Nutrition in lung cancer treatment: the forgotten pillar of care?

Malnutrition and cachexia in cancer patients, particularly those with lung cancer, represent a pervasive clinical challenge that compromises treatment outcomes, quality of life, and overall survival. This article analyzes the multifactorial etiology of oncological malnutrition, highlighting the chronic inflammatory state, tumor-induced anorexia, and metabolic abnormalities that accelerate muscle and weight loss. It underscores that rates of malnutrition can range from 30% to 80% across different tumor types, with lung cancer patients especially vulnerable due to their high inflammatory burden. The text reviews key tools for screening and diagnosing malnutrition, such as Nutriscore, Subjective Global Assessment (SGA), and Patient-Generated Subjective Global Assessment (PG-SGA), as well as the relevance of the Glasgow Prognostic Score in linking inflammation with poorer clinical outcomes. Strategies for early nutritional intervention include enteral and parenteral feeding, oral nutritional supplements (ONS), and customized dietary counseling. Additionally, specialized approaches such as immunonutrition, omega-3 fatty acids, and targeted micronutrient supplementation are discussed, reflecting evidence that multiple nutrients, including arginine and glutamine, can exert immunomodulatory and anti-inflammatory effects. Furthermore, the article emphasizes the importance of identifying and managing cancer-associated sarcopenia, in which screening tools like Strength, Assistance with walking, Rise from chair, Climb stairs, Falls (SARC-F)/calf circumference (CalF) offer early detection of muscle mass deficits. Psychological support and patient education are positioned as integral components of a holistic intervention plan, aimed at optimizing nutritional status and mitigating the side effects of chemotherapy and radiotherapy. Ultimately, the need for larger-scale randomized clinical trials is highlighted to refine best practices, establish standardized methodologies, and confirm the clinical benefits of comprehensive nutritional therapies in patients with lung cancer.