Clinical guidelines for nutritional therapy in cancer patients

Cancer Nutritional Therapy is a process involving the planning, implementation, and evaluation of nutritional interventions to treat tumors, their complications, or physical conditions, thereby improving the prognosis of cancer patients. It encompasses three stages: nutritional diagnosis, nutritional treatment, and efficacy evaluation. Nutritional therapy serves as the foundational, first-line, and core treatment for cancer patients. The nutritional diagnosis for cancer patients is conducted in three tiers: nutritional screening, nutritional assessment, and comprehensive evaluation. Patients with severe malnutrition routinely undergo comprehensive evaluation, with particular attention paid to their inflammatory burden and metabolic disorders. Based on the nutritional diagnosis and severity of malnutrition, categorized and individualized nutritional treatment is implemented. This follows the “Four Priority” principles: diet first, oral intake first, nutrition education first, and enteral nutrition first. It also adheres to the five-step nutritional treatment protocol: nutrition education, oral nutritional supplements (ONS), total enteral nutrition (TEN), partial parenteral nutrition (PPN), and total parenteral nutrition (TPN). Adjustments are made according to the patient’s specific condition to ensure a smooth nutritional transition. Daily dietary intake is the primary source of nutrition for cancer patients. Nutrition education is a mandatory routine treatment for all cancer patients, while ONS is the simplest form of medical nutritional therapy. The fundamental requirements of nutritional therapy are to ensure patients meet energy and protein targets: 25–30 kcal/(kg d) and 1.2–1.5 g/(kg d), respectively. For enteral nutrition formulas, balanced formulations are preferred for cancer patients, while disease-specific formulas are recommended for those with tumors or severe metabolic disorders. For parenteral nutrition, industrialized multi-chamber bags administered in an “all-in-one” format are the first choice. The efficacy of nutritional therapy should be comprehensively evaluated based on the response time. Weight, nutrition impact symptoms (NIS), and physical performance are effective self-assessment parameters for monitoring nutritional outcomes in cancer patients.