Treating Cancer via Parallel Pathways

Anti-Cancer Pathway Nutritional Pathway

Disease Nutritional Assessment

Staging

First-line First-level Intervention

Therapy (Balanced diet + Sufficient energy)

Follow-up + Follow-up + Re-evaluation

Re-evaluation

Second-line Upper-level intervention

therapy (Pharmaconutrition)
 Cornerstones of the parallel pathway
• Cancer are not all alike
• Cancer patients are not all alike
• The “cancer journey” is a dynamic process
• Metabolic and nutritional needs may widely vary during the
“cancer journey”
• Repeated, accurate patient’s evaluation is crucial
• Clear identification of the patient’s phenotype based on:
– Inflammantory response
– Calculated or estimated metabolic and nutritional needs
– Anorexia and food intake
– Ability to comply with prescribed treatment(s)
Prevalence of Malnutrition and Current Use of
Nutrition Support in Patiens With Cancer
jurnal of Parenteral and Enteral Nutrition Volume 38 Number
2 Februari 2014 196-204
Xavier Herbuterne, MD, PHD; Etinne Lemarie, MD; Mauricette
Michallet, MD, PhD; Calude Beauvillain de Montreuil, MD;
Stephane Michel Schneider, MD, PhD; and Francois Goldwasser,
MD, PhD
Abstract
• Backgrund and aims: the aim of this study was to evaluate
on 1 day the prevalence of malnutrition in different types
of cancer and the use of nutrition support in patiens with
cancer. Methods: A 1-day prevalence survey was carried
out in 154 French hospital wards. Malnutrition wad
defined as a body mass index (BMI) < 18,5 in patients <75
years old and/or body weight loss >10 % since disease
onset. Oral food intake was measured a visual analog scale
• Results: nutrition status was collected for 1903
patients (1109 men and 794 woman. 59.3 + 13.2
years). Cancer was local in 25% regional in 31%
and metastatic in 44% of patients. Performance
status was 0 or 1 in 49.8%, 2 in 23.7%, 3 or 4 in
19.6$ and not available in 6.5% of patients.
Overall, 39% of patients ware malnourished. The
prevalence of malnutrition by disease site was as
follow: head and neck, 48.9%;
leukemia/lymphoma, 34.0%; lung, 45.3%;
colon/rectum, 39.3%; esophagus and/or
stomach, 60.2%; pancreas, 66.7%; breast, 20.5%;
ovaries/uterus, 44.8%; and prostate, 13.9%.
• Regional cancer (odds ratio, 1.96; 95% confidence
interval, 1.42-2.7-), metastatic cancer (2.97;2.14-
4.12), pervious chemotherapy (1.41; 1.05-1.89),
and pervious radiotherapy (1.53; 1.21-1.92) werw
associated with malnutrition. Only 28.4% of non-
malnourished patiens received nutrition support.
In all, 55% of patients stated that they were
eating less than before the cancer, while 41.4% of
patients stated that they had received nutrition
counselling. Conclusions: The prevalence of
malnutrition is hight in patients with cancer, and
systematic screening for and treatment of
malnutrition is necessary. (JPEN J Paranter
Enteral Nutr. 2014;38:196-20)
 Take-home Messages
• Weight loss and cachexia negatively impact on prognosis and
quality of life of cancer patients
• The pathogenesis of weight loss and cachexia is multifactorial
and deriving from the complex interplay between the tumor,
inflammantory response amd the tumor-derived humoral
factors, but nutritional does play a prominent role
• Cancer cachexia is not an end-stage clinical condition
• Sarcopenia negatively sffects tolerance to treatment and
survival in cancer patients
• Nutritional and metabolic surveillance and intervention
should become part of the standart pf care for cancer patients
• New effective tools are now available to eraly diagnose and to
prevent or delay the onset of weight loss and cachexia
• Specific nutrients may counteract loss of weight and muscle
mass and improvw tolerance to antineoplastic treatments