Adherence to Oral Nutrition Supplementation in gastrointestinal cancer patients: A systematic review of the literature.
Creators: name: Frountzas, Maximos
Publisher: name: Open Science Framework
Year: 2023
Subjects: subject: Life Sciences

description: Malnutrition is common in oncologic patients due to the catabolic nature of the disease, and has been recognized as an important feature of negative outcomes, including high morbidity and mortality rates. Malnutrition is also responsible for prolonged hospitalization, increased hospital expenses, as well as increased risk for developing treatment-induced toxicities, reduced adherence to antineoplastic treatments and quality of life (QoL) deterioration. Apart from the increased risk of malnutrition due to the tumor, anticancer therapies could further aggravate nutritional deficiencies. In cancer patients, the prevalence of malnutrition is around 40% to 80%, while upper gastrointestinal and pancreaticobiliary malignancies present the first (60-85%) and second-highest (47.6%) malnutrition rates. During perioperative period, when (neo) adjuvant therapies might take place, patients with gastrointestinal (GI) cancer often complain about nonvolitional reduction in body weight and report symptoms that interfere with proper nutritional intake, such as premature satiety, anorexia, nausea, vomiting, dysphagia, and diarrhea. Therefore, the use of timely nutritional support is of utmost importance for improving nutritional status and prognosis in these patients. The European Society for Enteral and Parenteral nutrition (ESPEN) recommends targeted nutrition counselling and use of oral nutrition supplementation (ONS) as the first line of nutritional therapy for cancer patients. Recent studies suggest that ONS seems to be effective in the improvement of nutritional status and is, also, associated with favorable clinical outcomes in cancer patients. In particular, it has a positive impact on skeletal muscle mass, maintenance and/or increasing of body weight, chemotherapy tolerance and malnutrition-related indices. Furthermore, some ONS formulas, such as immune-enhancing ones, have been associated with reduced postoperative complications, infections and length of hospital stay. Τhe supply of ONS in GI oncology patients during perioperative period, either they receive chemotherapy or not, might promote their nutritional and functional status in different ways, such as increasing weight and muscle mass, improving general body composition and improving Qol (e.g. by decreasing fatigue symptoms). Nevertheless, oncology patients, usually, experience several symptoms due to their clinical condition and therapeutic regimens, that negatively affect their compliance with ONS products. The main reported barriers related to ONS compliance are bloating, early satiety, flavor, texture dislike, chemotherapy-related taste changes, and diarrhea. Moreover, dietary intake, motivation and psychosocial factors, such as anxiety and depression, seem to play an important role in compliance with ONS. Τhe aim of the present systematic review is to examine the factors affecting compliance with ONS in patients who underwent GI cancer surgery with or without adjuvant treatments.