[Nutritional management of oncologic patients]

Malnutrition is a common complication in the oncological patient, and this affects his or her quality of life and survival. The majority of these patients show nutritional problems in their evolution, especially anorexia and weight loss. The most severe picture is called neoplastic cachexia. The causes hereof are many and some are not well known as they are related to the tumor metabolism itself, the metabolic response to the release of cytokines, or even to the treatment: surgery, chemotherapy or radiation therapy. The nutritional support will not cure the cancer; the malignant cells must be eradicated by the anti-tumor therapies, but nutrition is a therapy that is complementary to the basic treatment, however, with nutritional intervention we can avoid a greater deterioration of the patient, improve some nutritional and immunological parameters, avoid complications, and improve the quality of life. The nutritional action plan should be based on the knowledge of the specific situation of each patient, assessing his or her nutritional status, type of tumor, expected response to treatment, and the capacity to handle the situation. As in any patient, the access route of the nutritional support may be oral, enteral, or parenteral, depending on the clinical situation. The oral route, supervised by an experienced team, is the safest and the most effective, but this requires an adequately functioning digestive system and that the patient be able to maintain an adequate caloric and proteineic ingestion. When oral feeding is impossible or insufficient, it is necessary to resort to enteral or parenteral nutrition, depending on the functionality of the digestive apparatus. Special attention should be paid to those patients in whom the failure of the oncological therapy leads to an expected fatal outcome. Within the palliative care the nutritional intervention is simple, cheap, and effective with regard to the improvement of the quality of life. Dietary advice and at home enteral nutrition may be of great help.