Cancer is a leading cause of morbidity and mortality globally, significantly impacting patients' quality of life. While survival rates have improved, the focus of healthcare is shifting towards a multidisciplinary approach that addresses all aspects of patient well-being. Malnutrition in cancer patients is a significant concern, linked to higher morbidity and mortality rates. Early detection and intervention are crucial to mitigate the negative effects of malnutrition, especially the development of refractory cachexia. Existing studies highlight the positive impact of early nutritional intervention on clinical improvement and survival, particularly in patients with high-risk tumors like those in the upper digestive tract. This study aimed to evaluate a new nutritional care model designed to achieve early detection and intervention of nutritional risk in oncology patients before the onset of irreversible cachexia.

The literature emphasizes the high prevalence of malnutrition among cancer patients and its negative impact on prognosis and quality of life. Studies such as the NUPAC study in Spain revealed that over 50% of cancer patients experience moderate or severe malnutrition, with a significant portion remaining undiagnosed. Other research highlights the importance of early detection protocols, suggesting that early intervention can significantly improve the identification of malnourished patients. ESPEN guidelines point to weight loss as a key indicator of nutritional deficit, and historical studies have demonstrated a strong link between weight loss at diagnosis and poor outcomes across various cancer stages. The need for a multidisciplinary approach and routine nutritional assessment at diagnosis and throughout treatment is consistently underscored in the literature.

This prospective study included adult patients (≥18 years) with a new diagnosis of solid tumors starting chemotherapy. Patients were divided into two groups based on tumor location and nutritional risk: Group 1 (high-risk tumors – head and neck, upper digestive tract) and Group 2 (low-risk tumors). Group 1 patients received immediate nutritional consultation, while Group 2 patients underwent initial Nutriscore screening. Patients with a Nutriscore ≥5 or weight loss during follow-up received individualized nutritional care. Nutritional assessment involved evaluating food intake, symptoms, and using tools like PG-SGA. Interventions ranged from nutritional advice to specialized support. Body weight was recorded at various time points (normal weight, initial weight, chemotherapy start/end weight). Weight loss ≥2% was considered significant. The primary outcome measure was weight gain or maintenance at the end of chemotherapy. Statistical analysis involved descriptive statistics, Wilcoxon rank test, Mann-Whitney U test, chi-square test, and multivariate logistic regression. Ethical approval and informed consent were obtained.

Of 234 patients in the final analysis, 84 (36%) required individualized nutritional care. Group 1 (high-risk tumors) comprised 27 (32.1%) of these patients, while 12 had a Nutriscore ≥5 at the start of treatment and another 45 patients experienced weight loss during follow up. The mean weight loss at the start of the study was -3.6% ± 8.2%, which improved significantly to 0% ± 7.3% by the end of chemotherapy (p<0.001). 71% of patients achieved weight gain or maintenance at the end of treatment. Patients with head and neck, gynecological, breast, or bladder cancer showed a high rate of weight maintenance or gain. While patients with esophageal-gastric or pancreatic cancer didn’t achieve weight gain, WL was reduced in significant proportion by the end of the treatment. Multivariate analysis showed no association between the outcome variable and tumor type, age, sex, or treatment intent. The median time from first nutrition consultation to the start of the individualized nutritional care program was 26 days.

This study demonstrates the effectiveness of early nutritional intervention in preventing or reducing weight loss in cancer patients undergoing chemotherapy. The high percentage (36%) of patients identified as needing nutritional intervention highlights the prevalence of malnutrition and the need for proactive screening. The significant improvement in weight loss from baseline to the end of chemotherapy supports the efficacy of the individualized nutritional care program. While the study lacked a control group, the findings align with the existing literature emphasizing the benefits of early nutritional interventions. The varied responses among different cancer types could inform future research focusing on tailored nutritional approaches. The incorporation of the protocol into clinical practice could significantly enhance the overall care and outcomes for cancer patients.

The study’s early nutritional care model, implemented irrespective of tumor location, proved effective in improving nutritional status during chemotherapy. Early detection and individualized intervention led to weight gain or maintenance in a significant portion of patients. The model's integration into routine clinical practice enhances comprehensive patient care. Future studies could focus on intensifying interventions for high-risk patients and exploring the impact of early nutritional support on treatment tolerance and long-term outcomes.

The study's main limitation is the absence of a control group, hindering direct comparison of the intervention's impact. The inclusion of a diverse cancer population complicates result comparison with previous studies that often focus on specific tumor types. The relatively short follow-up period might not fully capture long-term nutritional effects.