Nutrition in patients with cancer: a new area for medical oncologists? A practising oncologist’s interdisciplinary position paper

The nutritional status of every patient with cancer may be negatively affected by the cancer itself (ie, mechanical obstruction) or indirectly through tumour-induced metabolic changes (often referred to as cancer-induced malnutrition or cachexia).1 Most of the antineoplastic treatments are likely to cause bothersome side effects (eg, xerostomy, nausea, diarrhoea, taste alterations) that alter appetite and reduce food intake. Some of these side effects may persist for long after treatment has stopped and in some cases, patients do not ever recover (ie, taste alterations due to radiotherapy for head and neck cancer). This may provoke a loss in food enjoyment, which can lead patients to withdraw from social situations that may involve food,2 thus, suggesting that nutrition in patients with cancer is a complex issue that requires a multidisciplinary approach by involving oncologists, nutrition specialists, psychologists, nurses and other allied healthcare professionals. According to several studies, medical oncologists and other healthcare professionals treating patients with cancer seem to neglect nutritional issues, both considering screening and information or intervention.3 4 This has lead the European Cancer Patient Coalition to publish a Cancer Patient’s Nutritional Bill of Rights, which was presented in the European Parliament in Brussels in November 2017.5 The Bill of Rights is also based on the recently updated European Society of Parenteral and Enteral Nutrition guidelines on nutrition in patients with cancer patients.6 Nutrition is a major issue for most patients with cancer and their families, and its impact will often lead to highly emotionalised discussions in our daily practice. Many patients will be worried when they witness loss of appetite and weight. Family members will pronounce even more often concerns, even when patients try to belittle them: weight loss is for many scarily synonymous with late, fatal stage cancer. For all participants, there often is …