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Clinical and economic value of oral nutrition supplements in patients with cancer: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer

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Abstract

Malnutrition is a common clinical and public health problem that can frequently affect patients in hospital and community settings. In particular, cancer-related malnutrition results from a combination of metabolic dysregulation and anorexia, caused both by the tumor itself and by its treatment. Patients with head-neck cancer, or with gastroesophageal, pancreatic, lung, and colorectal cancer, are particularly at risk of developing malnutrition, with a prevalence varying between 30 and 50% depending on tumor location and anti-cancer treatment complications. Prevention and adequate management of malnutrition is now considered an essential key point of therapeutic pathways of patients with cancer, with the aim to enhance their quality of life, reduce complications, and improve clinical outcomes. Oral nutritional supplements (ONS) are part of the nutritional therapy and represent an effective tool to address cancer-related malnutrition, as supported by growing literature data. However, patients’ access to ONS — which is regulated by different national and regional policies in terms of reimbursement — is quite heterogeneous. This narrative review aims to summarize the current knowledge about the role of ONS in terms of cost-effectiveness in the management of actively treated patients with cancer, following surgery and/or radiotherapy/chemotherapy treatment and to present the position on this issue of the Alliance Against Cancer, the Italian National Oncology Network, coming up from a focused virtual roundtable of the Survivorship Care and Nutritional Support Working Group.

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Acknowledgements

The Alliance Against Cancer Survivorship Care and Nutritional Support Working Group (Nutritional Support Commission) is composed by: Renato Cannizzaro, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; Lupe Sanchez Mete, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Alessio Nencioni, Samir Sukkar, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Antonella Daniele, IRCCS Istituto Tumori “Giovanni Paolo II,” Bari, Italy; Roberta Masella, Istituto Superiore di Sanità, Rome, Italy; Maria Cristina Mele, Laura Lorenzon, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Riccardo Caccialanza, Paolo Pedrazzoli, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Elena Lamperti, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Marco Tonello, Mariateresa Nardi, Vittorina Zagonel, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Dario Scala, IRCCS CROB Rionero in Vulture, Potenza, Italy; Giovanni de Pergola, National Institute of Gastroenterology “Saverio de Bellis” Research Hospital, Castellana Grotte (Bari), Italy; Alba Zappalà, IDI-IRCCS-FLMM, Rome, Italy; Lucilla Titta, Istituto Europeo di Oncologia (IEO), IRCCS, Milan, Italy; Alessandra Longhi, Toni Ibrahim, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Patrizia Serra, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,” Meldola, Italy; Filippo Montemurro, Valentina Casalone, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy; Cristina Bosetti, Oscar Corli, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri; Roberto Mele, San Raffaele Scientific Institute IRCCS, Milan, Italy; Armando Santoro, Humanitas Clinical and Research Center—IRCCS, Rozzano (Milan), Italy; Elisabetta Iannelli, Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy; Francesco De Lorenzo, Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Roma, Italy; Giampiero Porzio, Italian Association of Medical Oncology (AIOM), Milan, Italy; Alessandro Laviano, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy; Angela Mastronuzzi, Antonella Diamanti, Children’s Hospital Bambino Gesù IRCCS, Rome, Italy.

Funding

This paper was partially funded by an unconditional grant from Unione Italiana Food and by the Italian Ministry of Health (Ricerca Corrente Reti IRCCS, RCR-2021–23671213 – National program in personalized oncology for the IRCCS of the Alliance Against Cancer network).

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Authors and Affiliations

  1. Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy

    Riccardo Caccialanza

  2. Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

    Alessandro Laviano

  3. Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Cristina Bosetti

  4. Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy

    Mariateresa Nardi

  5. Clinical Nutrition and Dietetics Unit, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy

    Valentina Casalone

  6. Department of Experimental Oncology, European Institute of Oncology, Milan, Italy

    Lucilla Titta

  7. Hospital Health Direction, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Roberto Mele

  8. Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology “Saverio de Bellis” Research Hospital, Castellana Grotte, Bari, Italy

    Giovanni De Pergola

  9. Italian Federation of Volunteer-Based Cancer Organizations, Rome, Italy

    Francesco De Lorenzo

  10. Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy

    Paolo Pedrazzoli

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  1. Riccardo Caccialanza
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  2. Alessandro Laviano
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  3. Cristina Bosetti
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  4. Mariateresa Nardi
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  5. Valentina Casalone
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  7. Roberto Mele
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  9. Francesco De Lorenzo
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  10. Paolo Pedrazzoli
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the Alliance Against Cancer (ACC) Survivorship Care, Nutritional Support Working Group

Contributions

All authors contributed to the article conception and design. Material preparation and literature collection were performed by all authors. The first draft of the manuscript was written by Riccardo Caccialanza, Alessandro Laviano, and Paolo Pedrazzoli. All authors commented on previous versions of the manuscript. All authors and the ACC Survivorship Care and Nutritional Support Working Group (Nutrional Support Commission) read and approved the final version of the manuscript.

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Correspondence to Riccardo Caccialanza.

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The ACC Survivorship Care and Nutritional Support Working Group (Nutrional Support Commission) is listed in the “Acknowledgements” section.

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Caccialanza, R., Laviano, A., Bosetti, C. et al. Clinical and economic value of oral nutrition supplements in patients with cancer: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. Support Care Cancer 30, 9667–9679 (2022). https://doi.org/10.1007/s00520-022-07269-y

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