Screen Elderly Cancer Patients for Malnutrition
EXPERT ANALYSIS AT THE ANNUAL MEETING OF THE INTERNATIONAL SOCIETY OF GERIATRIC ONCOLOGY
MANCHESTER, ENGLAND – Elderly cancer patients need to be screened for malnutrition, and individualized, multimodal interventions should be used in those found to require nourishment, according to the chair of a task force on nutrition in geriatric oncology.
"Nutrition is important in [elderly] cancer patients, yet still many oncologists neglect this aspect [of treatment]," the chair, Dr. Federico Bozzetti, told attendees during a special session on nutritional issues at the annual meeting of the International Society of Geriatric Oncology.
Standing in the way is a paucity of randomized clinical trials demonstrating the efficacy of nutritional support in cancer patients, and notably in those who are elderly, acknowledged Dr. Bozzetti, a surgical oncologist from the University of Milan.
Evidence links malnutrition to worse clinical outcomes, increased hospital stays, a longer duration of convalescence, reduced quality of life, increased morbidity, and increased mortality in the general patient population, however (Clin. Nutr. 2008;27:340-9; Eur. J. Clin. Nutr. 2007;62:687-94; Br. J. Nutr. 2004; 92:105-11; Am. J. Clin. Nutr. 1997;66:1232), Dr. Bozzetti noted.
"Old people, regardless of whether they are healthy or ill, need to be nourished," he said.
The International Society of Geriatric Oncology (SIOG) Task Force on Nutrition has as its initial aim development of a consensus-based report to provide practical guidance on nutritional support. The report is due for publication early next year.
Nutritional support currently falls "somewhere between medicine and supportive care," Dr. Bozzetti suggested, adding that beneficial effects are more likely to be seen in patients who are severely malnourished than in those who are mildly malnourished.
How Can You Screen For Malnutrition?
"Malnutrition is a subacute or chronic state of nutrition," said Dr. Zeno Stanga of University Hospital Bern (Switzerland), citing the European Society for Clinical Nutrition and Metabolism definition. It is a state "in which a combination of varying degrees of over- or undernutrition and inflammatory activity have led to a change in body composition and diminished function," he added.
Data suggest that up to 56% of geriatric patients are malnourished (Clin. Nutr. 2006;25:563-72), he noted, with around 20%-80% of cancer patients at severe nutritional risk.