Nutrition

Malnutrition and nutritional difficulties are very common in patients with advanced cancer receiving palliative care. These patients often have cancer cachexia, a multifactorial syndrome in which there is loss of skeletal muscle mass, negative protein and energy balance, alterations involving carbohydrate, lipid and protein metabolism, and neuroinflammation. The early assessment of malnutrition is particularly important in patients undergoing palliative surgery. Nutritional status can be assessed by an objective method or by validated nutritional screening tools. These tools are easy to administer even by nonexpert personnel or by the patient themselves and should be used in every surgery department. Malnutrition worsens and increases postoperative complications, surgical risk factors, and mortality. Nutritional support must be prescribed as soon as possible to malnourished patients and patients at risk of malnutrition. The main goals of perioperative nutritional support are to minimize negative protein balance by avoiding starvation; to maintain muscle, immune, and cognitive functions; and to enhance postoperative recovery. Enteral feeding is the first choice route of nutrient administration although parenteral nutrition must be recommended in cases of intestinal failure. Immunonutrition improves surgical outcomes by reducing both infectious and noninfectious complications, as well as the time spent in hospital. Nutritional support therapy is rarely indicated in terminally ill cancer patients.