Tumours, nutrition makes a difference but only half of the centres offer patients targeted pathways

In recent years there has been much talk of humanisation and global care of the cancer patient, but nutrition continues to represent an area that is still too neglected. The early and ongoing nutritional management of the cancer patient must become an integral and systematic part of the treatment pathway, in line with the latest scientific evidence, with the Charter of Rights of the cancer patient, and with the Ministry of Health's Guidelines. Our survey 'Nutritional screening pathways in oncology' photographs the current Italian situation and provides insights and proposals that Cipomo, the College of Primary Hospital Oncologists, will present at the national congress of the Italian Association of Medical Oncology (Aiom), in Rome from 7 to 9 December, and that it will pursue in the coming months, to translate the data into concrete actions in hospital centres.

Dalla survey, emerge che solo metà dei centri oncologici italiani (49%) dispone di percorsi nutrizionali strutturati e accessibili in modo uniforme. Le differenze territoriali sono marcate: i centri del Nord ne sono dotati con maggiore frequenza, mentre in molte realtà del Centro e del Sud Italia la gestione resta frammentata. Nella metà dei casi, la valutazione nutrizionale alla diagnosi non viene effettuata regolarmente e spesso è riservata solo ai pazienti con calo ponderale evidente o con neoplasie che compromettono l’alimentazione, oppure ai ricoverati. In quattro centri su dieci non vengono raccolte neppure le abitudini alimentari dei pazienti. Inoltre, l’indagine ha coinvolto un campione di 100 strutture oncologiche ospedaliere: il 52% delle risposte è arrivato dai centri del Nord, il 29% dal Centro e il 19% dal Sud: una distribuzione che riflette, ancora una volta, la diversa concentrazione delle strutture oncologiche nel Paese e la conseguente disomogeneità dei percorsi assistenziali.

These data confirm that nutrition remains one of the most underestimated areas in oncology, despite having a direct impact on clinical outcomes. Standardising access to dedicated nutritional pathways is a priority: there cannot be a different quality of care depending on the territory. It is an issue of equity and entitlement for all cancer patients. Malnutrition, whether by default or excess, represents one of the most significant challenges in the management of cancer patients. Inadequate nutritional status affects quality of life, treatment tolerance, prognosis and healthcare costs. Photographing and measuring the problem serves to make it evident, raise awareness in the oncology community and promote concrete interventions for the future.

Only in half of the centres are indications on proper nutrition provided systematically, mainly to patients undergoing active therapy or suffering from diseases that interfere with nutrition. The use of validated screening tools recommended by the Espen guidelines and also referred to by Aiom, is not yet uniformly widespread. In half of the cases it is oncologists or nurses who deal with nutritional assessment, while the presence of nutritionists and dieticians is not yet guaranteed everywhere.

Almost all of the respondents consider it useful to have information material for patients and to initiate a dietary intake with monitoring of nutritional status and personalised prescriptions at least for patients at risk. An encouraging sign comes from the almost unanimous consensus among oncologists: 99% consider projects integrating proper nutrition and physical activity, an inseparable pair of prevention and treatment, to be fundamental.