Nutritional deficiencies in patients with cancer are very common and have a multitude of causes. Poor nutritional intake may be secondary to the location of the cancer, chemotherapy, postoperative state, or the cancer itself (regardless of location).
Malnutrition affects up to 80% of patients with cancer, especially those with primary gastrointestinal tract and head and neck malignancies.1
A challenging question that is often encountered both in the inpatient and outpatient setting is how to optimize a patient’s nutritional status for both medical outcomes and quality of life.
Oncology patients with malnutrition clinically do worse with respect to survival, response to treatment (chemotherapy and surgery), and adverse events secondary to chemotherapy.2
There are multiple screening tools and risk calculators to determine a patient’s nutritional status including the Nutritional Risk Index (NRI), subjective global assessment (SGA), and nutritional risk screening (NRS-2002).3
In addition to these scores, a patient’s body weight, body mass index (BMI), and laboratory values (total protein, prealbumin, albumin, cholesterol, and complete blood count) should also be evaluated during their clinical course.
When evaluating a patient for potential nutritional support, it is important to consider how the nutrition will be provided, as it can be accomplished in several different ways. Enteral (direct administration into the gastrointestinal tract) nutrition can be provided via a nasogastric (NG) tube, dobhoff tube (DHT), percutaneous endoscopic gastrostomy (PEG) tube, or jejunostomy.
Long term parenteral (delivered through the venous system) nutrition can be delivered through central venous catheters such as peripherally inserted central catheter (PICC) or chest ports.
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As most of these delivery modalities are somewhat invasive, it is important to consider the type and prognosis of the cancer, anticipated duration of nutritional support, upcoming surgeries, and/or planned chemotherapy and amount of family support available to assist with the patient’s care.
Unfortunately, there are no consensus guidelines on when to start enteral or parenteral nutrition in patients with cancer.
Many of the retrospective studies conducted to evaluate this question along with complication rates are often confounded by the heterogeneity of the prior clinical trials.