Nutritional Challenges in Older Cancer Patients: A Narrative Review of Assessment Tools and Management Strategies

Background/Objectives: Malnutrition, sarcopenia, cachexia, and frailty often coexist in older cancer patients and are associated with worse treatment tolerance, reduced quality of life, and increased mortality. These syndromes can be underrecognized, and the therapeutic approach is often fragmented. In light of this, the aim of this review was to synthesize current evidence on the screening and clinical management of nutritional aspects and the related tools, favoring multidimensional and personalized nutritional care. Methods: This narrative review was conducted according to the SANRA guidelines. A comprehensive literature search was performed on PubMed for studies published between January 2000 and June 2025, with no language restrictions. Eligible studies included adults aged ≥65 with cancer, addressing malnutrition, sarcopenia, cachexia, frailty, or nutrition-related interventions. Results: Malnutrition affects 30-80% of older cancer patients and is strongly associated with reduced survival, impaired treatment tolerance, and poorer quality of life. Tools such as PG-SGA, G8, GNRI, and CONUT offer practical options for early risk identification. Nutritional interventions, including oral supplements, dietary counseling, symptom management, and multimodal strategies (nutrition plus exercise), are associated with improved clinical outcomes. Evidence also supports the prognostic value of early screening and individualized nutrition care pathways. Conclusions: Malnutrition represents a modifiable risk factor in geriatric oncology and should be assessed considering other related conditions such as sarcopenia, cachexia, and frailty. Systematic screening and targeted interventions should be integrated into standard cancer care to improve outcomes in older adults. Future research should prioritize personalized nutrition strategies and multicenter trials focused on survival, function, and quality of life.