Presentation: Malnutrition and Wasting in Patients with Cancer, a Brief Primer for Clinical Oncology

This presentation by Lauren Atkins provides key nutrition-focused strategies for nurses supporting patients under 50 with colorectal cancer. It highlights early recognition of malnutrition and sarcopenia beyond BMI, the importance of protein and muscle preservation, timely initiation of supplements, and proactive referral and reinforcement to optimise treatment tolerance and long-term outcomes.

Malnutrition and sarcopenia are highly prevalent but often under-recognised and under-treated in adults with cancer. Both conditions are associated with poorer treatment tolerance, reduced quality of life, and worse clinical outcomes. This COSA position statement provides practical recommendations for routine screening of all cancer patients for malnutrition and sarcopenia, using validated tools. It emphasises early identification, comprehensive assessment, and timely, individualised interventions—including nutrition therapy, exercise, and multidisciplinary care. The statement highlights the importance of integrating nutrition and muscle health into standard oncology practice to improve patient outcomes and recovery.

This randomised controlled trial examined older adults (≥65 years) with locally advanced gastric cancer undergoing neoadjuvant chemotherapy. Over 8 weeks, high-protein oral nutritional supplements (ONS) were compared to standard nutrition care. ONS improved calorie and protein intake and reduced malnutrition risk, though no significant differences were found in physical function or quality of life. Both groups experienced quality of life declines and increased fatigue during treatment. While ONS may help maintain nutritional status, further research is needed to assess long-term benefits.

A comparative study that showed that early nutritional intervention in patients with Head and Neck Cancer (HNC) receiving concurrent chemoradiotherapy resulted in improved treatment tolerance and fewer admissions to hospital. Suggesting that nutritional intervention must be initiated before chemoradiotherapy, and continued after treatment completion.

Older adults with cancer are at high risk for malnutrition and cachexia, particularly when undergoing chemotherapy. Despite this, nutritional risk is often under-recognised and under-treated in this population. This systematic review highlights that malnutrition is common both before and during chemotherapy, with digestive symptoms and weight loss frequently observed. Malnutrition is associated with poorer tolerance to chemotherapy, early treatment discontinuation, increased toxicity, and higher mortality. The authors recommend routine nutritional assessment and early, individualised interventions as part of comprehensive geriatric oncology care.

The 2025 ERAS Society guideline provides updated, evidence-based recommendations for perioperative care in elective colorectal surgery. Key elements include preadmission education, risk and comorbidity assessment, nutritional screening, and early oral feeding. The protocol emphasises multimodal pain relief, early mobilisation, and minimally invasive surgery. Some recommendations have changed: prehabilitation is no longer specifically recommended, immunonutrition is now considered for malnourished patients, and a slightly positive fluid balance is preferred. Adherence to the full ERAS protocol improves recovery, reduces complications, and shortens hospital stay, though evidence quality varies across interventions.

Malnutrition is a frequent and serious concern in patients with cancer, yet nutritional risk is often under-recognised and under-treated by clinicians and care teams. These ESPEN practical guidelines provide clear, evidence-based recommendations for the screening, assessment, and management of nutrition in adult cancer patients. The guidance emphasises early and regular nutritional evaluation from diagnosis, individualised interventions (including dietary counseling, oral nutritional supplements, enteral or parenteral nutrition as needed), and the importance of maintaining physical activity. The guidelines also address nutrition support during surgery, radiotherapy, chemotherapy, and in palliative care, highlighting the need for a multidisciplinary approach to optimise patient outcomes, treatment tolerance, and quality of life.

In these nutrition guidelines by Kiss N et al. 2026, it emphasises the importance of early nutrition support and regular dietitian involvement to prevent malnutrition in head and neck cancer.

Malnutrition is common in gynecologic cancer patients and worsens surgical outcomes. Immunonutrition (special nutrients like arginine, omega-3s, nucleotides, antioxidants) may help reduce infections, improve healing, and shorten hospital stays when used as part of Enhanced Recovery After Surgery (ERAS) protocols. However, challenges include high cost, poor patient compliance after surgery, and lack of standard guidelines. Evidence is promising but not yet conclusive—more research is needed before routine use.

Malnutrition and muscle wasting are common and serious concerns for patients with cancer, yet nutritional risk is often under-recognised and under-treated by clinicians and care teams. This review highlights that early and proactive nutritional screening, assessment, and individualised intervention are essential parts of oncology care. Evidence and guidelines support integrating nutrition counseling and, when needed, oral nutritional supplements to improve body composition, treatment tolerance, quality of life, and survival. A multidisciplinary approach, with nutrition as a central component, is recommended to optimise outcomes for cancer patients.

This systematic review and meta-analysis evaluated high-protein supplementation (≥10 g/serving) during cancer therapy. Across 35 randomised controlled trials (3701 patients), high-protein supplements reduced weight loss, improved muscle strength, and lowered hospitalisation rates. No significant effect was found on health-related quality of life. Effects on survival, fat mass, and therapy toxicity were inconsistent. Supplements were generally safe and well-tolerated. Most studies had moderate to high risk of bias, so results should be interpreted cautiously. High-protein supplementation may benefit cancer patients, especially those with prior weight loss, but more robust trials are needed.

Cancer-related cachexia is often under-recognised and inadequately managed, despite its impact on treatment outcomes and patient quality of life. These ESMO Clinical Practice Guidelines offer practical recommendations for identifying and managing cachexia in adult cancer patients, emphasising early intervention and a multidisciplinary approach.