Nutritional Wasting in Cancer and Quality of Life: The Value of Early Individualized Nutritional Counseling

  • P. Ravasco
  • I. M. Grillo
  • M. Camilo
Reference work entry


To devise a meaningful nutritional therapy in cancer, a greater understanding of nutritional dimensions as well as patients’ expectations and disease impact is essential. We have shown that nutritional deterioration in patients with gastrointestinal and head and neck cancer was multifactorial and mainly determined by the tumor burden and location. In a larger cohort, stage and location were yet again the major determinants of patients’  Quality of Life, despite the fact that nutritional deterioration combined with intake deficits were functionally more relevant than cancer stage. Based on this framework, the potential role of integrated oral nutritional support on outcomes was investigated. In a pilot study using individualised  nutritional counseling on a heterogeneous patient population, the achieved improvement of nutritional intake was proportional to a better Quality of Life. The role of early nutritional support was further analysed in a prospective randomised controlled trial in head and neck cancer patients stratified by stage undergoing radiotherapy. Pre-defined outcomes were: nutritional status and intake, morbidity and Quality of Life, at the end and 3 months after radiotherapy. Nutritional interventions, only given during radiotherapy, consisted of three randomisation arms: individualised nutritional counseling versus ad libitum diet + high protein supplements versus ad libitum diet. Nutritional interventions 1 and 2 positively influenced outcomes during radiotherapy; however, 3 months after its completion individualised nutritional counseling was the single method capable of sustaining a significant impact on patients’ outcomes. The early provision of the appropriate mixture of foods and textures using regular foods may modulate outcomes in cancer patients.


Nutritional Intervention Nutritional Intake Neck Cancer Patient Nutritional Counseling Regular Food 

List of Abbreviations:




European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30


Group 1 (Individualised Dietary Counselling Based on Regular Foods)


Group 2 (ad libitum intake + supplements)


Group 3 (ad lib intake)








