Nutritional Therapy as A Cancer Management Adjunct: A Systematic Review

Abstract

Background: Cancer-related malnutrition is a common issue that can seriously affect treatment outcomes. While clinical guidelines suggest that regular nutritional assessments and interventions should be part of cancer care, there's still some uncertainty about how much these measures help and their effects on survival rates. This systematic review investigated the effectiveness of nutritional therapy when used alongside cancer treatment. Methods: A systematic review was carried out in line with the PRISMA 2020 guidelines, searching through electronic databases and grey literature sources. The studies focused on adults diagnosed with any type of cancer who were receiving structured nutritional interventions. These interventions encompassed enteral nutrition, parenteral nutrition, immunonutrition, micronutrient supplementation, or specialized diets. The comparisons were made against standard care or other nutritional strategies. The primary outcomes were indicators of nutritional status and how patients tolerated treatment, while secondary outcomes included postoperative results, quality of life, and survival rates. The risk of bias was assessed using established methodological appraisal tools. Results: Out of 1,258 records, 55 studies were selected. The findings on nutritional therapy showed consistent improvement in weight stabilization, better nutritional assessment scores, and the preservation of lean body mass. There were evidence of fewer interruptions in chemotherapy, better adherence to treatment, and a drop in severe treatment-related side effects. Strong randomized evidence pointed to fewer postoperative infections and complications, while moderate evidence suggested shorter hospital stays and enhanced wound healing. Conclusion: Nutritional therapy offers a range of benefits for cancer care, especially when it comes to enhancing nutritional status, improving treatment tolerance, aiding postoperative recovery, and boosting overall quality of life. There is correlation between nutritional therapy and cancer care improvement that suggests its incorporation in cancer care unit, thereby positively influencing therapeutic care of oncology cases. However, large-scale, standardized randomized trials with longer follow-up periods suggest further studies.

Keywords:

Nutrition, Therapy, Cancer management, Oncology

References

Akhimien, P., Adeniji, F., and Anyiam, F. E. (2019). Assessment of the nutrition-related cancer prevention knowledge among undergraduate students in University of Port Harcourt, Rivers Nigeria. International Research Journal of Oncology, 2(2), 119–130.

Akhimien, P., Adeniji, F., and Anyiam, F. E. (2019). Nutrition-related cancer prevention and dietary practices: A cross-sectional assessment among Nigerian tertiary students. International Research Journal of Oncology, 2(2), 119-130.

Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., ... Preiser, J. C. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11–48.

Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Fearon, K., Hütterer, E., Isenring, E., Kaasa, S., Krznarić, Ž., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Muscaritoli, M., Oldervoll, L., Ravasco, P., Solheim, T., Strasser, F., de van der Schueren, M., and Preiser, J. C. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11–48. https://doi.org/10.1016/j.clnu.2016.07.015

Arends, J., Baracos, V., Bertz, H., Bozzetti, F., Calder, P. C., Deutz, N. E. P., ... Preiser, J. C. (2017). ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical Nutrition, 36(5), 1187–1196.

Argilés, J. M., Busquets, S., Stemmler, B., and López-Soriano, F. J. (2014). Cancer cachexia: Understanding the molecular basis. Nature Reviews Cancer, 14(11), 754–762.

Argilés, J. M., Busquets, S., Stemmler, B., and López-Soriano, F. J. (2014). Cancer cachexia: Understanding the molecular basis. Nature Reviews Cancer, 14(11), 754–762. https://doi.org/10.1038/nrc3829

Augenlicht, L. H., Anthony, G. M., Church, T. L., et al. (1999). Dietary composition influences tumor growth in experimental models. Proceedings of the National Academy of Sciences, 96(14), 7913–7918.

Baldwin, C., Spiro, A., Ahern, R., and Emery, P. W. (2012). Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis. Journal of the National Cancer Institute, 104(5), 371–385.

