A Roadmap for Helping Cancer Patients Overcome Malnutrition

By Declan Walsh, MD and Michele Szafranski, RD, CSO, LDN

Malnutrition is one of the most common – and serious – complications of cancer and its treatments, with up to 80% of cancer patients ending up malnourished. This can be caused by things like cancers that interfere with eating and/or digestion and by treatment side effects like mouth sores, loss of appetite and fatigue.

Malnutrition can weaken a patient’s response to treatment, decrease quality of life and make it harder to fight infections. Making matters worse, it can lead to cancer cachexia (CC) – a disorder characterized by muscle loss, diminished immune function and impaired physical function. Some estimates indicate that CC is responsible for 20% to 30% of cancer-related deaths.

That’s a key reason why Atrium Health Levine Cancer decided to launch one of the nation’s first comprehensive programs that aims to prevent and overcome malnutrition in cancer patients. From standardized screening to personalized nutrition planning, we’re spearheading ways to help patients stay healthier and stronger, so they can survive and thrive.

Why Malnutrition is Overlooked and Undertreated

Malnutrition often gets worse as treatment progresses and side effects mount, but it’s chronically overlooked and underdiagnosed. We think there are two main reasons why.

First, oncologists have to deal with multiple complex symptoms in their patients, and sometimes weight loss – a key indicator of malnutrition – doesn't get the attention it deserves.

Second, more and more patients are obese, and that makes malnutrition harder to identify. Overweight or obese patients can lose significant weight but appear well-nourished, because their body weight is still relatively high or in a normal range. High concentrations of body fat can also make it harder to see that a patient is losing lean muscle mass, which is another malnutrition warning sign.

Early Intervention is Vital

Here at Levine Cancer, we recognized that early screening could help identify malnutrition sooner, so we incorporated a malnutrition screening tool into patients’ appointments. If this screening indicates a patient is potentially malnourished, we automatically refer them to our team of 14 dietitians who specialize in helping cancer patients. These experts see more than 2,500 new patients and 12,000 returning patients each year, and physicians and nurses can refer patients directly to our dietitians if they suspect malnutrition.

Once a patient is referred, a dietitian reviews their chart and evaluates their nutrition status based on phenotypic criteria like weight loss, low body mass index and reduced muscle mass, and on etiologic criteria such as reduced food intake and inflammation. This enables the dietitian to identify malnutrition, assess its severity and schedule one-on-one appointments with any patients who need help.

Tailored Nutrition Plans for Every Patient

These appointments are critical because they help us create tailored nutrition plans for each patient. The appointment starts by assessing a patient’s nutritional needs based on their cancer, treatment and overall health. Then we evaluate their current diet and food intake and look for ways to improve it.

We also ask patients about how they ate before they were diagnosed with cancer and about any dietary preferences (such as being vegetarian or vegan) that they would like their nutrition plan to include. The goal is to develop a plan that reflects not only the patient’s lifestyle, but also their specific cancer and treatments, to give them the best chance to stay well-nourished and strong.

Our team also addresses treatment-related side effects, like nausea or taste changes, with support that’s tailored to each patient’s unique needs. For example, if a patient is undergoing platinum-based treatment, we teach them how to reduce metallic tastes.

Setting a New Standard

These nutritional interventions can be literal lifesavers – research shows that patients who receive nutritional intervention tolerate chemotherapy better, boosting their chances of survival. And we continue our nutritional help once treatment is over, by offering classes on weight management, healthy cooking and eating well after cancer.

It’s all part of Levine Cancer’s push to address all aspects of a patient’s health, so they live better and stay healthier throughout cancer treatment – and beyond.

To learn more about Levine Cancer’s cancer nutrition program or refer a patient, call 980-442-2506.