The Value of Medical Nutrition in Oncology

In 2020, the number of deaths caused by cancer reached 10 million and over 19 million new cancer cases were diagnosed, making cancer a leading cause of death globally.¹

Adverse lifestyle and environmental risk factors, including obesity, ultraviolet (UV) radiation exposure and alcohol consumption, are expected to drive an increased incidence of cancer worldwide.¹

The prevalence of malnutrition in patients with cancer varies, depending on the age of the patient, the type and stage of cancer (see Figure) and anticancer treatment used.² Overall, 80% of patients with cancer experience involuntary weight loss over the course of their illness.² This causes changes in body composition and a loss of muscle mass, which is associated with decreased strength, functional capacity and quality of life.³ This phenomenon can also be prevalent in patients with cancer who are overweight or obese for whom malnutrition can be more difficult to detect.² However, cancer-induced malnutrition remains often under-recognised and undertreated.⁴
 

Malnutrition can develop as a result of the tumour or be associated with side effects of cancer treatment (e.g., nausea, taste alterations, mucositis) that hinder a patient’s ability to consume, digest or absorb adequate nutrition causing the risk of malnutrition to increase as the illness progresses. Patients with cancer who are malnourished have a lower chance of survival, with almost 20% of deaths being related to malnutrition.⁵ Malnourished patients also have a higher risk of poor response to treatment and have a higher risk of chemotherapy-induced toxicity, which means they may require more frequent treatment breaks.⁶ These factors combined lead to a poorer prognosis for patients with cancer who suffer from malnutrition. 

Improved clinical outcomes with medical nutrition

Maintaining or improving nutritional intake is crucial for patients with cancer but can be challenging. Targeted medical nutrition can help patients who are malnourished or at risk of malnutrition to meet their nutritional needs.⁷ By stabilising, and potentially improving, patients’ nutritional status weight loss can be reduced, and weight gain may even be facilitated.⁸

Nutritional screening should start from the time of diagnosis as a part of integrated therapy because patients’ nutritional status significantly impacts treatment outcomes.⁸ Additionally, the most common treatment types such as chemotherapy, radiotherapy and surgery, have side effects that can make nutritional intake particularly challenging.^2,9 Therefore, a baseline screening of nutritional status would allow better observation of the impact of these therapies on subsequent nutritional status. 

Economic value of medical nutrition 

Medical nutrition does not only show clinical, nutritional and functional benefits for patients with cancer, but offers economic benefits as well.

A systematic review examining the cost effectiveness of the use of ONS in hospital settings has found that the mean cost saving was 12.2% compared to patients who did not receive ONS.¹⁰

Providing medical nutritional support is associated with fewer treatment delays, fewer unplanned hospitalisations¹¹, an 11% reduction in hospital costs¹² and reduced hospital stay duration.^13,14 Length of hospital stay has been reported to be reduced by 18.7-21.7% in patients who received medical nutrition compared with those who did not^12,13 and the use of medical nutrition is also associated with decreased direct medical costs¹² and reduced use of healthcare resources.^14,15

Patients with cancer who received medical nutrition as part of their therapy also had lower complication rates compared with patients receiving standard care, which not only contributes to improved patient outcomes, but to cost effectiveness too.¹⁶ A systematic review of 16 studies investigating patients with gastrointestinal cancers undergoing surgery found that perioperative medical nutrition therapy reduced infection rates compared with those who did not receive medical nutrition.¹⁶

As the incidence of cancer continues to rise globally,¹ so too will the associated economic burden of patient care. Healthcare providers must reach for available tools that can not only support their patients’ recovery and quality of life, but also minimise the economic impact of their care, both individually and globally.

Medical nutrition is effective in preventing or treating disease-related malnutrition and also reduces healthcare costs associated with cancer treatment. Patients with cancer often suffer from symptoms that affect their eating, so nutritional counselling and selection of a palatable, convenient to use medical nutrition supplement is necessary to ensure that the amount consumed is as close as possible to the amount prescribed to the patient.