Unmet needs in clinical nutrition in oncology: a multinational analysis of real-world evidence.

Background: Knowledge about cancer-related malnutrition and the use of clinical nutrition (CN) in the real-world setting are lacking. We investigated diagnosis and treatment frequency of malnutrition in a multinational survey to identify unmet needs in cancer patients' care.
Methods: Retrospective analyses were conducted on data from three administrative healthcare datasets from France ( n  = 570,727), Germany ( n  = 4642) and Italy ( n  = 58,468). Data from France described frequency and timing of malnutrition diagnosis in hospitalized gastrointestinal cancer patients. The German data detailed home parenteral nutrition (HPN) use in cancer patients with stage III/IV cancers. The Italian data analysed three cohorts: metastatic with CN, metastatic without CN, and patients without metastatic disease.
Results: In France, malnutrition diagnosis at first hospitalization occurred in 10% of patients, 13% were subsequently diagnosed, and 77% had no malnutrition diagnosis. In Germany, 16% of patients received HPN. Patients started HPN around 3 months before death. In Italy, 8.4% of metastatic cancer patients received CN; average time between metastasis diagnosis and first CN prescription was 6.6 months. Average time between first CN prescription and death was 3.5 months.
Conclusions: These data indicate that in the real-world clinical practice, cancer-related malnutrition is under-recognized and undertreated. CN often appears to be prescribed as an end-of-life intervention or is not prescribed at all.Appropriate CN use remains challenging, and current practice may not allow optimal oncologic outcomes for patients at nutritional risk. Improving awareness of malnutrition and generating further evidence on clinical and economic benefits of CN are critical priorities in oncology.
Competing Interests: Conflict of interest statement: RC reports personal fees, speakers’ honoraria, research grants, or membership on advisory boards for Akern, Baxter Healthcare, B. Braun, Eli Lilly, Fresenius Kabi, Nestlé Health Science and Nutricia. OM reports speakers’ honoraria for Baxter and Pfizer. IS reports speakers’ honoraria for AbbVie, Gilead, Baxter Healthcare, Intercept, Shire and Jansen. PP reports speakers’ honoraria and teaching for Baxter Healthcare. FO is an employee of Baxter. The other authors declare they have no conflict of interests.
(© The Author(s), 2020.)