Baldwin, C., Spiro, A., Ahern, R., and Emery, P. W. (2012). Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis. Journal of the National Cancer Institute, 104(5), 371–385. https://doi.org/10.1093/jnci/djr556

Baldwin, C., Spiro, A., McGough, C., Norman, A. R., Gillbanks, A., Thomas, K., ... Cunningham, D. (2011). Oral nutritional supplements in patients undergoing chemotherapy: A systematic review. Clinical Nutrition, 30(6), 791–797.

Béliveau R, Gingras D. Role of nutrition in preventing cancer. Can Fam Physician. 2007 Nov;53(11):1905-11. PMID: 18000267; PMCID: PMC2231485.

Cheng Q, Xie J, Duan Y, Li J, She Z, Lu W, Chen Y. The psychological distress of gastrointestinal cancer patients and its association with quality of life among different genders. Support Care Cancer. 2024 May 6;32(6):329. doi: 10.1007/s00520-024-08533-z. PMID: 38709308; PMCID: PMC11074025.

Donaldson MS. Nutrition and cancer: a review of the evidence for an anti-cancer diet. Nutr J. 2004 Oct 20;3:19. doi: 10.1186/1475-2891-3-19. PMID: 15496224; PMCID: PMC526387.

Drover, J. W., Dhaliwal, R., Weitzel, L., Wischmeyer, P. E., Ochoa, J. B., Heyland, D. K., and Canadian Clinical Practice Guidelines Committee. (2011). Perioperative use of arginine-supplemented diets: A systematic review of the evidence. Journal of the American College of Surgeons, 212(3), 385–399. https://doi.org/10.1016/j.jamcollsurg.2010.10.016.

Fearon, K., Strasser, F., Anker, S. D., Bosaeus, I., Bruera, E., Fainsinger, R. L., ... Baracos, V. E. (2011). Definition and classification of cancer cachexia: An international consensus. The Lancet Oncology, 12(5), 489–495.

Fearon, K., Strasser, F., Anker, S. D., Bosaeus, I., Bruera, E., Fainsinger, R. L., Jatoi, A., Loprinzi, C., MacDonald, N., Mantovani, G., Davis, M., Muscaritoli, M., Ottery, F., Radbruch, L., Ravasco, P., Walsh, D., Wilcock, A., Kaasa, S., and Baracos, V. E. (2011). Definition and classification of cancer cachexia: An international consensus. The Lancet Oncology, 12(5), 489–495. https://doi.org/10.1016/S1470-2045(10)70218-7

Folasire, O. F., Folasire, A. M., & Chikezie, S. (2016). Nutrition-related cancer prevention knowledge of undergraduate students at the University of Ibadan, Nigeria. South African Journal of Clinical Nutrition, 29(4), 165–171. https://doi.org/10.1080/16070658.2016.1217648 .

Gupta, D., and Lis, C. G. (2010). Pretreatment serum albumin as a predictor of cancer survival: A systematic review. Nutrition Journal, 9, 69.

Gupta, D., Lis, C. G., Pretreatment serum albumin as a predictor of cancer survival: A systematic review. Nutrition Journal, 9, 69. https://doi.org/10.1186/1475-2891-9-69

Hébuterne, X., Lemarié, E., Michallet, M., de Montreuil, C. B., Schneider, S. M., and Goldwasser, F. (2014). Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN Journal of Parenteral and Enteral Nutrition, 38(2), 196–204.

Izuegbuna, O. O., Sodiq, T., Olawumi, H. O., Olatoke, S. A., and Agodirin, O. (2023). Body composition, energy expenditure and caloric intake among breast cancer patients at a teaching hospital in Nigeria: A cross-sectional study. ecancer, 17, 1600.

Khajoueinejad, N., Santiago, C., Turner, K., & Pimiento, J. M. (2025). Nutritional Support for Gastrointestinal Cancer Patients: New (and Old) Frontiers in Management, a Narrative Review. Nutrients, 17(24), 3917. https://doi.org/10.3390/nu17243917.

