ESPEN guidelines on nutrition in cancer patients
Open accessAbstract
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
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In cancer patients who are malnourished or at risk of malnutrition, nutritional therapy has been shown to improve body weight and energy intake but not survival.
“In cancer patients who are malnourished or at risk of malnutrition, nutritional therapy has been 462 shown to improve body weight and energy intake but not survival.”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [12]
The retrieved passages contain publication metadata rather than the guideline’s findings. Searches for survival, body weight, energy intake, and nutritional therapy found no passage in our copy addressing the claimed effects, so the claim cannot be verified from it. (LLM, conf=0.72)
Experimental — accuracy not yet measuredNutritional support improves intake and weight, and some aspects of quality of life under radiotherapy.
“There is good evidence that 463 nutritional support improves intake and weight, and some aspects of quality of life under 464 radiotherapy [12].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [12]
The available indexed passages identify the guideline but contain bibliographic metadata rather than its recommendations or evidence review. Searches for radiotherapy, nutritional support, intake, weight, and quality of life found no passage addressing the claimed effects, so the claim cannot be verified from our copy. (LLM, conf=0.72)
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GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305 · see citing works
Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., Filiberti, A., Flechtner, H., Fleishman, S. B., Haes, J. C. J. M. D., et al. (1993) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/85.5.365 · Cited by 16,005 · see citing works
Self-citationGRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology
Guyatt, G. H., Oxman, A. D., Schünemann, H. J., Tugwell, P., & Knottnerus, A. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.09.011 · Cited by 3,094 · see citing works
Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., Phillips, S., Sieber, C., Stehle, P., Teta, D., et al. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.05.021 · Cited by 2,553 · see citing works
Bjelakovic, G., Nikolova, D., Gluud, L. L., Simonetti, R. G., & Gluud, C. (2007) · JAMA · doi:10.1001/jama.297.8.842 · Cited by 2,275 · see citing works
Nutrition and physical activity guidelines for cancer survivors
Rock, C. L., Doyle, C., Demark‐Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., Bandera, E. V., Hamilton, K. K., Grant, B., McCullough, M., et al. (2012) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21142 · Cited by 1,995 · see citing works
Deutz, N. E. P., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., Cederholm, T., Cruz-Jentoft, A., Krznariç, Z., Nair, K. S., et al. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.04.007 · Cited by 1,738 · see citing works
Muscaritoli, M., Anker, S. D., Argilés, J., Aversa, Z., Bauer, J. M., Biolo, G., Boirie, Y., Bosaeus, I., Cederholm, T., Costelli, P., et al. (2010) · Clinical Nutrition · doi:10.1016/j.clnu.2009.12.004 · Cited by 1,732 · see citing works
Self-citationWang, X., Ouyang, Y., Liu, J., Zhu, M., Zhao, G., Bao, W., & Hu, F. B. (2014) · BMJ · doi:10.1136/bmj.g4490 · Cited by 1,596 · see citing works
Speck, R. M., Courneya, K. S., Mâsse, L. C., Duval, S., & Schmitz, K. H. (2010) · Journal of Cancer Survivorship · doi:10.1007/s11764-009-0110-5 · Cited by 1,352 · see citing works
Bauer, J., Capra, S., & Ferguson, M. (2002) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601412 · Cited by 1,178 · see citing works
Effect of 10 Days of Bed Rest on Skeletal Muscle in Healthy Older Adults
Kortebein, P., Ferrando, A., Lombeida, J., Wolfe, R., & Evans, W. J. (2007) · JAMA · doi:10.1001/jama.297.16.1772-b · Cited by 933 · see citing works
Physical activity and survival after colorectal cancer diagnosis
Meyerhardt, J. A., Giovannucci, E. L., Holmes, M. D., Chan, A. T., Chan, J. A., Colditz, G. A., & Fuchs, C. S. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2006.06.0855 · Cited by 857 · see citing works
Physical activity for cancer survivors: meta-analysis of randomised controlled trials
Fong, D. Y. T., Ho, J. W. C., Hui, B. P. H., Lee, A. M., Macfarlane, D. J., Leung, S. S. K., Cerin, E., Chan, W. Y. Y., Leung, I. P. F., Lam, S. H. S., et al. (2012) · BMJ · doi:10.1136/bmj.e70 · Cited by 782 · see citing works
Barriers to Providing Nutrition Counseling by Physicians: A Survey of Primary Care Practitioners
