Supportive and palliative nutritional care for cancer patients (pts) with malnutrition and cachexia – a survey of healthcare providers (HCPs)

Background

Malnutrition and cachexia are common in cancer pts and can negatively affect anticancer-treatment response, toxicities and complications, survival, and quality of life (QOL). Nutrition support can be effective in improving weight loss and, potentially, pt outcomes. However, it is not routinely integrated into clinical practice, possibly due to insufficient HCP awareness of the impact of weight loss, and available practice guidance, as a prior survey (ESMO 2015, Abstr 1606) also reported. We hypothesize that the role of nutrition in supportive care and competencies managing cachexia are also contributors.

Methods

ECCO-ESMO-ECC 2015 delegates visiting the Nutricia booth took part in the survey, which was created by the authors.

Results

Of 963 participants, 72% were medical oncologists and 56% Europe based, mirroring congress attendee distribution. 44% routinely assess malnutrition before initiating, 30% during, and 9% after (curative) anticancer treatment. Importance of supportive nutrition was ascribed to curative (80%), noncurative (58%), and end-of-life care (39%). Main impacts of malnutrition were pt QOL (56%) or function (44%) and toxicities (53%), with variation amid professions. Dietary advice and/or nutritional supplements were given to >61% pts by 15%, and 21–60% by 56%, with the main goals QOL (69%), anticancer treatment completion (52%), and fast recovery (50%). Main nutritional care barriers were lack of assessment/monitoring tools (61%), costs of supplements (42%), no clear guidelines (29%), and lack of time (28%). Approaches to minimize weight loss were antiemetic therapy (56%), appetite stimulation (48%), and other anticachexia drugs (43%), more effective anticancer treatment (47%), and lowering the anticancer treatment dose (11%). 78% apply nutritional measures for cancer cachexia pts, but 9% were unaware of the cancer cachexia concept.

Conclusions

A small majority of HCPs recognise the negative impact of malnutrition and cachexia on cancer care outcomes, but a minority routinely apply nutritional assessment and care. Clinical practice tools, education, and guidelines are needed to improve nutritional care practice in cancer supportive and palliative care.

Clinical trial identification

Legal entity responsible for the study

Nutricia

Funding

Nutricia

Disclosure

F. Strasser: Advisory board: Acacia, ACRAF, Amgen, Baxter, Celgene, Danone, Fresenius, GlaxoSmithKline, Grunenthal, Helsinn, Isis, Global, Millennium/Takeda, Mundipharma, Novartis, Novelpharm, Nycomed, Obexia, Ono, Otsuka, Pfizer, Pharm-Olam, PsiOxus, PrIME, Santhera, Sunstone, Teva, Vifor. Corporate-sponsored research: Novartis. Industry grants for clinical research: Celgene, Fresenius, Helsinn. R. Audisio: Corporate-sponsored research: Honoraria for independent presentations at meetings sponsored by industry (Nutricia and Roche). N. Georgiou: Corporate-sponsored research Employee of Nutricia Advanced Medical Nutrition. All other authors have declared no conflicts of interest.