OBJECTIVES: Malnutrition (MN) in cancer patients is associated with poorer clinical outcomes. Here we demonstrate benefits of timely nutritional therapy based on amalgamated real-world data that informs treatment optimization.

METHODS: We analyzed data from three observational, retrospective studies that used administrative healthcare data to investigate diagnosis of malnutrition and use of nutritional therapy in cancer patients in France (N=644,720), Italy (N=58,468) and Germany (N=4,642) to highlight the clinical benefits of clinical nutrition in oncology. Methods included descriptive statistic, propensity score matched analysis to compare length and frequency of hospitalizations in France in patients with early, late, and no MN diagnosis during hospitalization, and Kaplan-Meier survival analysis.

RESULTS: Despite ESPEN recommendations for routine screening, MN diagnoses rates are much lower than anticipated based on literature indicating rates of 40-60% (10% at first hospitalization in France). Nutritional therapy remains under-utilized (i.e. in only 50% of patients with cachexia in Germany) even if clearly indicated. Data from Italy and Germany shows that nutritional therapy is often initiated as an end-of-life measure 3 to 4 months before death. Results from France indicate that early MN diagnosis (i.e. at first, compared to after first cancer hospitalization) is associated with a ~45% lower frequency of cancer hospitalizations and a reduced length-of-stay (-25%) during follow-up. Data from Italy indicates a survival advantage of over 3 months among patients with and without metastatic disease, whose malnutrition was diagnosed and treated early.

CONCLUSIONS: Our analyses indicate that MN diagnosis and use of nutritional therapy remains low and sub-optimal. Our results, notwithstanding limitations of administrative retrospective data, provide indication that early use of clinical nutrition may help to improve patients’ outcomes and optimize use of health care resources. Improving malnutrition diagnosis and generating evidence to confirm benefits of clinical nutrition using detailed clinical data are immediate priorities in oncology.