Kushner, R. F. (1995) · Preventive Medicine · doi:10.1006/pmed.1995.1087 · Cited by 604 · see citing works
Raffaghello, L., Lee, C., Safdie, F. M., Wei, M., Madia, F., Bianchi, G., & Longo, V. D. (2008) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0708100105 · Cited by 587 · see citing works
Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive
Jaeschke, R., Guyatt, G. H., Dellinger, P., Schunemann, H., Levy, M. M., Kunz, R., Norris, S., Bion, J., & for the GRADE working group (2008) · BMJ · doi:10.1136/bmj.a744 · Cited by 577 · see citing works
Meat Intake and Mortality: A Prospective Study of Over Half a Million People
Sinha, R., Cross, A. J., Graubard, B. I., Leitzmann, M. F., & Schatzkin, A. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.6 · Cited by 543 · see citing works
Strasser, F., Luftner, D., Possinger, K., Ernst, G., Ruhstaller, T., Meissner, W., Ko, Y.-D., Schnelle, M., Reif, M., & Cerny, T. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2005.05.1847 · Cited by 413 · see citing works
Self-citationESPEN guideline on ethical aspects of artificial nutrition and hydration
Druml, C., Ballmer, P. E., Druml, W., Oehmichen, F., Shenkin, A., Singer, P., Soeters, P., Weimann, A., & Bischoff, S. C. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2016.02.006 · Cited by 401 · see citing works
Ferris, F. D., Bruera, E., Cherny, N., Cummings, C., Currow, D., Dudgeon, D., JanJan, N., Strasser, F., von Gunten, C. F., & Von Roenn, J. H. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.20.1558 · Cited by 396 · see citing works
Self-citationBradbury, K. E., Appleby, P. N., & Key, T. J. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.071357 · Cited by 328 · see citing works
Ravasco, P., Monteiro-Grillo, I., & Camilo, M. (2012) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.018838 · Cited by 251 · see citing works
Self-citationDemers, M., Dagnault, A., & Desjardins, J. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2013.10.015 · Cited by 209 · see citing works
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CAMPBELL, K. L., WINTERS-STONE, K. M., WISKEMANN, J., MAY, A. M., SCHWARTZ, A. L., COURNEYA, K. S., ZUCKER, D. S., MATTHEWS, C. E., LIGIBEL, J. A., GERBER, L. H., et al. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002116 · Cited by 2,988 · see citing works
Baracos, V. E., Martin, L., Korc, M., Guttridge, D. C., & Fearon, K. C. H. (2018) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2017.105 · Cited by 1,738 · see citing works
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Arends, J., Baracos, V., Bertz, H., Bozzetti, F., Calder, P. C., Deutz, N. E. P., Erickson, N., Laviano, A., Lisanti, M. P., Lobo, D. N., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2017.06.017 · Cited by 1,305 · see citing works
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Rock, C. L., Thomson, C. A., Sullivan, K. R., Howe, C. L., Kushi, L. H., Caan, B. J., Neuhouser, M. L., Bandera, E. V., Wang, Y., Robien, K., et al. (2022) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21719 · Cited by 741 · see citing works
Fasting and cancer: molecular mechanisms and clinical application
Nencioni, A., Caffa, I., Cortellino, S., & Longo, V. D. (2018) · Nature Reviews Cancer · doi:10.1038/s41568-018-0061-0 · Cited by 518 · see citing works
ESPEN practical guideline: Clinical nutrition and hydration in geriatrics
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.01.024 · Cited by 516 · see citing works
ESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
Lunde, P., Nilsson, B. B., Bergland, A., Kværner, K. J., & Bye, A. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9751 · Cited by 214 · see citing works
Increased gut permeability in cancer cachexia: mechanisms and clinical relevance
Bindels, L. B., Neyrinck, A. M., Loumaye, A., Catry, E., Walgrave, H., Cherbuy, C., Leclercq, S., Van Hul, M., Plovier, H., Pachikian, B., et al. (2018) · Oncotarget · doi:10.18632/oncotarget.24804 · Cited by 147 · see citing works
Pötgens, S. A., Brossel, H., Sboarina, M., Catry, E., Cani, P. D., Neyrinck, A. M., Delzenne, N. M., & Bindels, L. B. (2018) · Scientific Reports · doi:10.1038/s41598-018-30569-5 · Cited by 114 · see citing works
Chia seeds (<i>Salvia hispanica</i> L.): A therapeutic weapon in metabolic disorders
Khalid, W., Arshad, M. S., Aziz, A., Rahim, M. A., Qaisrani, T. B., Afzal, F., Ali, A., Ranjha, M. M. A. N., Khalid, M. Z., & Anjum, F. M. (2023) · Food Science & Nutrition · doi:10.1002/fsn3.3035 · Cited by 108 · see citing works
