“Timely diagnosis of a nutritional problem is essential to ensure the correct management of malnourished cancer patients. Early interception of nutritional problems is essential to set up appropriate and effective nutritional support “. He said it Riccardo Caccialanza, director of Uoc Dietetics and Clinical Nutrition of the Irccs Foundation of the San Matteo Polyclinic of Pavia, speaking at the online presentation of the new “Consensus Document – The management of cancer patients with nutritional problems” promoted by NHSc (Nestlé Health Science).
“If started at the time of diagnosis – underlined Caccialanza – or as soon as the risk of malnutrition is found, nutritional support therapy can improve patient outcomes in terms of quality of life and survival. Nutritional screening should be carried out – using validated tools – at the time of diagnosis and repeated systematically at regular intervals throughout the course of the disease, especially in patients who are more at risk of malnutrition due to type of cancer, stage of disease or treatment undertaken ” .
However, despite the numerous evidences on the need for adequate nutritional intervention in cancer patients and the availability of guidelines and recommendations for nutritional support in these patients, in clinical practice – it emerged from the meeting – due attention is not always paid to nutritional aspects and nutritional screening is not yet part of standard outpatient and inpatient procedures with the result that many patients do not receive adequate and timely support. Even in cases where a state of malnutrition is diagnosed, about 50% are not treated or are treated inadequately.
The analysis of local experiences and the mapping of the various phases of the management process of nutritional problems in patients with head-neck and gastrointestinal cancer have allowed us to describe the current model of management of nutritional problems. Although there was a greater focus on the needs of the cancer patient from a nutritional point of view than in the past, the general level of competence and awareness of clinical nutrition in oncology differs among different clinicians and healthcare professionals, with inhomogeneity in the management of the problem at both intra- and interregional level.
Artificial nutrition “generally begins in the hospital – recalled Caccialanza – but often continues at the patient’s home after discharge. It is therefore essential to guarantee an appropriate and safe continuity of care through a territorial network in charge of supporting the patient and family members, monitoring the nutritional status and adherence to the prescribed plans. To date there are few specific rehabilitation facilities for nutritional pathways, therefore the patient must be followed and supported at home. In a scenario in which we hope that nutrition will become a cornerstone of support therapies for chronic diseases, not only oncological, we must review the territorial assistance system, focusing on greater integration between hospitals and home care provided by the NHS and the Local Health Authorities. , and making use of tools such as remote monitoring (telemedicine) “.
And on the importance of a multidisciplinary team: “It is essential that the clinical nutritionist collaborates with oncologist, radiotherapist, nurse, hospital pharmacist and therapist, that is, all the figures who take charge of the cancer patient. Only thanks to teamwork can we avoid prolonged and inappropriate hospitalizations ”concluded Caccialanza.
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