Barriers to timely nutrition support in patients with cancer: A scoping review

In clinical cancer settings, malnutrition can go undiagnosed and patients often receive nutrition care only after they have lost substantial weight or developed severe side effects. Neglecting to provide nutrition care to a patient in a timely manner can lead to increased difficulties in supporting them and to poorer clinical outcomes. The aim of this review was to identify the barriers to timely nutrition support for patients with cancer before and during medical treatment. PubMed and CINAHL platforms were used to search for relevant published literature in June 2022. The search was updated in January 2025. Advanced search was used using the terms "cancer," "malnutrition," "nutritional support," and their synonyms in combination with "under-recognition" and associated synonyms. The protocol was prospectively registered on OSF Open Science. A total of 4584 records were identified in the databases, and 41 abstracts were selected for full article screening. A total of 19 articles were included in the review. Evidence from the studies indicates that malnutrition identification and dietetic support are not always implemented in current practice. Identified barriers were grouped into four interconnected macro themes: educational barriers, communication barriers, resource barriers, and sociocultural barriers. This scoping review identifies four barriers to early nutrition support in oncological settings and discusses their implications and how they influence each other. Clinical governance should consider and look to address all barriers when trying to implement dietetic support or design pathways in a timely and efficient manner.