Fitch M, Springall E, et al. Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review. Ann Oncol. 2014;25(3):564–77.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors thank Marta Pulido, MD, for editing the manuscript and editorial assistance. This study was funded by Fresenius Kabi, Barcelona, Spain.

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Authors and Affiliations

  1. Department of Digestive and General Surgery, Hospital Universitario Rey Juan Carlos, Madrid, Spain

    M. Durán-Poveda

  2. Department of Medical Oncology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain

    P. Jimenez-Fonseca

  3. Department of Hospital Pharmacy, Hospital HLA-Vistahermosa, Alicante, Spain

    M. Sirvent-Ochando

  4. Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, Seville, Spain

    P. P. García-Luna & J. L. Pereira-Cunill

  5. Nutrition Department, Clínica Diagonal, Esplugues de Llobregat, Barcelona, Spain

    B. Lema-Marqués

  6. Oncology Nursing Department, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain

    M. T. Parejo-Arrondo

  7. Department of Medical Oncology, HM CIOCC, Calle Oña 10, 28050, Madrid, Spain

    C. Belda-Iniesta

Authors
  1. M. Durán-Poveda
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  2. P. Jimenez-Fonseca
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  3. M. Sirvent-Ochando
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  4. P. P. García-Luna
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  5. J. L. Pereira-Cunill
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  6. B. Lema-Marqués
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  7. M. T. Parejo-Arrondo
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  8. C. Belda-Iniesta
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Corresponding author

Correspondence to C. Belda-Iniesta.

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Durán-Poveda, M., Jimenez-Fonseca, P., Sirvent-Ochando, M. et al. Integral nutritional approach to the care of cancer patients: results from a Delphi panel. Clin Transl Oncol 20, 1202–1211 (2018). https://doi.org/10.1007/s12094-018-1846-z

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  • DOI: https://doi.org/10.1007/s12094-018-1846-z

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