Supportive Care in Cancer

, Volume 24, Issue 1, pp 469–480 | Cite as

Nutrition intervention approaches to reduce malnutrition in oncology patients: a systematic review

  • Jia Li Charmaine Lee
  • Lai Peng Leong
  • Su Lin LimEmail author
Review Article



Malnutrition is a very common problem in oncology patients and is associated with many negative consequences including poorer prognosis, quality of life and survival. However, malnutrition in oncology patients is often overlooked although there is growing evidence showing that it can be prevented or reduced through nutrition intervention. This paper aims to provide an updated review on the effectiveness of different nutrition intervention approaches on nutrition status outcomes in oncology patients.


Randomised controlled trials (RCTs) published between 1994 and 2014 which examined the effects of nutrition intervention approaches—in particular, nutrition counselling (NC), oral nutrition supplements (ONS) and tube feeding (TF)—on nutrition status outcomes of oncology patients were identified and reviewed.


Thirteen papers from 11 RCTs with a total of 1077 participants were included. The intervention approaches included NC (four studies), NC + ONS (five studies), ONS (three studies) and TF (three studies). The various results suggest that NC with or without ONS was associated with consistent improvements in several nutrition status outcomes. On the other hand, ONS and TF were associated with inconsistent improvements in few aspects of nutrition status outcomes.


The referral of oncology patients for NC is recommended given the strong evidence of its beneficial effects on the prevention and reduction of malnutrition. Other forms of nutrition support including ONS and TF may then be included if deemed suitable and necessary for the individual.


Nutrition intervention Nutrition status Nutrition counselling Oral nutrition supplements Tube feeding Cancer 



