Current perspectives of healthcare providers on weight loss and supportive nutritional care in cancer patients

Abstract

Background: Malnutrition and cachexia occur in most cancer patients (pts) impacting quality of life (QoL) and anticancer treatment (Tx) outcomes. Nutritional care can help reverse weight loss and improve pt outcomes; however, previous surveys at ESMO (2014, 2015) suggest nutritional care/assessment is insufficiently implemented in clinical practice, despite educational and academic efforts. Methods: This survey created by the authors, including questions from prior surveys, was completed by ESMO 2016 delegates visiting the Nutricia booth. Results: Of 2,011 respondents, 78% were medical oncologists, 56% were Europe based; 61% always discuss nutritional aspects during multidisciplinary tumor boards. To assess malnutrition, 44% measure weight, 30% evaluate systemic inflammation, and 14% assess muscle loss. Eligibility of pts to receive nutritional support is assessed before (48% [44% in 2015; 47% in 2014]) or during (54%) initiation of anticancer Tx, at primary diagnosis (28%), if weight loss is visible during outpatient visits (42%), and when anticancer Tx ends (26%). Main impacts of malnutrition are increased anticancer Tx toxicity (58%; 2015: 53%; 2014: 53%), surgery/radiotherapy complications (40%; 37%; 36%), anticancer Tx discontinuation/decreased effectivity (54%; 40%; 40%), decreased QoL (58%; 56%; 54%), impaired physical function (47%; 44%; 45%), or distress of family members (35%; 32%; 32%). Main goals of nutritional support include QoL (65%; 69%; 64%), completion of anticancer Tx (54%; 52%; 45%), or stabilizing weight (48%; 44%; 47%). Popular approaches to minimize weight loss are antiemetics (48%; 56%), appetite stimulants (41%; 48%), more-effective anticancer Tx (39%; 47%), anticachexia drugs (38%; 43%), and timely and individually tailored dietary advice (36%). During systemic Tx, 85% apply physical exercise programs (either alone or in combination with nutritional care). Conclusions: Compared with our previous surveys, awareness and assessment of malnutrition in cancer pts seems slightly increased. HCPs recognize impacts of malnutrition but may need better guidance on how to improve nutritional care in the supportive and palliative setting.