Orsso, C. E., Montes‐Ibarra, M., Findlay, M., van der Meij, B. S., de van der Schueren, M. A. E., Landi, F., Laviano, A., & Prado, C. M. (2022) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.12954 · Cited by 73 · see citing works
Self-citationTrujillo, E. B., Kadakia, K. C., Thomson, C., Zhang, F. F., Livinski, A., Pollard, K., Mattox, T., Tucker, A., Williams, V., Walsh, D., et al. (2024) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2688 · Cited by 67 · see citing works
Soares, J. D. P., Howell, S. L., Teixeira, F. J., & Pimentel, G. D. (2020) · Current Pharmaceutical Design · doi:10.2174/1381612826666200218100420 · Cited by 61 · see citing works
Kiss, N., Baguley, B. J., Ball, K., Daly, R. M., Fraser, S. F., Granger, C. L., & Ugalde, A. (2019) · JMIR mhealth and uhealth · doi:10.2196/12281 · Cited by 56 · see citing works
Nishie, K., Yamamoto, S., Nagata, C., Koizumi, T., & Hanaoka, M. (2017) · Lung Cancer · doi:10.1016/j.lungcan.2017.07.023 · Cited by 52 · see citing works
Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology
Gillis, C., Hasil, L., Kasvis, P., Bibby, N., Davies, S. J., Prado, C. M., West, M. A., & Shaw, C. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.644706 · Cited by 46 · see citing works
Currow, D. C., Maddocks, M., Cella, D., & Muscaritoli, M. (2018) · International Journal of Molecular Sciences · doi:10.3390/ijms19113471 · Cited by 27 · see citing works
Self-citationKirkham, A. A., Ford, K. L., Ramos Da Silva, B., Topolnyski, J., Prado, C. M., Joy, A. A., Paterson, D. I., Boulé, N., Pituskin, E., Haykowsky, M. J., et al. (2023) · Obesity · doi:10.1002/oby.23654 · Cited by 21 · see citing works
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Suarez, R., Chapela, S., Llobera, N. D., Montalván, M., Vásquez, C. A., Martinuzzi, A. L. N., Katsanos, C. S., Verde, L., Frias-Toral, E., Barrea, L., et al. (2024) · Current Nutrition Reports · doi:10.1007/s13668-024-00556-6 · Cited by 20 · see citing works
Impact of Diets on Response to Immune Checkpoint Inhibitors (ICIs) Therapy against Tumors
Zhang, X., Li, H., Lv, X., Hu, L., Li, W., Zi, M., & He, Y. (2022) · Life · doi:10.3390/life12030409 · Cited by 18 · see citing works
Zhang, Y., Bellafronte, N. T., Najafitirehshabankareh, G., Jimenez, M. H., Jaeger-McEnroe, E., Plourde, H., Hendrickson, M., & Gillis, C. (2024) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2024.108743 · Cited by 4 · see citing works
- Authors
- Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Fearon, K., Hütterer, E., Isenring, E., Kaasa, S., Krznaric, Z., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Muscaritoli, M., Oldervoll, L., Ravasco, P., Solheim, T., Strasser, F., de van der Schueren, M., & Preiser, J.-C.
- Affiliations
- University of Freiburg (DE)
- Centre Léon Bérard (FR)
- University of Alberta (CA)
- University of Milan (IT)
- Western General Hospital (GB)
- Medical University of Vienna (AT)
- Norwegian University of Science and Technology (NO)
- Beatson West of Scotland Cancer Centre (GB)
- Karlstad University (SE)
- Sapienza University of Rome (IT)
- University of Basel (CH)
- University of Lisbon (PT)
- Kantonsspital St. Gallen (CH)
- Université Libre de Bruxelles (BE)
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 36
- Issue
- 1
- Pages
- 11-48
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2505149831
- Cited by
- 3,114
- References
- 24
- Citations by year
- 2026: 356 · 2025: 339 · 2024: 339 · 2023: 317 · 2022: 402 · 2021: 446 · 2020: 372 · 2019: 251 · 2018: 186 · 2017: 92 · 2016: 7
- FWCI
- 143.87
- Type
- journal article
- Language
- en
- Open access
- green
- research.bond.edu.au
- Licence
- Locations
- Clinical Nutrition (publishedVersion)
- Bond University Research Portal (Bond University) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- e-publications@bond (Bond University) (submittedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- edoc (University of Basel) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- European Society of Surgical Oncology
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- cancer patients, malnutrition, dietary management, malnutrition screening, muscle mass loss, nutrition counseling, parenteral nutrition, exercise training, pharmaconutrients, advanced cancer, cancer survivors, metabolic disorders, cancer treatment side effects
- MeSH terms
- Diet, Humans, Neoplasms, Nutritional Requirements, Nutritional Status, Societies, Scientific, Meta-Analysis as Topic, Exercise, Nutrition Assessment, Randomized Controlled Trials as Topic, Nutrition Policy, Evidence-Based Medicine, Observational Studies as Topic
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