Tumors, why only one center out of two deals with nutrition?

On the one hand, there is weight loss, even more than 15-20%. On the other, there is an increase, with the accumulation of fat mass at the expense of muscle mass. They are two sides of the same coin, that is, the management of nutrition in those with cancer. With important repercussions: in the first case on the possibility of following treatment, in the second on the risk of metabolic syndrome and recurrence. In both cases, therefore, on the prognosis. And then there are all the other patients, who perhaps initially do not have obvious nutritional problems, but who with the diagnosis begin to change their eating habits, perhaps depriving themselves of essential foods, without any medical supervision. It is in this scenario that a new data must be considered: about half (49%) of cancer centers do not yet provide a path dedicated to nutrition and food. This is what emerges from the survey “Nutritional screening pathways in oncology” conducted by the Italian College of Chief Hospital Oncologists (Cipomo) on one hundred facilities throughout Italy, and presented today at the XXIX National Congress of the scientific society, underway in Florence.

There is a lack of organized routes

“Today there is a great awareness of the importance of nutrition, which is increasingly taken into consideration, but is not yet systematized”, explains Luisa Fioretto , president of Cipomo and director of the Oncology Department of Ausl Toscana Centro. In many cases, there is still a lack of organized pathways, as required by the guidelines and in compliance with the skills of the various professionals: “Already during the first oncological visit, for example, an initial analysis of the patient's nutritional status should be carried out. It must be considered that over half of oncological patients present alterations in their nutritional status, with 9% clearly malnourished and 42% at risk of malnutrition at the time of the first visit”.

Nutritional screening at the first visit

But nutritional screening is done at the same time or immediately after the first visit only in two-thirds of the oncology centers considered in the survey, while 33% are left out. “In most cases, however, it is routinely performed only on patients with weight loss, overweight or underweight, not on all patients - Federica Grosso , scientific director of the survey and oncologist at the University Hospital of Alessandria, tells Salute - If there are no obvious weight problems, in 40% of cases they are not even asked about eating habits. However, this can have a big impact: the patient could be vegan or have decided not to touch sugars anymore, as often happens. Knowing this is important, because it can lead to deficiencies”. In addition, 30% of hospitals do not use validated nutritional screening tools. Furthermore, when performed, nutritional screening is entered into the computerized medical record in a systematic way only in 65% of cases.

Undernutrition and sarcopenia

The most frequent cases of malnutrition occur in head and neck cancers, gastrointestinal cancers - especially stomach, pancreas, liver (excluding colorectal cancer) and lung cancer, or when there are metastases in the digestive tract, the experts explain. In women with breast cancer undergoing anti-hormonal therapy, however, attention must be paid to weight gain, a consequence of the therapies themselves, with the appearance of sarcopenia. "Our goal, however, which is why we conducted this survey, is for all cancer patients to be sent to a nutrition professional," Grosso emphasizes.

The presence of nutrition specialists

It is no coincidence that “what can I eat?” is one of the first questions asked after a diagnosis. Today, in fact, there is a lot of talk about the health of the microbiota and it is now known that adequate nutritional support improves tolerance to treatments, supports the immune system, and preserves quality of life. Well, but are there specialized figures in the centers that provide nutritional programs? Here the data are more positive: they are present in 86% of cases. We are talking about nutritionists and dieticians (51%), dietitian doctors (27%), oncologists and dedicated nurses (11% each).

The necessary reorganization

Despite the critical issues, the consensus on the importance of nutrition in oncology is almost unanimous: 97% of survey participants believe a national path on nutrition is necessary, 98% hope for greater integration in oncology paths and a further 97% require more training for oncologists. In short, the glass can still be seen as half full: "Dedicated outpatient clinics and nutritional paths represent one of the key aspects addressed within the Cipomo laboratory, which has started a process of organizational reconfiguration of hospital oncology departments in the country - concludes President Fioretto - Early and continuous nutritional management must become an integral and systematic part of the oncology path in continuity with territorial services, in line with the Charter of the rights of the oncology patient, the Aiom Guidelines and the Guidelines of the Ministry of Health".