Nutrition

Oncology: why foods for special medical purposes are an investment for the National Health Service

With an annual investment of 50 million, an estimated 97 million in costs have been avoided, but it is necessary to ensure uniform access across the whole country

by Maurizio Muscaritoli*, Paolo Sciattella**

3 July 2026

Senior woman with cancer visiting oncologist in clinic New Africa - stock.adobe.com

4' min read

Translated by AI

Versione italiana

Key points

One in two patients is already malnourished at their first appointment
Oral nutritional supplements in oncology
Average costs for malnourished patients covered by the National Health Service
Ensuring consistency across the region

4' min read

Translated by AI

Versione italiana

Clinical nutrition in oncology can no longer be regarded as a secondary support. It is an essential component of patient care, with documented effects on clinical outcomes, treatment tolerance, quality of life and the sustainability of the National Health Service. Cancer-related malnutrition is, in fact, a common condition, often present at the time of diagnosis, and still under-assessed in care pathways.

One in two patients is already malnourished at their first appointment

Scientific evidence shows that more than one in two cancer patients already exhibits alterations in their nutritional status at their first oncology consultation. Unintentional weight loss, reduced food intake and loss of skeletal muscle mass are not merely side effects of the disease: they are independent predictors of a poor prognosis. They can reduce survival, increase the toxicity of treatments, contribute to complications, lead to treatment interruptions or changes, increase the need for hospital admissions and readmissions, and significantly impair quality of life.

In this context, foods for special medical purposes (FSMPs), and in particular oral nutritional supplements, are a key tool in clinical nutrition. These are not generic products; their use requires medical supervision and must form part of a care pathway that includes an appropriate prescription, monitoring of treatment adherence and assessment of clinical outcomes. Their aim is to help patients meet their energy and protein requirements when diet alone is insufficient, as is often the case due to loss of appetite, the side effects of treatments, difficulty eating or disease-induced metabolic changes.

Oral nutritional supplements in oncology

The appropriate use of oral nutritional supplements (ONS) in oncology is associated with improved body composition indices, weight maintenance and better tolerance of chemotherapy and radiotherapy treatments. The key point is that clinical nutrition should not be relegated to the margins of the cancer care pathway, but should be integrated at an early stage, as part of a multidisciplinary approach, alongside the patient’s clinical, oncological and functional assessment.

The issue, however, is not merely clinical. Malnutrition also has a significant economic impact. In a forthcoming pharmacoeconomic study, the economic burden of malnutrition in newly diagnosed cancer patients in Italia was estimated, along with the potential value of timely and continuous access to oral nutritional supplements. The analysis considered six particularly relevant cancer sites: lung, head and neck, colorectal, oesophagus, stomach and pancreas. Out of approximately 129,500 new cases per year relating to these conditions, it was estimated that around 51 per cent of patients are malnourished or at risk of malnutrition.

Average costs for malnourished patients covered by the National Health Service

The average annual cost per patient associated with malnutrition was found to be around 2,600 euros, taking into account hospital admissions, A&E visits and specialist consultations. Nationwide, the total cost to the National Health Service amounts to around 175 million euros a year. This figure only reflects part of the problem, as it does not include all the indirect costs linked to the loss of productivity among patients and carers, nor the organisational impact on healthcare facilities.

The second part of the analysis estimated the effect of early access to oral nutritional supplements. The investment required to provide nutritional treatment with ONS to the population under consideration amounts to approximately 50 million euros per year. Against this investment, the reduction in hospital admissions, A&E visits and specialist consultations would generate avoided costs of around 97 million euros per year, resulting in a net economic benefit of around 45 million. In other words, every euro invested in ONS would generate approximately two euros in value for the National Health Service.

The return on investment becomes even more significant when one considers the impact of malnutrition on the number of days spent in hospital. The analysis estimates that treatment with ONS could help prevent around 220,000 hospital days per year, resulting in a reduction in hospital costs of around 200 million euros. From this perspective, the return on investment can be as high as six euros for every euro invested.

These figures clearly show that clinical nutrition in oncology is not an additional cost, but a high-value investment. It improves patient outcomes, makes the use of resources more efficient and can free up care capacity within a healthcare system that is already under considerable pressure.

Ensuring consistency across the region

However, one issue remains unresolved: access to AFMS is not guaranteed uniformly across the country. In the absence of full recognition within the Essential Levels of Care, provision depends on the decisions of the Regions and, in some cases, on individual local organisations. The result is a patchy landscape, in which patients with the same clinical needs may receive different care depending on where they live.

Overcoming this fragmentation is a matter of ethics. Including AFMS in the Essential Levels of Care (LEA) for cancer patients who are malnourished or at risk of malnutrition would mean recognising clinical nutrition as an integral part of treatment, ensuring continuity of care and reducing unjustifiable disparities in access to care. This approach is consistent with the scientific evidence and with a modern vision of the National Health Service: providing better care, spending more wisely, and guaranteeing the same rights to all patients.

*President of the Italian Society of Clinical Nutrition and Metabolism (SINuC) and full professor of internal medicine at Sapienza University of Rome

**CEIS-EEHTA, Lecturer in Health Economics, Faculty of Economics, University of Rome “Tor Vergata”