on November 02, 2026
Nutrition is part of the cancer care pathway
When discussing oncology, attention is naturally focused on diagnosis and cancer therapies. However, there is another dimension that accompanies the entire journey: the person's nutritional status.
Cancer and its treatments can affect appetite, metabolism, the ability to eat, body composition, and energy and protein requirements. Surgery, chemotherapy, radiotherapy, and immunotherapy can also cause symptoms that make it more difficult to eat adequately.
For this reason, nutritional assessment should not be considered an optional intervention or one reserved for the more advanced stages of the disease.
Italian ministerial guidelines provide for nutritional screening and assessment throughout the entire cancer care pathway, from diagnosis to treatment and follow-up, through a metabolic-nutritional pathway alongside the oncological one.
The starting material highlights precisely this need: to intervene early and not wait until malnutrition is already evident.
Malnutrition and cancer: a clinical problem to be identified early
Weight loss in a person with cancer should not automatically be interpreted as an inevitable consequence of the disease.
Instead, it may represent a sign that needs to be assessed.
Reduced food intake, systemic inflammation, metabolic alterations, and loss of muscle mass can contribute to the development of malnutrition and cachexia, conditions that can impair the person's functional status.
ESPEN guidelines therefore recommend regular screening for nutritional risk in cancer patients and state that nutritional therapy should be started early, before malnutrition becomes severe.
However, body weight alone is not sufficient.
A person can lose a significant amount of muscle mass even when their overall weight changes little. For this reason, modern assessment must also consider, when appropriate, body composition, muscle mass, function, food intake, and clinical progress.
Before therapy, during therapy, after therapy
Cancer nutrition is not a static intervention.
Needs change depending on the stage of the journey.
Before surgery, the goal may be to identify and correct a condition of malnutrition or nutritional risk.
During surgery and in the period following it, the focus is on recovery, energy and protein intake, and the preservation of muscle mass.
During chemotherapy and radiotherapy, the main problem may be maintaining a sufficiently tolerable diet despite nausea, taste alterations, mucositis, diarrhea, dysphagia, pain, or fatigue.
The starting material highlights precisely these side effects as possible factors that contribute to reduced food intake and malnutrition.
During follow-up, however, the pathway changes again: the goal becomes consolidating a balanced diet, maintaining an adequate nutritional status, and supporting the person in the phase following treatment.
The Italian Ministry of Health emphasizes the need for a personalized nutritional program associated with cancer treatment from the first point of access to services and continued throughout the different stages of the journey.
The first intervention is often the simplest: nutritional counseling
When a person is still able to eat orally, nutritional intervention should, whenever possible, start with a simple and sustainable strategy.
This does not mean prescribing a rigid diet.
It means understanding how much the person actually eats, what they are able to tolerate, which symptoms interfere with eating, and which foods can be used to increase energy and protein intake.
ESPEN guidelines identify nutritional counseling as the first level of intervention in patients who can eat but have malnutrition or are at risk of developing it. If diet and counseling are not sufficient, oral nutritional supplements can be used; when oral intake remains inadequate, enteral or parenteral nutrition may be considered, depending on the clinical situation.
It is therefore wrong to think that cancer nutrition necessarily means resorting to nutritional products or artificial nutrition.
These are tools in a progressive strategy, to be used only when truly necessary.
Protein and muscle mass: a central goal
One of the most important aspects of cancer nutrition concerns the maintenance of muscle mass.
Muscle loss can accompany cancer and contribute to reduced strength and functional capacity. For this reason, protein intake must be assessed individually, especially in patients at risk of malnutrition or undergoing demanding treatments.
ESPEN guidelines generally recommend a protein intake of at least 1 g/kg of body weight per day, with the possibility of increasing it to approximately 1.5 g/kg when clinically appropriate.
However, this does not mean that a "high-protein" diet is automatically suitable for every patient.
Renal function, age, body composition, type of cancer, nutritional status, physical activity, and ongoing treatment must be considered when defining individual requirements.
Physical exercise, when possible and appropriately prescribed, is also part of the strategy to counteract muscle mass loss. International guidelines therefore consider nutrition and exercise complementary elements of cancer nutritional management.
When the effects of therapy make eating difficult
One of the characteristics of cancer nutrition is the need to address the symptoms that prevent eating.
A person with mucositis may not be able to tolerate foods they previously ate normally.
A person with dysphagia may have difficulty swallowing.
Taste and smell alterations can make some foods unappealing.
Nausea and vomiting can drastically reduce intake.
Diarrhea and other gastrointestinal disorders can further affect food choices and tolerability.
In these cases, simply providing a standard menu is not enough.
The cause of the eating difficulty must be addressed, and the consistency, quantity, meal frequency, energy density, and composition of the diet must be adapted to the specific situation.
This is why cancer nutritional counseling is, first and foremost, a personalized clinical intervention.
There is no universal anti-cancer diet
The growing focus on cancer nutrition has also created an opposite problem: the spread of extremely restrictive dietary protocols presented as tools to "starve the cancer" or enhance therapies.
This is an area that requires particular caution.
ESPEN guidelines emphasize that there are no diets proven in a reproducible way to cure cancer or prevent recurrence, and recommend avoiding regimens lacking a solid scientific basis that could increase the risk of energy, protein, or micronutrient deficiencies.
This is particularly important for patients who are already losing weight.
A highly restrictive diet, even if based on foods considered "healthy," can become counterproductive if it leads to a reduction in calorie and protein intake precisely when the body needs them most.
The quality of nutrition matters, but it must be compatible with the clinical condition
In conditions of nutritional stability, a greater presence of plant-based foods, whole grains, legumes, fruit, and vegetables, and a reduction in ultra-processed foods represent principles consistent with an overall healthy diet.
