Nutrition is a fundamental biological process for life that pursues well-being and the preservation of human health. Essentially, it provides the necessary nutrients for the proper functioning, growth, and maintenance of vital functions. There is abundant evidence that adequate nutrition in people with cancer can promote their healing.

What is malnutrition?

Malnutrition and unintentional weight loss are predictors of treatment response, regardless of tumor type and stage. Weight loss in people with cancer is related to decreased quality of life and worse disease prognosis.

Malnutrition interferes with these people’s response to their disease and treatment. Among other alterations, it is mainly marked by changes in body composition, excess extracellular water, fat tissue deficits, and cachexia (a catabolic state in which metabolic alterations cause massive weight loss, mainly at the expense of muscle mass).

Under these conditions, the immune system is compromised due to muscle function deterioration, decreasing functional capacity, increasing infection risk, and at the same time increasing the risk of toxicity induced by concomitant treatments such as chemotherapy. Overall, it results in a lower response and inevitably leads to a decrease in quality of life.

Why does it occur?

It occurs due to an imbalance between nutrient intake and uptake against their requirements and losses. In people with cancer, it arises from a confluence of different factors:

  1. Factors related to the tumor; weight loss, anorexia, early satiety, asthenia, anemia, or mechanical and functional alterations of the digestive system such as dysphagia, pain, and nausea.
  2. Factors related to the patient; psychological factors such as fear, depression, or anxiety may appear. Depending on the case, alcohol and tobacco consumption can reduce appetite. Alcohol also causes malabsorption of vitamin B12, folic acid, zinc, and magnesium. Lack of oral hygiene habits can lead to tooth loss, making food intake difficult.
  3. Factors related to treatment. It is important to consider that nutritional status will determinatively influence tolerance to the different treatments described below, as well as their joint recurrence in many cases.
    1. Surgery increases energy-protein requirements in processes of healing and fighting infections. If it also involves organ removal, it can physically limit feeding.
    2. Radiotherapy can cause effects such as asthenia and anorexia throughout treatment. Depending on tumor location, it can also present different side effects. For example, radiotherapy in head and neck cancer can cause cavities, infection, and mouth inflammation, pharynx inflammation, xerostomia, and anorexia. In the thorax, it can cause esophageal transit alterations, reflux, and esophagitis. And in the abdominal region, diarrhea, vomiting, enteritis, and alterations in nutrient absorption in the intestine.
    3. Chemotherapy more commonly produces xerostomia, mucositis, nausea, vomiting, intestinal inflammation, and alterations in taste and smell.
    4. Immunotherapy causes nausea, vomiting, fever, tiredness, and anorexia.

What is the mission of the nutrition consultation?

The presence of a nutrition specialist in the Oncohealth Institute arises from the need to provide specialized response both for its preventive and therapeutic action. This comprehensive approach in treating people with cancer is the result of joint work between the Oncology and Endocrinology and Nutrition Departments of the Jiménez Díaz Foundation. From this consultation, nutritional treatment is individualized, carrying out a daily practice that is rigorous and at the same time close, humane, and respectful with the patient. The main functions of the nutrition consultation are:

  • Early detection of the risk of malnutrition. This is also possible thanks to close collaboration with the Oncology Nursing Unit and is carried out in all patients at the beginning and periodically throughout treatment.
  • In patients at risk of malnutrition or with established malnutrition, assistance is provided and a thorough nutritional status assessment is carried out through:
    1. Clinical Assessment
    2. Functional Assessment
    3. Anthropometric Assessment
    4. Other assessments
  • Adjustment of oral and/or enteral dietary-nutritional treatment.
  • Monitoring and, if necessary, modification of the treatment.
  • Research and presentation of results.

What are the objectives of nutritional treatment?

It is important to remember that nutrition is a supportive, not curative, treatment, whose main objectives are:

  1. Maintain or improve nutritional status.
  2. Minimize symptoms affecting food intake.
  3. Improve response to radiotherapy and chemotherapy treatment.
  4. Reduce surgical risks.
  5. Improve quality of life.

Miguel Aganzo Yeves