Not Significant




Patient Generated-Subjective Global Assessment


Quality of Life






  1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman B, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F. (1993). J Natl Cancer Inst. 85: 365–376.PubMedCrossRefGoogle Scholar
  2. Andreyev H, Norman AR, Oates J, Cunningham D. (1998). Eur J Cancer. 34: 503–509.PubMedCrossRefGoogle Scholar
  3. Belghiti J, Langonnet F, Bourstyn E, Fekete F. (1983). Br J Surg. 70: 339–341.PubMedGoogle Scholar
  4. Bodger K, Heatley R. (2001). In: Payne James J, Grimble G, Silk D (eds.) Artificial Nutrition Support in Clinical Practice. GMM, London, pp. 137–148.Google Scholar
  5. Broadhead E, Hughes PM, Kelly CG, Seal CJ. (2001). Proc Nutr Soc. 60: 55A.Google Scholar
  6. Chao KSC, Perez CA, Brady LW. (1999). Fundamentals of patient management. In: Chao KSC, Perez CA, Brady LW (eds.) Radiation Oncology: Management Decisions. Lippincot-Raven, Philadelphia, pp. 1–13.Google Scholar
  7. de Graeff A, Pironi L, Hordijk G-J, Battermann JJ, Blijham GH, Winnubst JAM. (1999). Head Neck. 21: 291–296.PubMedCrossRefGoogle Scholar
  8. De Wys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC. (1980). Am J Med. 69: 491–497.Google Scholar
  9. Donaldson S. (1997). Cancer Res. 37: 2407–2413.Google Scholar
  10. Esper D, Harb W. (2005). Nutr Clin Pract. 20: 369–376.PubMedCrossRefGoogle Scholar
  11. Gibney E. (2002). The Physical, Psychological and Metabolic Effects of Nutritional Depletion and Subsequent Repletion. University of Cambridge, Cambridge.Google Scholar
  12. Grosvenor M, Bulcavage L, Chlebowski R. (1989). Cancer. 63: 330–334.PubMedCrossRefGoogle Scholar
  13. Hiram O. (1936). JAMA. 106: 458–460.Google Scholar
  14. Jagoe R, Goodship T, Gibson G. (2001). Ann Thorac Surg. 71: 936–943.PubMedCrossRefGoogle Scholar
  15. Keys A, Brozec J, Henschel A. (1950). The Biology of Human Starvation. University of Minnesota Press, Minneapolis.Google Scholar
  16. King’s Fund Centre. (1992). A New Approach to Nutrition as Treatment. King’s Fund Centre, London.Google Scholar
  17. Lees J. (1999). Eur J Cancer Care. 8: 133–136.CrossRefGoogle Scholar
  18. McKeena S, Thorig L. (1995). Nutrition. 11: 308–309.Google Scholar
  19. McMillan DC, Watson WS, Preston T, Mcardle CS. (2000). Clin Nutr. 19: 403–406.PubMedCrossRefGoogle Scholar
  20. Mehnert A, Shim EJ, Koyama A, Cho SJ, Inui H, Paik NS, Koch U. (2006). Breast Cancer Res Treat. 10: 50–56.Google Scholar
  21. Muldoon M, Barger SD, Flory JD, Manuck SB. (1998). Brit Med J. 316: 542–545.PubMedGoogle Scholar
  22. Mutlu E, Mobarhan S. (2000). Nutr Clin Care. 3: 3–23.CrossRefGoogle Scholar
  23. Nelson J, Walsh D, Sheehan FA. (1994). Mayo Clinic Diet Manual: A Handbook of Nutrition Practices. Mosby, St. Louis, MO.Google Scholar
  24. Newton F, Burney S, Millar JL, Frydenberg M, Ng KT. (2006). BJU Int. 97: 1179–1183.PubMedCrossRefGoogle Scholar
  25. Nordin K, Glimelius B. (1997). Acta Oncol. 36: 803–810.PubMedCrossRefGoogle Scholar
  26. Ottery F. (1996). Nutrition. 12: s15–s19.PubMedGoogle Scholar
  27. Padilla GV, Grant MM, Lipsett J, Anderson PR, Rhiner M, Bogen C. (1992). Cancer. 70: 1450–1456.PubMedCrossRefGoogle Scholar
  28. Persson C, Sjoden PO, Glimelius B. (1999). Clin Nutr. 18: 71–77.PubMedCrossRefGoogle Scholar
  29. Plata-Salaman C. (1996). Nutrition. 12: 69–78.PubMedCrossRefGoogle Scholar
  30. Ravasco P, Monteiro-Grillo I, Camilo M. (2003b). Radiother Oncol. 67: 213–220.PubMedCrossRefGoogle Scholar
  31. Ravasco P, Monteiro Grillo I, Camilo M. (2007). Cancer Invest. 25: 1–7.CrossRefGoogle Scholar
  32. Ravasco P, Monteiro Grillo I, Marques Vidal P, Camilo ME. (2003a). Clin Oncol. 15: 443–450.CrossRefGoogle Scholar
  33. Ravasco P, Monteiro Grillo I, Marques Vidal P, Camilo ME. (2004). Support Care Cancer. 12: 246–252.PubMedCrossRefGoogle Scholar
  34. Ravasco P, Monteiro Grillo I, Marques Vidal P, Camilo ME. (2005a). J Clin Oncol. 23: 1431–1438.PubMedCrossRefGoogle Scholar
  35. Ravasco P, Monteiro Grillo I, Marques Vidal P, Camilo ME. (2005b). Head Neck. 27: 659–668.PubMedCrossRefGoogle Scholar
  36. Ried L, Tueth MJ, Handberg E, Nyanteh H. (2006). Qual Life Res. 15: 675–686.PubMedCrossRefGoogle Scholar
  37. Rubin P, Wasserman T. (1998). Int J Radiat Oncol Biol Phys. 14: 29–38.Google Scholar
  38. Sproat K, Russell C. (1994). Ross Products Division, Abbot Laboratories, Columbus.Google Scholar
  39. Stratton R, Green CJ, Elia M. (2003). Disease-Related Malnutrition: An Evidence-Based Approach to Treatment. CABI Publishing, Wallingford.Google Scholar
  40. Tandon S, Gupta SC, Sinha SN, Naithani YP. (1984). Indian J Med Res. 80: 180–188.PubMedGoogle Scholar
  41. Testa MA, Simonson DC. (1996). N Engl J Med. 334: 835–840.PubMedCrossRefGoogle Scholar
  42. The EuroQoL Group. (1990). Health Policy. 16: 199–208.CrossRefGoogle Scholar
  43. Their S. (1992). Med Care. 30: MS15–MS22.CrossRefGoogle Scholar
  44. Van Bokhorst-de, Van der Schueren MAE, Quak JJ, von Blomberg-van der Flier BME, Kuik DJ, Langendoen SI, Snow GB, Green CJ, Van Leeuwen PAM. (2001). Ann J Clin Nutr. 73: 323–332.Google Scholar
  45. Van der Schueren MA, Van Leeuwen PA, Sauerwein HP, Kuik DJ, Snow GB, Quak J. (1997). Head Neck, 19: 419–425.CrossRefGoogle Scholar
  46. Van der Schueren MAE, Quak JJ, von Blomberg-van der Flier BME, Kuik DJ, Langendoen SI, Snow GB, Green CJ, Van Leeuwen PAM. (2001). Am J Clin Nutr. 73: 323–332.Google Scholar
  47. Warren S. (1932). Am J Med Sci. 184: 610–615.CrossRefGoogle Scholar
  48. Wasserman TH, McDonald A. (1995). Int J Radiot Oncol Biol. 33: 965–966.CrossRefGoogle Scholar
  49. Wilson I, Cleary P. (1995). JAMA. 273: 59–65.PubMedCrossRefGoogle Scholar
  50. Wood RM, Lander VL, Mosby EL, Hiatt WR. (1989). Oral Surg Oral Med Pathol. 68: 391–395.CrossRefGoogle Scholar
  51. World Health Organisation. (1952). Handbook of Basic Documents. Palais des Nations, Geneva.Google Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • P. Ravasco
  • I. M. Grillo
  • M. Camilo

There are no affiliations available

Personalised recommendations