Only 35 years ago,  in other words, since some forms of neoplasms, from diseases with short-term prognosis began to gradually turn into manageable diseases with a chronic perspective, doctors and oncological experts began to carry out researches and studies on the nutrition of the cancer patient to understand how to best treat these diseases from a nutritional point of view.

Malnutrition in cancer patients is still very frequent, especially due to aggressive therapies, such as chemotherapy and radiotherapy, which typically cause numerous side effects such as nausea, gastrointestinal dysfunction, learned food aversions, etc …; these conditions expose them to loss of muscle mass, an increased risk of physical impediment, surgical complications, toxicity or even mortality. In fact, it can be estimated that about 40% of cancer patients suffer from any of the above conditions, and that a quarter of these die because of malnutrition, rather than because of disease progression.

Proper nutrition therefore plays a fundamental role for a person suffering from cancer, also for the prognostic picture, especially for patients unable to use the oral or enteral feeding in an adequate and sufficient way to pursue nutritional needs.


In order to supply with the correct nutrients, a specific therapeutic procedure is implemented, which guarantees sufficient nutrition. This is called “Clinical Nutrition” and involves the introduction of nutrients into the gastrointestinal tract through probes (nasogastric tube or PEG, enteral nutrition), or directly into the circulatory stream (parenteral nutrition) with a peripheral or central venous catheter; the latter method is used only if it is impossible to apply oral or enteral nutrition.

Enteral nutrition is usually substantiated in the use of bags that may contain commercial medicinal products, produced by pharmaceutical companies, or galenic preparations that are formulated specifically according to the needs of individual patients. The bags can completely replace the patient’s nutrition (total nutrition) or supplement the feeding per os.

Some studies carried out since 2011, however, show that parenteral nutrition would not always lead to actual clinical benefits.

In fact, PN should generate a considerable contribution of the caloric stocks, thus reversing the effects of malnutrition and improving responses to treatments, nevertheless the slowing down of protein catabolism and the sporadic reversal of the loss of visceral proteins, do not always generate clinical benefit. In the palliative context, PN is functional and prolongs survival, but at the same time it has been shown that it can cause negative effects such as: line infections, fluid and electrolyte imbalances, liver and pancreas problems. For this reason, guidelines are drawn up and constantly updated, increasingly targeted and aware, to be followed above all for the satisfaction of the nutrient needs in cancer patients, with advanced cancer, promoting the management of symptoms and the quality of life for terminal ones.

Of different orientation comes from another Italian study, presented at a congress by specialists and doctors of the AOU Careggi hospital in Florence, to demonstrate the effectiveness of clinical nutrition in cancer patients. This retrospective study analyzed data from administrative resources on a sample of patients from 10 local hospital units (i.e. about 5.9 million people) over a period of 6 years; and described the use of clinical nutrition, assessing the timing of the prescription and the impact in terms of survival on malnourished cancer patients.

This research was carried out based on the 5 categories of oncological diseases with the greatest impact, namely tumors of the gastrointestinal tract, genitourinary and respiratory tract, hematological diseases, and head-neck tumors. The experts went to evaluate how many patients receive clinical nutrition in Italy, and the data collected was very poor, emerging a use of 8.4% for metastatic patients and a 3.1% in non-metastatic patients. In addition, they identified the time of prescription of clinical nutrition in the history of patients, resulting very delayed for more than 50% of cases, with a consequent negative, significant reverberation on life expectancy; in fact, in terms of the impact of the use of this procedure and the timing of survival of the malnourished matastatic patient, it has been shown that, for tumors of the gastro enteric tract and urinary genitus, the use of it increases the survival of patients and in reference to timing, lengthens life expectancy for over three months.

These data have been compared with other studies conducted throughout Europe, and being retrospective, they do not guarantee a definitive value, but can be defined as a sort of baseline for the formulation of a hypothesis that helps us to configure a general perspective picture of the reality. Thanks to this study it was understood that: artificial nutrition despite the possibility of some side effects, is overall very recommendable and the malnutrition is diagnosed too rarely and too late, negatively impacting the patient’s treatment and outcome.

To increase the awareness of patients and doctors towards the need to implement adequate nutrition in the presence of this disease, in 2016, the Italian Society of Parenteral Nutrition (SINPE) signed together with the Italian Association of Medical Oncology (AIOM) a document that contains practical recommendations to promote nutritional support in oncology and a charter of rights of the cancer patient to support a timely and efficient administration of nutrients.