ESPEN guidelines on nutrition in cancer patients

Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplements to improve their treatment outcomes, quality of life, and overall survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer survivorship to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information with which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity guidelines during the continuum of cancer care, briefly highlighting important issues during cancer treatment and for patients with advanced cancer, but focusing largely on the needs of the population of individuals who are disease free or who have stable disease following their recovery from treatment. It also discusses select nutrition and physical activity issues such as body weight, food choices, food safety, and dietary supplements; issues related to selected cancer sites; and common questions about diet, physical activity, and cancer survivorship.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21142

Nutrition and physical activity guidelines for cancer survivors.

Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

ESPEN guideline: Clinical nutrition in surgery

To review the literature on the MNA® to Spring 2006, we searched MEDLINE, Web of Science & Scopus, and did a manual search in J Nutr Health Aging, Clin Nutr, Eur J Clin Nutr and free online available publications. Validation and validity: The MNA® was validated against two principal criteria, clinical status and comprehensive nutrition assessment using principal component and discriminant analysis. The MNA® short- form (MNA®-SF) was developed and validated to allow a 2-step screening process. The MNA® and MNA®-SF are sensitive, specific, and accurate in identifying nutrition risk. Nutritional Screening: The prevalence of malnutrition in community-dwelling elderly (21 studies, n = 14149 elderly) is 2 ± 0.1% (mean ± SE, range 0- 8%) and risk of malnutrition is 24 ± 0.4% (range 8-76%). A similar pattern is seen in out-patient and home care elderly (25 studies, n = 3119 elderly) with prevalence of undernutrition 9 ± 0.5% (mean ± SE, range 0-30%) and risk of malnutrition 45 ± 0.9% (range 8-65%). A high prevalence of undernutrition has been reported in hospitalized and institutionalized elderly patients: prevalence of malnutrition is 23 ± 0.5% (mean ± SE, range 1- 74%) in hospitals (35 studies, n = 8596) and 21 ± 0.5% (mean ± SE, range 5-71%) in institutions (32 studies, n = 6821 elderly). An even higher prevalence of risk of malnutrition was observed in the same populations, with 46 ± 0.5% (range 8-63%) and 51 ± 0.6% (range 27-70%), respectively. In cognitively impaired elderly subjects (10 studies, n = 2051 elderly subjects), detection using the MNA®, prevalence of malnutrition was 15 ± 0.8% (mean ± SE, range 0-62%), and 44 ± 1.1% (range 19-87%) of risk of malnutrition. Characteristics: The large variability is due to differences in level of dependence and health status among the elderly. In hospital settings, a low MNA® score is associated with an increase in mortality, prolonged length of stay and greater likelihood of discharge to nursing homes. Malnutrition is associated with functional and cognitive impairment and difficulties eating. The MNA® detects risk of malnutrition before severe change in weight or serum proteins occurs. Nutritional Intervention: Intervention studies demonstrate that timely intervention can stop weight loss in elderly at risk of malnutrition or undernourished and is associated with improvements in MNA® scores. The MNA® can also be used as a follow up assessment tool. Conclusion: The MNA® is a screening and assessment tool with a reliable scale and clearly defined thresholds, usable by health care professionals. It should be included in the geriatric assessment and is proposed in the minimum data set for nutritional interventions.

https://www.mna-elderly.org/publications/341.pdf

The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us?

Nutrition status has an important effect on quality of life and sense of well-being in cancer patients. Malnutrition and weight loss are often contributors to the cause of death in cancer patients. 1 Cancer cachexia is a syndrome characterized by progressive, involuntary weight loss. Clinical features include host tissue wasting, anorexia, skeletal muscle atrophy, anergy, fatigue, anemia, and hypoalbuminemia. Causes of cancer cachexia include anorexia, mechanical factors affecting the gastrointestinal tract related to tumor, side effects of surgery, chemotherapy and/or radiation therapy, alterations in intermediary and energy metabolism, and changes in the host cytokine and hormonal milieu. The cancer cachexia syndrome (CCS), which is observed in approximately 50% of cancer patients, involves heterogeneous physiologic and metabolic derangements resulting in potentially life-threatening malnutrition. 2 Although often seen in patients with advanced malignancies, CCS may be present in the early stages of tumor growth. Weight loss in cancer patients is of prognostic significance. For any given tumor type, survival is shorter in patients who experience pretreatment weight loss. 3-5

/pdf/a-s-p-e-n-clinical-guidelines-nutrition-support-therapy-3reeerrfsm.pdf

A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation.

Weight loss is common in patients with cancer. Many factors, such as physiological abnormalities, response to the tumour, and treatment, contribute to this weight loss. Cancer-related weight loss affects a patient's response to treatment, as well as survival and quality of life. Several nutritional screening and assessment tools have been developed for patients with cancer. This review describes the weight loss seen in patients with cancer as well as the methods of screening for nutritional deterioration and weight loss early in a cancer diagnosis. Nutritional approaches to the supportive care of patients with cancer are also discussed.

Importance of nutritional screening in treatment of cancer-related weight loss

It is clear that cancer patients develop complex nutrition issues. Nutrition support may or may not be indicated in these patients depending on individual patient characteristics. This review article, the first in a series of articles to examine the A.S.P.E.N. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients Cancer Guidelines, evaluates the evidence related to the use of nutrition screening and nutrition assessment in cancer patients. This first article will provide background concerning nutrition issues in cancer patients as well as discuss the role of nutrition screening and nutrition assessment in the care of cancer patients. The goal of this review is to enrich the discussion contained in the Clinical Guidelines, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequent published studies. Future articles will explore the guidelines related to nutrition support in oncology patients receiving anticancer therapies.

Review of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines for Nutrition Support in Cancer Patients: Nutrition Screening and Assessment

Malnutrition and weight loss negatively affect outcomes in surgical cancer patients. Decades of research have sought to identify the most appropriate use of nutrition support in these patients. National and international guidelines help to direct clinicians' use of nutrition support in surgical patients, but a number of specific issues concerning the use of nutrition support continue to evolve. This review focuses on 5 key issues related to perioperative nutrition support in cancer patients: (1) Which perioperative cancer patients should receive nutrition support? (2) How can the nutrition status and requirements of these patients be optimally assessed? (3) What is the optimal route of administration (parenteral nutrition vs enteral nutrition) and composition of nutrition support in this setting? (4) When should feedings be initiated? (5) What is the role of glycemic control in these patients?

Perioperative Nutrition Support in Cancer Patients

This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies.

Maureen B. Huhmann

Papers

A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation.

Importance of nutritional screening in treatment of cancer-related weight loss

Review of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines for Nutrition Support in Cancer Patients: Nutrition Screening and Assessment

Perioperative Nutrition Support in Cancer Patients

Nutrition support in surgical oncology.