Principles of nutrition therapy. Screening and assessment

Background. Nutritional problems frequently occur in cancer patients and are associated with an impaired prognosis; expert nutritional care of cancer patients, however, is not yet available in all institutions and for all patients. Aim. This review outlines the currently recommended diagnostic and therapeutic concepts for clinical nutrition. Material and methods. This text is based on the recently published expert guidelines on clinical nutrition for cancer patients. Results. To reliably provide adequate nutritional support the responsibilities and standard operating procedures for diagnostics and treatment of nutritional deficits should be defined in all clinical oncology units. Screening for risk factors of malnutrition should be mandatory. Further aims are the early detection of all treatable causes of nutritional deficits and a multimodal treatment approach. Nutritional support should ensure provision of daily energy and nutrient requirements with a special focus on protein. In cases of severe upper gastrointestinal defects enteral tube feeding may be used and small bowel defects may require intravenous nutrition. To increase anabolism, nutritional support should always be accompanied by an exercise program. Systemic inflammatory reactions induced by cancer and/or infections should be monitored and possibly antagonized to reduce catabolic effects, anorexia and fatigue. Screening may be implemented using brief and simple standard tools, e.g. nutrition risk screening (NRS-2002). In patients at risk further assessment is required to diagnose and grade nutrition impact symptoms. Muscle mass should be monitored regularly using anthropometry, bioimpedance analysis or computed tomography. To monitor metabolic derangements, determination of C-reactive protein and serum albumin levels is appropriate. Physical performance can be classified by the Eastern Cooperative Oncology Group and World Health Organization (ECOG/WHO) performance index. Conclusion. When implemented these recommendations ensure that clinical nutrition is integrated as an essential component into best supportive care and will contribute to optimizing anticancer treatment.