[How can we integrate nutritional support in medical oncology?]

Malnutrition concerns 20% of cancer patients. It is an independent risk factor for morbidity and mortality. And nutritional support has to be integrated in anti-cancer treatment project, and could improve the prognosis and quality of life. Two axes in cancer cachexia care could be identified: nutritional and pharmacological. The first level of care includes dietetic counselling and oral nutritional supplements. When oral intakes are less 60% of needs, we have to use artificial nutrition, enteral if digestive tract is functional, otherwise parenteral nutrition. Immunonutrition in oncology concerns omega-3 fatty acids, some amino acids (arginine, glutamine, polyamins), the anti-oxidant micronutrients. Their indications and contraindications begin to emerge in oncology. Among molecules usefull in cancer cachexia, numerous were tested for their orexigen effect. The only ones, megestrol acetate and corticosteroids proved their efficacy in short cures. Today, nutrition is not any more palliative care but has to be included in anti-cancer treatment plan. According to the degree of malnutrition or malnutrition risk, different levels of nutritional support could be purposed. And immunonutrition could improve beneficial effects of nutritional support during cancer chemotherapy or radiotherapy.