Help Improve Quality of Life for Oncology Patients: Changing From Reactive Nutrition Support to Proactive Nutrition Intervention in Clinical Practice

TON - November/December 2014 Vol 7 No 6

The diagnosis of cancer and the following treatment both have a profound impact on all aspects of a patient’s life. Quality of life is impacted in many aspects, including physical functioning, psychological well-being, and social life. Even at diagnosis, up to 50% of cancer patients present with some nutritional deficit that may be impacting physical functioning.1 Most of the anticancer treatments (ie, surgery, chemotherapy, and radiation) will jeopardize food intake and therefore nutrition status at some point during treatment. This disruption contributes further to declining quality of life throughout care and into survivorship.

In order to help improve or minimize the impact of treatment on quality of life, it is important to identify patients at risk of malnutrition at diagnosis or early during care.2 In 2007, a group of researchers published a review of the literature that highlighted the relationship between quality of life and nutrition intervention in patients with cancer.2 The researchers made practice recommendations based on findings from the literature linking weight loss and other nutrition-related symptoms to low quality of life and reduced response to antitumor treatment.2 The group concluded:

  • Early nutrition intervention can reduce or reverse poor nutrition status, improve performance, and improve quality of life.
  • There should be a prescription for patient-tailored nutrition intervention (ie, counseling, oral nutrition supplementation, tube feeding, or parenteral nutrition).
  • The role of nutrition intervention in curative care is to increase treatment tolerance and response, decrease complications, and reduce mortality.
  • The role of nutrition in palliative care is to improve quality of life by improving clinical symptom management (vomiting, nausea, etc).
A review published in February 2014 by a group of experts continues to highlight the importance of early identification of malnutrition and cachexia in oncology patients.3 The group emphasized the importance of completing a clinical assessment of all patients for malnutrition and cachexia in order to prescribe the appropriate intervention. Cancer-related weight loss, or cachexia, is different from simple starvation due to the tumor-associated metabolic abnormalities that prevent normal nutrition refeeding to restore nutrition status. When patients reach the stage of cancer cachexia, conventional nutrition support alone is not sufficient to reverse this state.4 Unfortunately, malnutrition and cachexia are common during cancer care and are related to low quality of life.2 Cancer cachexia represents 10% to 22% of all cancer deaths.5

Inadequate intake may be the primary reason for weight loss in some patients. In such cases, conventional nutrition support may be given in the form of counseling, oral nutrition supplements, or tube feeding. Cancer cachexia has the additional clinical challenges of altered metabolism and systemic inflammation. In patients with cachexia, multimodal therapy—including oral nutrition supplements with or without omega-3 fatty acids, nonsteroidal anti-inflammatory drugs, and exercise—should all be considered.3 The authors conclude that, regardless of tumor type, each patient should have access to individualized nutrition care throughout the course of treatment and into survivorship.3

Proactive and continuous nutrition care can be integrated into treatment pathways to significantly impact quality of life. Associations and accrediting organizations support comprehensive cancer care that includes nutrition services.6,7 Although nutrition services are generally available to all patients, access may be difficult. Therefore, each member of the multidisciplinary team has responsibility to identify areas of patient need, including nutrition. Creating an automatic or required nutrition screen such as the Malnutrition Screening Tool (MST) at each visit will help identify early signs of nutrition risk and allow for early intervention. It is also helpful to have simple and readily available nutrition interventions, such as education or oral nutrition supplements, to encourage clinicians to start intervention as soon as a patient is identified as being at risk for malnutrition.

Nutrition intervention has been shown to reduce the number of complications patients may experience during the acute phase of curative oncology treatment.2 Expert reviews have demonstrated that improvement in patient outcome can be achieved with early and proactive nutrition intervention.2,3 Providing nutrition as an integrated part of the oncology patient’s treatment plan is one way you can make a significant contribution to a patient’s quality of life.

Tiffany DeWitt works for Abbott Nutrition Research & Development.




References
  1. Halpern-Silveira D, Susin LR, Borges LR, et al. Body weight and fat-free mass changes in a cohort of patients receiving chemotherapy. Support Care Cancer. 2010;18(5):617-625.
  2. Marin Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007;26(3):289-301.
  3. Aapro M, Arends J, Bozzetti F, et al. Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol. 2014;25(8):1492-1499.
  4. earon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489-495.
  5. Tisdale MJ. Cachexia in cancer patients. Nat Rev Cancer. 2002;2(11):862-871.
  6. Marino MJ, Patton A, eds. Cancer Nutrition Services: A Practical Guide for Cancer Programs. Association of Community Cancer Centers; 2012. http://www.accc- cancer.org/resources/NutritionPrograms-Overview.asp.
  7. Commission on Cancer, American College of Surgeons. Cancer Program Standards 2012, Version 1.2.1: Ensuring Patient-Centered Care. Chicago, IL: American College of Surgeons; 2012. https://www.facs.org/quality%20programs/cancer/coc/standards.

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