But a cancer patient is not a healthy person to whom a preventive diet can simply be applied.
This is a fundamental point.
If a person has anorexia, weight loss, and malnutrition, the priority cannot be to impose dietary restrictions.
First, energy, protein, hydration, and adequate tolerability must be ensured, and only then should the overall quality of the diet be addressed according to the clinical conditions.
The pathway described in the starting material emphasizes precisely the need to avoid extremely selective approaches in malnourished patients or those at high risk of malnutrition.
The microbiota enters the new cancer nutrition
Cancer nutrition is becoming increasingly complex because research is deepening the understanding of the relationship between diet, the gut microbiota, metabolism, and response to therapies.
The Ministry of Health document explicitly mentions, among innovative approaches, the relationship between cancer therapy and the microbiome.
This does not mean that a "microbiota diet" already exists that can automatically improve treatment response.
Rather, it means that the gut and its microbial ecosystem represent an area of research in which diet, metabolism, and the body's response to therapies can interact.
This is a particularly interesting topic for a vision of Integrated Medicine, provided that personalization remains anchored to clinical assessment and available evidence.
The person before the diet
One of the most important issues that emerged from the starting material concerns the relationship between diet and the person.
Changing the way of eating does not simply mean providing a list of allowed and forbidden foods.
Diet is linked to family history, culture, habits, pleasure, social interaction, and often identity.
In oncology, all this takes on even greater weight.
The diagnosis can suddenly change the relationship with food: what previously represented pleasure can become a source of fear, while the desire to "do something" against the disease can lead to excessive food eliminations.
Counseling must therefore also consider the psychological dimension.
The material highlights the need to take care of the person and not just the pathology, involving the family in the nutritional journey when necessary.
Nutrition as part of care
The most modern approach no longer considers nutrition an intervention to be activated only when severe weight loss appears.
It considers it part of multidisciplinary care.
Oncologists, nutritionists, dietitians, nurses, physiotherapists, psychologists, and other professionals can contribute, according to the needs, to building a pathway in which the treatment of the neoplasm and the maintenance of the person's general condition proceed in parallel.
The Italian ministerial document identifies precisely an organizational model based on an integrated and personalized pathway, linked to the different levels of care.
It is a perspective particularly close to the philosophy of the Casa della Salute Moltitudo: considering the person in their complexity and not reducing them to a single diagnosis.
When nutrition is integrated with movement, sleep, stress management, the emotional dimension, and daily habits, it becomes part of a broader work on the body's ability to face a complex phase of its history.
The journey continues even after therapies
The term "end of therapy" does not necessarily coincide with the end of the nutritional journey.
Follow-up represents a phase in which to consolidate what has been learned, recover any deficits, and build sustainable eating habits.
For cancer survivors, international recommendations indicate the importance of regular physical activity and a prudent and balanced diet.
However, even here, there is no need to turn diet into a new source of anxiety.
The goal is to gradually build a more conscious relationship with food, compatible with real life.
A dietary pathway is not an unchangeable prescription
Cancer nutrition must be dynamic.
What is suitable today may not be in a month.
Nutritional requirements may change with treatment, weight, body composition, the onset of side effects, recovery after surgery, or the transition to follow-up.
For this reason, monitoring is an essential component of the journey.
It is not simply a matter of checking whether the patient "followed the diet".
It is about understanding whether the intervention is achieving the clinical goal: maintaining or restoring nutritional status, supporting physical function, ensuring adequate intake, and making eating compatible with the therapeutic phase.
The Moltitudo approach: personalize before restricting
From a Moltitudo perspective, cancer nutrition can be interpreted as a supportive and signaling medicine, always within the scope of clinical nutrition and without replacing cancer therapies.
The starting point should not be: "What diet should a cancer patient follow?"
The more appropriate question is:
"What does this person need at this stage of their clinical journey?"
They may need to regain weight.
They may need to preserve muscle mass.
They may need to increase protein intake.
They may need to make eating tolerable when it is compromised by therapy.
They may need to manage a gastrointestinal disorder.
Or, during the follow-up phase, they may need to turn the experience of illness into an opportunity to build a more balanced and sustainable eating style.
Personalization arises precisely from these differences.
And this is the difference between a simple "anti-cancer diet" and a cancer clinical nutrition journey.
PLEASE NOTE
This article is for informational and educational purposes only and does not constitute medical advice, nor does it replace the diagnosis, prescriptions, or recommendations of an oncologist, nutritionist, dietitian, or other healthcare professional.
In cancer patients, nutrition must be personalized based on the disease, therapy, nutritional status, body composition, symptoms, and individual clinical conditions.
Highly restrictive diets, prolonged fasting, or the indiscriminate elimination of entire food groups may be inappropriate and, in malnourished patients or those at risk of malnutrition, potentially harmful.
No food, supplement, or dietary plan replaces prescribed cancer therapies. Any supplements must be evaluated with a doctor, also in relation to possible interactions with pharmacological treatments.
Bibliography
1. Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition. 2021;40:2898-2913.
2. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017;36:11-48.
3. Italian Ministry of Health. Guidelines on nutritional pathways in cancer patients. 2017, with subsequent updates and guidance on the cancer nutritional pathway.
4.
de van der Schueren MAE, Laviano A, Blanchard H, et al. Systematic review and meta-analysis of nutritional interventions in cancer patients. Reference literature for the evaluation of nutritional interventions and the maintenance of nutritional status.
5. High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study. Clinical Nutrition. A multicenter randomized study that evaluated the usefulness of high-protein oral supplements during anticancer treatment.
6. Prado CM, Purcell SA, Alish C, et al. Nutrition interventions to treat low muscle mass in cancer. Current Opinion in Clinical Nutrition and Metabolic Care. 2020.
