Oncology

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.

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.

The 2025 ERAS guidelines mark a major leap in perioperative nutrition care, introducing preoperative immunonutrition and refined postoperative strategies. With stronger evidence and a proactive approach, they offer essential tools for optimising outcomes in colorectal surgery.

Malnutrition in cancer patients is a critical yet often under-treated issue that significantly affects treatment outcomes and survival. This short systematic review outlines practical strategies for early diagnosis and management, including validated screening tools, nutritional therapy, and exercise. It emphasises the importance of regular dietetic counselling and monitoring of muscle mass, with additional support for patients diagnosed with cancer cachexia.

Malnutrition is common and often overlooked in surgical patients, especially those with cancer. This ESPEN guideline emphasises early screening, individualised nutrition interventions, and integrating nutrition into surgical care (including Enhanced Recovery After Surgery protocols). Early oral feeding, prehabilitation, and multidisciplinary teamwork are recommended to improve outcomes, reduce complications, and support recovery.

Evidence based guidelines which were developed to translate current best evidence and expert opinion and translated into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of malnutrition in adult cancer patients. These guidelines were commissed and financially supported by ESPEN and by the European Partnership for Action Against Cancer(EPAAC).

A study evaluating the benefit of oral nutritional supplements(ONS) in addition to nutritional counselling in head and neck cancer(HNC) patients undergoing radiotherapy. HNC patients receiving radiotherapy and nutritional counselling with ONS had better weight maintenance, protein-calorie intake and quality of life than those patients who did not receive ONS.

Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. However, cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients and their families. These ESPEN expert group recommendations provide clinical guidance in managing cancer related malnutrition.