Journal: Nutrition and cancer
This publication reviews malnutrition and cachexia in advanced lung cancer, emphasizing their high prevalence and impact on outcomes. Systemic inflammation (notably IL-6 and TNF-α), metabolic changes, and anorexia drive progressive weight and muscle loss, leading to poorer prognosis, reduced treatment tolerance, and impaired quality of life and survival.
The authors highlight the importance of early identification using validated tools such as the Patient-Generated Subjective Global Assessment. Management should be aligned with patient-centered goals, focusing on function and quality of life rather than survival alone.
- Oral nutritional supplements: Oral nutritional supplements, particularly high-protein and EPA-enriched formulas, can improve weight, muscle mass, and quality of life, though adherence is a practical limitation.
- Enteral nutrition: Enteral nutrition is recommended for patients with a functional gastrointestinal tract but inadequate oral intake (e.g., dysphagia), with evidence of improved nutritional biomarkers and fewer complications.
- Parenteral nutrition: Parenteral nutrition is reserved for true intestinal failure given infection risks and limited survival benefit.
The article advocates a multimodal approach combining nutrition, exercise, and pharmacologic strategies (including appetite stimulants and agents such as anamorelin under investigation). It underscores ethical, cultural, and legal dimensions of artificial nutrition, prioritizing autonomy, informed consent, and respect for cultural values.
Key barriers include inconsistent nutritional screening and constrained resources. The authors call for lung cancer–specific trials of enteral nutrition, consensus definitions of cachexia, and strategies to ensure equitable access to nutritional support, particularly in underserved populations.