Prof. Marian de van der Schueren

Presentation Roadmap/ Summary

In this lecture the diagnostic scheme for screening, assessment, diagnosis and grading of malnutrition is introduced. The evidence for nutritional interventions in patients undergoing radiotherapy, chemotherapy or surgery is shown. The importance of screening for symptoms impacting on nutritional intake will be discussed. Suggestion of a flowchart how to approach patients at nutritional risk is presented for discussion.

Learning Objectives

At the conclusion of the presentation, the participant will be able to understand:

1. To know the three-step approach of nutritional screening, assessment and intervention
2. To know the effects of nutritional intervention for patients undergoing radiotherapy, chemotherapy or surgery
3. To realise that there are gaps to be filled in nutrition-oncological literature

Key Takeaways/ Fast Facts

• Early screening for cancer associated malnutrition offers opportunity for early intervention.
• Screening should be repeated at regular intervals.
• Screening should involve parameters of nutritional status as well as nutritional impact symptoms
• Stepwise approach/escalation route of nutrition intervention: nutritional counseling – oral supplementation - enteral nutrition – parenteral nutrition.

Key references

1. de van der Schueren MAE, Laviano A, Blanchard H, et al. Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Ann Oncol. 2018 May 1;29(5):1141-1153.
2. Langius JA, Zandbergen MC, Eerenstein SE, et al. Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr. 2013 Oct;32(5):671-8.
3. Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017 Jun;36(3):623-650
4. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005 Mar 1;23(7):1431-8.