Some 36% of cancer patients experienced unintentional weight loss during their treatment, yet one-third of these were never seen by a dietitian or provided with any nutritional support, a new survey has revealed.

The survey of over 1,000 patients undergoing cancer treatment was conducted by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN) in collaboration with University College Cork (UCC).

According to IrSPEN, the findings suggest a major gap in cancer care that needs to be urgently addressed. It pointed out that poor nutritional intake and weight loss in cancer patients is linked with a higher risk of complications, a poorer response to treatments such as chemotherapy, and even reduced survival rates.

"Because many cancer patients struggle to maintain weight, early nutritional care, advice and support aimed at preventing weight loss and preserving muscle is vital to cancer care.

"This as a critical concern and we are calling on all healthcare professionals working with cancer patients to pay greater attention to nutritional problems, such as loss of appetite. Even modest weight loss increases the risk of treatment side-effects and poorer outcomes," explained IrSPEN director, Niamh Rice.

She said that addressing the shortage of dietitians specialising in cancer care ‘is a clear starting point'.

Dietitians are the only qualified healthcare professionals that assess, diagnose and treat dietary and nutritional problems. Their advice is based on current scientific evidence.

"There are just 33 whole time equivalent dietitians allocated to cancer patients nationally and three clinical specialist dietitians in the country. This is significantly short of what is required," Ms Rice noted.

The survey found that 45% of cancer patients had experienced significant nutritional and eating problems.

However, while 87% said that nutritional support and advice was ‘very important' or ‘extremely important' to them, just 39% had been seen by a dietitian at some point. Many with serious nutritional problems had not.

Furthermore, despite the high prevalence of appetite loss, weight loss and other nutrition-related problems, over 60% of patients said they were not asked about diet by their medical team.

"The survey results point to major gaps between patients' needs for nutritional information, advice, support and care and that which was actually provided, within and outside designated cancer centres in Ireland.

"Cancer patients have the highest rate and severity of malnutrition of any patient group, yet even those with evident serious nutritional problems are frequently not receiving the right information, advice or support at the right time," commented IrSPEN president, Prof John Reynolds.

He pointed out that nutritional problems can ‘limit the effectiveness of even the best therapies'.

This marks the first time this type of research has been carried out in Ireland, and it is one of the largest studies of its kind in Europe relative to the number of cancer patients nationally. As well as the survey, in-depth interviews with patients were also conducted.

According to Dr Aoife Ryan, who led the research team in UCC, 52% of patients reported muscle loss.

"Muscle loss among cancer patients is linked with poorer response to treatment and a poorer survival outlook. Failure to address nutritional deterioration puts the patient at risk of poor tolerance to chemotherapy, increased complications in surgery and increased need for hospital inpatient care.

"Apart from undermining the effectiveness of expensive therapies, it increases healthcare costs. This doesn't make any sense, since the costs of providing good nutritional care are very modest in comparison," she pointed out.

She added that continued weight loss is linked with poorer survival and for patients in whom a cure is no longer possible, 'delays in providing nutrition support impacts quality of life and survival time'.

Responding to the findings, the CEO of the Irish Cancer Society, Averil Power, expressed her concern.

"This research shows that patients need clearer, more accessible information on diet and cancer. Without this, their health is being put at risk. The Irish Cancer Society encourages patients to seek credible information from registered dietitians, to use the website www.cancer.ie, call the National Cancer Nurseline 1800 200 700 or call into one of our 13 Daffodil Centres to get information they can rely on," she commented.

The results of the survey were released at an IrSPEN policy seminar and conference in Dublin, where a number of recommendations were made. These included:
-Investment in dietetic services for cancer patients, with the immediate appointment of 10 specialist dietitians
-Nutrition screening should take place at all points where care is delivered, including daycare and outpatients chemotherapy and radiotherapy services
-Nutrition education and training should be provided to oncologists and other oncology medical staff.