The Nutrition Society Paper of the Month for February is from Proceedings of the Nutrition Society and is entitled ‘Nutrition support and clinical outcome in advanced cancer patients’ by authors Alessandro Laviano, Luca Di Lazzaro and Angela Koverech.
The progress made in cancer research over the last few decades is undeniable. Better knowledge of the mechanisms underlying cancer initiation, progression and dissemination has led to more effective preventive treatments. However, although the number of cancer deaths is declining year on year, more and more people are suffering from cancer. More importantly, new challenges are now limiting the effectiveness of the available anti-cancer therapies, including the need to provide adequate therapies to the growing number of older patients, many of whom are suffering from multiple diseases.
In contrast to patients with localised disease, advanced cancer patients have to undergo long, aggressive and frequently combined anti-cancer therapies, which impact on their nutritional status. Until now, preserving cancer patients’ body weight and composition was a target for supportive care following cancer therapy. However, new clinical data analysed in our paper show that nutrition support during anti-cancer therapies also contributes to achieving better outcomes.
Weight loss and particularly muscle wasting are both common features of advanced cancer patients. Malnutrition – better defined as “cachexia”, since nutritional deterioration is secondary to both reduced food intake and metabolic disturbance leading to increased protein degradation – is a negative prognostic factor for these patients. Consequently, meeting energy and protein requirements during anti-cancer therapies is key to improving the efficacy of therapies. Supportive clinical data have also been reported in patients with aggressive tumours – i.e., pancreatic ductal adenocarcinoma – suggesting that anti-cancer therapies can deliver their effects more efficiently when a patient’s nutritional health is preserved.
Addressing the metabolic disturbances brought on by a growing tumour could improve patients’ clinical outcomes. Since an increased inflammatory response is a key feature of cancer patients, this has led researchers to consider the use of anti-inflammatory nutrients as possible modulators. Omega-3 fatty acids modulate inflammatory responses, and the preliminary results show that supplementation of omega-3 fatty acids may help to improve the survival of cancer patients with advanced disease.
Cancer is a systemic disease, and should be therapeutically targeted as such. Therefore, effective anti-cancer therapies should simultaneously target cancer cells while supporting the patient’s general health and well-being. With this in mind, nutrition support is slowly but progressively moving from being used as an end-stage therapy to becoming a key component of concurrent care.
It is now clear that cancer patients should receive long-term dietetic advice and specific nutritional therapies during their clinical journey (including cycles of chemotherapy, radiotherapy, surgery, etc.). It is also becoming clearer that the time of eating has a significant impact on cancer outcomes, as demonstrated in patients with breast cancer.
International and medical oncology societies now recommend that the quantity and quality of nutrients at each step of a cancer patient’s journey, as well as the adoption of a healthy dietary pattern, should be considered as important prognostic factors. Interestingly, this approach would yield significant clinical benefits for patients at a fraction of the costs for developing new drugs.