Managing Adult Malnutrition

Including a pathway for the appropriate use of
oral nutritional supplements (ONS)

Optimising Nutritional Care in Cancer

The information in this resource has been collated by experts in the field of nutrition and cancer care to enable health and care professionals to recognise nutritional issues and provide some first line resources to improve nutrition, help alleviate nutrition impact symptoms and enhance the patient experience.

Our thanks to Mhairi Donald, Consultant Oncology Dietitian and Dr Anne Holdoway, Consultant Dietitian who have helped us to compile this resource.

Many aspects of cancer can adversely affect an individual’s nutritional status. The cancer itself and the associated treatments (radiotherapy, chemotherapy, immunotherapy, surgery), can interfere with an individual’s ability to eat and drink, digest and absorb food and increase nutritional requirements. Symptoms that impact on the ability to eat and drink such as pain, nausea, loss of appetite, early satiety, changes in taste and smell and psychological stress are common. Left unnoticed and untreated, weight loss and muscle loss can be profound contributing to the development of syndromes such as sarcopenia, cachexia and malnutrition. In the absence of dietary advice and nutritional therapy (nutritional support), poor nutritional status adversely affects function, the everyday lived experience, health-related quality of life as well as the response to treatment and survival1-6.

Research has identified that nutrition is considered highly important by cancer patients across their trajectory of care from the period of diagnosis through treatment and beyond into survivorship and in palliation7 (See Table 1 below). Many experience diet-related issues throughout the journey which can persist well beyond the treatment phase. In addition more than half of cancer survivors feel confused about nutrition7.

In everyday practice nutrition in cancer continues to be overlooked or under-treated8, adding diet-related anxiety to anxieties that already exist amongst patients and their families. Timely nutritional care and dietary advice offers the capacity to alleviate diet-relates issues, improve nutritional intake and alleviate concern9, 10.

Note: Dietitians are skilled to undertake a detailed nutrition assessment and provide individualised dietary counselling and guide decision making on nutrition support. As nutritional issues are common and affect a high number of individuals with cancer, access to a dietitian may not be immediate and hence other members of the healthcare team can play a crucial role in identifying and alleviating nutritional issues and monitoring nutritional status to optimise outcomes and the patient experience. This resource aims to provide practical information and guidance to assist healthcare professionals in identifying the issues and offer dietary advice and oral nutrition support to patients with cancer in a timely manner.

Table 1: Cancer survivor reported nutritional problems adapted from Sullivan et al7

CANCER TYPE
Dietary/Nutritional Problems %
Unintentional Weight Loss %
Perceived Muscle Loss %
Head & Neck
86
72
63
Brain
55
24
61
Gastrointestinal
52
57
63
Breast
43
21
45
Blood
40
36
54
Gynae/Genitourinary
36
34
50
Lung
36
36
55
Other
45
37
48

  • Decreased dietary intake and cancer cachexia (characterised mainly by loss of appetite, unintentional weight loss and muscle wasting) may all contribute to cancer-related malnutrition11
  • Disease-related malnutrition, cachexia and sarcopenia (loss of muscle) occurs frequently in patients with cancer and untreated causes poorer outcomes and increases mortality12
  • Up to 83% of patients experience malnutrition during the course of their disease depending on the tumour type, tumour location, stage of disease, treatment received and the type of nutritional assessment method used9-11, 13-14
  • 1 in 3 patients attending out patients are at nutritional risk 15
  • Nutritional risk is associated with common clinical issues (e.g. fatigue, anorexia, gastrointestinal symptoms, sore mouth). These issues are usually noted and recorded. They can be a good indicator for the healthcare team that further nutritional assessment is warranted and trigger a referral for more detailed assessment by a dietitian or nutrition team15
  • Nutritional issues and poor nutritional status may result from the local effects of the cancer itself, the metabolic response to the cancer, and the treatments used which may include one or a combination of chemotherapy, radiotherapy, immunotherapy and surgery. All may produce immediate short term but also long-term effects and symptoms that limit the ability to eat and drink
  • Timely nutritional interventions can improve nutritional status, body composition, function, symptoms, quality of life (QoL), the patient experience and ultimately survival
  • Nutrition intervention should be considered at every point along the pathway – from prehabilitation through treatment to rehabilitation and living with and beyond cancer – in conjunction with individually tailored exercise, psychological and behaviour change interventions. Such interventions can reduce length of hospital stay, improve cardiorespiratory fitness and nutritional status, enhance recovery and reduce post-treatment complications16

GO TO NUTRITION AND CANCER RESOURCES

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Resources

A selection of publications for use by healthcare professionals, patients and carers are available in the resources section of the website.

RESOURCES AREA

Support for Patients & Carers

A number of resources are available that have been developed to support patients and carers.

PATIENTS & CARERS

Specific support for common conditions

A number of resources are available that have been developed to assist healthcare professionals supporting patients at risk of malnutrition as a result of a specific condition. These include:

COPD

Further Information

We can be contacted regarding the malnutrition pathway materials and website

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