Key Takeaways From the ESPEN Congress 2022 – Nutrition in Oncology

Every year the European Society for Clinical Nutrition and Metabolism (ESPEN) organizes a congress to facilitate discussion of the latest insights and science on the role of nutrition in disease and health. 

After 2 years of virtual engagements, a hybrid event was organized in 2022 with a physical meeting being held in Vienna, Austria. The live participation also allowed us to present an abstract in the poster session. 

This article focuses on the importance of health status during cancer treatment. 

While nutrition for patients with cancer has been studied in detail, many opportunities remain to improve medical nutrition products for this population. In particular, several sessions at ESPEN 2022 focused on best practices in enhanced recovery after surgery (ERAS) protocols, fine-tuning nutritional requirements for patients with cancer through proper screening, and protein intake as a key element for maintaining muscle mass.

Malnutrition 

Early screening of patients with cancer for nutritional issues is strongly recommended because of the high prevalence of malnutrition at diagnosis and the ongoing risk of malnutrition during treatment. Weight and nutritional status are related to health outcomes during disease progression, so early intervention can have a significant impact on patient outcomes.

The prevalence of malnutrition varies greatly between patients and is dependent on various factors. However, cancers in the upper gastrointestinal tract (e.g., head and neck and esophageal cancers) are known to be associated with weight loss. In contrast, breast and prostate cancer are associated with weight gain, but adequate nutrition is still important.

Muscle maintenance is an independent component of body weight, so even when patients with cancer gain weight, there is a risk of sarcopenia resulting from chemotherapy toxicity. Patients with sarcopenia may therefore require treatment dose reduction or interruption. Accordingly, nutritional treatment for patients with cancer should focus on muscle mass rather than total body weight. 

Medical nutrition is associated with improved clinical outcomes, better response to anti-cancer treatments and reduced risk of chemotherapy toxicity in patients with malnutrition*.

The Role of the Microbiome

The relationship between the gut and various diseases is gaining attention as further scientific insight is developed. Several ESPEN sessions were devoted to discussing the latest discoveries regarding the relationship between microbiome composition and malnutrition, cachexia, and cancer.

Protein supplementation is an important strategy for maintaining muscle mass and function, particularly in the context of cancer-related inflammation and cachexia having a detrimental effect on muscle homeostasis. Inflammation and limited variety in a patient’s diet – both issues in patients with cancer – have also been linked to low microbiota richness, which is in turn associated with low lifestyle scores. 

Patients with cancer and cachexia have a significantly different microbiome profile compared with a control population, suggesting that additional research is required to investigate whether patients with cancer may benefit from probiotics to support gut health, reduce inflammation, increase muscle mass, and improve quality of life.

In the future, pro- and postbiotics may play a larger role in supporting the gut microbiome and the overall health of patients with cancer. For now, malnutrition and muscle maintenance are the main priority as further opportunities for oral nutritional supplements (ONS) are investigated. Compact formats that provide substantial nutrition in a small volume are well-suited for this population. For example, the inclusion of nutrients that can provide digestive comfort, such as fast-absorbing whey protein, can improve the patient experience in nutritional therapy and modular proteins can be useful when fortification of the normal meals is the goal.

Goals of Nutritional Therapy

For nutrition support to be successful, treatment needs to be optimized for individual patients. While there are overarching principles that should be considered when developing treatment protocols and policy, a personalized approach is required when implementing nutrition plans for individual patients.

Therefore, when implementing nutritional therapy, healthcare providers should aim to:

• Offer a positive, personalized experience for the patient, with focus on feasibility of nutrition goals, considering their health status, for example, the presence of swallowing issues, mouth sores, or taste changes. Personal preferences should also be considered, such as facilitating a meal plan that allows the patient to eat with their family or integrating supplements into their daily routines.
• Increase dietary intake, with a primary focus on energy and proteins.
• Use nutrition to improve patient quality of life compared with no intervention.
• Ultimately reduce adverse events and achieve better outcomes with cancer therapy.
• Utilize a holistic approach, guided by a dietitian or clinical nutritionist within the treatment team.

In general, nutrition therapy is cost-effective and reduces other treatment costs, for example, by reducing the risk of treatment interruption and complications after surgery, and shortening length of hospital stay.

However, the exact savings depend on the type of cancer, the stage of the disease, and the nutritional status of the patient.