American Dietetic Association Medical Nutrition Therapy


Body mass index






Eicosapentaenoic acid


Fat-free mass


Group rehabilitation


Individual support


Individual support and group rehabilitation


Nutrition counselling


Nasogastric tube feeding


No intervention


Oral nutrition supplements


Percutaneous endoscopic gastrostomy feeding


Patient-generated subjective global assessment


Patient participation-based dietary intervention


Quality of life


Randomised controlled trial




Tube feeding


Usual care


Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Montoya J, Domingo F Jr, Luna C, Berroya R, Catli C, Ginete J, Sanchez O, Juat N, Tiangco B, Jamias J (2010) Nutritional status of cancer patients admitted for chemotherapy at the National Kidney and Transplant Institute. Singap Med J 51(11):860–864Google Scholar
  2. 2.
    Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L (2012) Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 31(3):345–350. doi: 10.1016/j.clnu.2011.11.001 CrossRefPubMedGoogle Scholar
  3. 3.
    Wie GA, Cho YA, Kim SY, Kim SM, Bae JM, Joung H (2010) Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea. Nutrition 26(3):263–268. doi: 10.1016/j.nut.2009.04.013 CrossRefPubMedGoogle Scholar
  4. 4.
    Martin L, Jia C, Rouvelas I, Lagergren P (2008) Risk factors for malnutrition after oesophageal and cardia cancer surgery. Br J Surg 95(11):1362–1368. doi: 10.1002/bjs.6374 CrossRefPubMedGoogle Scholar
  5. 5.
    Garabige V, Giraud P, De Rycke Y, Girod A, Jouffroy T, Jaulerry C, Brunin F, Rodriguez J (2007) Impact of nutrition management in patients with head and neck cancers treated with irradiation: is the nutritional intervention useful? Cancer Radiother 11(3):111–116. doi: 10.1016/j.canrad.2006.11.005 CrossRefPubMedGoogle Scholar
  6. 6.
    Bower MR, Martin RC 2nd (2009) Nutritional management during neoadjuvant therapy for esophageal cancer. J Surg Oncol 100(1):82–87. doi: 10.1002/jso.21289 CrossRefPubMedGoogle Scholar
  7. 7.
    Britton B, Clover K, Bateman L, Odelli C, Wenham K, Zeman A, Carter GL (2012) Baseline depression predicts malnutrition in head and neck cancer patients undergoing radiotherapy. Support Care Cancer 20(2):335–342. doi: 10.1007/s00520-011-1087-y CrossRefPubMedGoogle Scholar
  8. 8.
    Hong JH, Omur-Ozbek P, Stanek BT, Dietrich AM, Duncan SE, Lee YW, Lesser G (2009) Taste and odor abnormalities in cancer patients. J Support Oncol 7(2):58–65PubMedGoogle Scholar
  9. 9.
    Steinbach S, Hummel T, Bohner C, Berktold S, Hundt W, Kriner M, Heinrich P, Sommer H, Hanusch C, Prechtl A, Schmidt B, Bauerfeind I, Seck K, Jacobs VR, Schmalfeldt B, Harbeck N (2009) Qualitative and quantitative assessment of taste and smell changes in patients undergoing chemotherapy for breast cancer or gynecologic malignancies. J Clin Oncol 27(11):1899–1905. doi: 10.1200/JCO.2008.19.2690 CrossRefPubMedGoogle Scholar
  10. 10.
    Jager-Wittenaar H, Dijkstra PU, Vissink A, van der Laan BF, van Oort RP, Roodenburg JL (2011) Malnutrition and quality of life in patients treated for oral or oropharyngeal cancer. Head Neck 33(4):490–496. doi: 10.1002/hed.21473 CrossRefPubMedGoogle Scholar
  11. 11.
    Van Cutsem E, Arends J (2005) The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 9(Suppl 2):S51–63. doi: 10.1016/j.ejon.2005.09.007 CrossRefPubMedGoogle Scholar
  12. 12.
    Hill A, Kiss N, Hodgson B, Crowe TC, Walsh AD (2011) Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr 30(1):92–98. doi: 10.1016/j.clnu.2010.07.015 CrossRefPubMedGoogle Scholar
  13. 13.
    Norman K, Stobaus N, Smoliner C, Zocher D, Scheufele R, Valentini L, Lochs H, Pirlich M (2010) Determinants of hand grip strength, knee extension strength and functional status in cancer patients. Clin Nutr 29(5):586–591. doi: 10.1016/j.clnu.2010.02.007 CrossRefPubMedGoogle Scholar
  14. 14.
    Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M (2010) Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer 18(4):433–437. doi: 10.1007/s00520-009-0681-8 CrossRefPubMedGoogle Scholar
  15. 15.
    Silander E, Nyman J, Bove M, Johansson L, Larsson S, Hammerlid E (2012) Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer: a randomized study. Head Neck 34(1):1–9. doi: 10.1002/hed.21700 CrossRefPubMedGoogle Scholar
  16. 16.
    Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A (2011) Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 98(2):268–274. doi: 10.1002/bjs.7305 CrossRefPubMedGoogle Scholar
  17. 17.
    Datema FR, Ferrier MB, Baatenburg de Jong RJ (2011) Impact of severe malnutrition on short-term mortality and overall survival in head and neck cancer. Oral Oncol 47(9):910–914. doi: 10.1016/j.oraloncology.2011.06.510 CrossRefPubMedGoogle Scholar
  18. 18.
    Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495CrossRefPubMedGoogle Scholar
  19. 19.
    Dodson S, Baracos VE, Jatoi A, Evans WJ, Cella D, Dalton JT, Steiner MS (2011) Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med 62:265–279. doi: 10.1146/annurev-med-061509-131248 CrossRefPubMedGoogle Scholar
  20. 20.
    Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, Baggio V, Lamon S, Babare R, Rosti G, Giometto M, Boscolo-Rizzo P, Kiwanuka E, Tessarin M, Caregaro L, Marchiori C (2010) Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer 18(7):837–845. doi: 10.1007/s00520-009-0717-0 CrossRefPubMedGoogle Scholar
  21. 21.
    van den Berg MG, Rasmussen-Conrad EL, Wei KH, Lintz-Luidens H, Kaanders JH, Merkx MA (2010) Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy. Br J Nutr 104(6):872–877. doi: 10.1017/S0007114510001315 CrossRefPubMedGoogle Scholar
  22. 22.
    Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG (2012) Role of nutritional status in predicting quality of life outcomes in cancer—a systematic review of the epidemiological literature. Nutr J 11:27. doi: 10.1186/1475-2891-11-27 PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Isenring E, Capra S, Bauer J, Davies PS (2003) The impact of nutrition support on body composition in cancer outpatients receiving radiotherapy. Acta Diabetol 40(Suppl 1):S162–164. doi: 10.1007/s00592-003-0054-6 CrossRefPubMedGoogle Scholar
  24. 24.
    Simpson F, Doig GS (2005) Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med 31(1):12–23CrossRefPubMedGoogle Scholar
  25. 25.
    Ravasco P, Monteiro-Grillo I, Camilo M (2012) Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy. Am J Clin Nutr 96(6):1346–1353. doi: 10.3945/ajcn.111.018838 CrossRefPubMedGoogle Scholar
  26. 26.
    Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2005) Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 23(7):1431–1438. doi: 10.1200/jco.2005.02.054 CrossRefPubMedGoogle Scholar
  27. 27.
    Isenring EA, Bauer JD, Capra S (2007) Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc 107(3):404–412. doi: 10.1016/j.jada.2006.12.007 CrossRefPubMedGoogle Scholar
  28. 28.
    Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91(3):447–452. doi: 10.1038/sj.bjc.6601962 PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Baldwin C, Spiro A, McGough C, Norman AR, Gillbanks A, Thomas K, Cunningham D, O’Brien M, Andreyev HJ (2011) Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial. J Hum Nutr Diet 24(5):431–440. doi: 10.1111/j.1365-277X.2011.01189.x CrossRefPubMedGoogle Scholar
  30. 30.
    Kim H, Suh EE, Lee HJ, Yang HK (2014) The effects of patient participation-based dietary intervention on nutritional and functional status for patients with gastrectomy: a randomized controlled trial. Cancer Nurs 37(2):E10–e20. doi: 10.1097/NCC.0b013e31829193c8 CrossRefPubMedGoogle Scholar
  31. 31.
    Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27(8):659–668. doi: 10.1002/hed.20221 CrossRefPubMedGoogle Scholar
  32. 32.
    Persson CR, Johansson BB, Sjöden PO, Glimelius BL (2002) A randomized study of nutritional support in patients with colorectal and gastric cancer. Nutr Cancer 42(1):48–58. doi: 10.1207/S15327914NC421_7 CrossRefPubMedGoogle Scholar
  33. 33.
    Corry J, Poon W, McPhee N, Milner AD, Cruickshank D, Porceddu SV, Rischin D, Peters LJ (2008) Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation. J Med Imaging Radiat Oncol 52(5):503–510. doi: 10.1111/j.1440-1673.2008.02003.x CrossRefPubMedGoogle Scholar
  34. 34.
    Salas S, Baumstarck-Barrau K, Alfonsi M, Digue L, Bagarry D, Feham N, Bensadoun RJ, Pignon T, Loundon A, Deville JL, Zanaret M, Favre R, Duffaud F, Auquier P (2009) Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: prospective randomized trial. Radiother Oncol 93(3):503–509. doi: 10.1016/j.radonc.2009.05.016 CrossRefPubMedGoogle Scholar
  35. 35.
    Baldwin C, Weekes CE (2012) Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials. J Hum Nutr Diet 25(5):411–426. doi: 10.1111/j.1365-277X.2012.01264.x CrossRefPubMedGoogle Scholar
  36. 36.
    Davies M (2005) Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs 9:S64–S73CrossRefPubMedGoogle Scholar
  37. 37.
    MacDonald N (2003) Is there evidence for earlier intervention in cancer-associated weight loss? J Support Oncol 1:279–286PubMedGoogle Scholar
  38. 38.
    van Bokhorst-de van der Schueren MA (2005) Nutritional support strategies for malnourished cancer patients. Eur J Oncol Nurs 9:S74–S83CrossRefGoogle Scholar
  39. 39.
    Caro MMM, Laviano A, Pichard C (2007) Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 26(3):289–301CrossRefGoogle Scholar
  40. 40.
    Langius JA, Zandbergen MC, Eerenstein SE, van Tulder MW, Leemans CR, Kramer MH, Weijs PJ (2013) Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr 32(5):671–678. doi: 10.1016/j.clnu.2013.06.012 CrossRefPubMedGoogle Scholar
  41. 41.
    Garg S, Yoo J, Winquist E (2010) Nutritional support for head and neck cancer patients receiving radiotherapy: a systematic review. Support Care Cancer 18(6):667–677CrossRefPubMedGoogle Scholar
  42. 42.
    Daly JM, Hearne B, Dunaj J, LePorte B, Vikram B, Strong E, Green M, Mugglo F, Groshen S, DeCosse JJ (1984) Nutritional rehabilitation in patients with advanced head and neck cancer receiving radiation therapy. Am J Surg 148(4):514–520CrossRefPubMedGoogle Scholar
  43. 43.
    Tisdale MJ (2003) Pathogenesis of cancer cachexia. J Support Oncol 1(3):159–168PubMedGoogle Scholar
  44. 44.
    Elia M (2011) Oral nutritional support in patients with cancer of the gastrointestinal tract. J Hum Nutr Diet 24(5):417–420CrossRefPubMedGoogle Scholar
  45. 45.
    Murphy RA, Yeung E, Mazurak VC, Mourtzakis M (2011) Influence of eicosapentaenoic acid supplementation on lean body mass in cancer cachexia. Br J Cancer 105(10):1469–1473PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Kumar NB, Kazi A, Smith T, Crocker T, Yu D, Reich R, Bepler G (2010) Cancer cachexia: traditional therapies and novel molecular mechanism-based approaches to treatment. Curr Treat Options in Oncol 11(3–4):107–117CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Jia Li Charmaine Lee
    • 1
  • Lai Peng Leong
    • 1
  • Su Lin Lim
    • 2
    • 3
    Email author
  1. 1.Food Science and Technology Programme, Department of ChemistryNational University of SingaporeSingaporeSingapore
  2. 2.Dietetics DepartmentNational University HospitalSingaporeSingapore
  3. 3.School of Exercise and Nutrition SciencesQueensland University of TechnologyBrisbaneAustralia

Personalised recommendations