Klement, R. J., and Champ, C. E. (2014). Calories, carbohydrates, and cancer therapy with radiation: Exploiting the five R’s through dietary manipulation. European Journal of Clinical Nutrition, 68(4), 409–414. https://doi.org/10.1038/ejcn.2014.16

Langius, J. A. E., Zandbergen, M. C., Eerenstein, S. E. J., van Tulder, M. W., Leemans, C. R., Kramer, M. H. H., and Weijs, P. J. M. (2013). Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: A systematic review. Clinical Nutrition, 32(5), 671–678. https://doi.org/10.1016/j.clnu.2013.06.012

Laviano, A., Di Lazzaro, L., and Koverech, A. (2018). Nutrition support and clinical outcome in advanced cancer patients. Proceedings of the Nutrition Society, 77(4), 388–393.

Lis, C. G., Gupta, D., Lammersfeld, C. A., Markman, M., and Vashi, P. G. (2012). Role of nutritional status in predicting quality of life outcomes in cancer. Supportive Care in Cancer, 20(8), 1861–1869.

Miller, K. D., Nogueira, L., Devasia, T., Mariotto, A. B., Yabroff, K. R., Jemal, A., ... Siegel, R. L. (2022). Cancer treatment and survivorship statistics, 2022. CA: A Cancer Journal for Clinicians, 72(5), 409–436.

Murphy, R. A., Mourtzakis, M., Chu, Q. S. C., Reiman, T., Mazurak, V. C., and Baracos, V. E. (2011). Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer. Cancer, 117(16), 3774–3780. https://doi.org/10.1002/cncr.25933.

Muscaritoli, M., Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Hütterer, E., Isenring, E., Kaasa, S., Krznarić, Ž., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Oldervoll, L., Ravasco, P., Solheim, T., Strasser, F., and de van der Schueren, M. (2021). ESPEN practical guideline: Clinical nutrition in cancer. Clinical Nutrition, 40(5), 2898–2913. https://doi.org/10.1016/j.clnu.2021.02.005.

Oladeji, A. A., Folasire, A. M., and Folasire, O. F. (2025). Nutritional status and quality of life in head and neck cancer patients: Insights from a Nigerian study. Journal of Community Medicine and Public Health Reports, 6(03).

Planas, M., Álvarez-Hernández, J., León-Sanz, M., Celaya-Pérez, S., Araujo, K., and García de Lorenzo, A. (2016). Prevalence of hospital malnutrition in cancer patients: A sub-analysis of the PREDyCES study. Supportive Care in Cancer, 24(1), 429–435.

Pontillo, M., Trio, R., Rocco, N., Cinquerrui, A., Di Lorenzo, M., Catanuto, G., Magnoni, F., Calenda, F., Castiello, C. L. J., Ingenito, M., Margherita, A. L., Velotti, N., & Musella, M. (2025). Dietary Interventions for Breast Cancer Prevention: Exploring the Role of Nutrition in Primary and Tertiary Prevention Strategies. Healthcare, 13(4), 407. https://doi.org/10.3390/healthcare13040407.

Prado, C. M. M., Lieffers, J. R., McCargar, L. J., Reiman, T., Sawyer, M. B., Martin, L., and Baracos, V. E. (2008). Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: A population-based study. The Lancet Oncology, 9(7), 629–635. https://doi.org/10.1016/S1470-2045(08)70153-0.

Prado, C. M., Purcell, S. A., and Laviano, A. (2020). Nutrition interventions to treat low muscle mass in cancer. Journal of Clinical Oncology, 38(28), 3276–3286.

Puckett M, Neri A, Underwood JM, Stewart SL. Nutrition and Physical Activity Strategies for Cancer Prevention in Current National Comprehensive Cancer Control Program Plans. J Community Health. 2016 Oct;41(5):1013-20. doi: 10.1007/s10900-016-0184-8. PMID: 26994988; PMCID: PMC5011446.

Ravasco, P., Monteiro-Grillo, I., Vidal, P. M., and Camilo, M. E. (2005). Dietary counseling improves patient outcomes: A prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Journal of Clinical Oncology, 23(7), 1431–1438.

Ravasco, P., Monteiro-Grillo, I., Vidal, P. M., and Camilo, M. E. (2005). Dietary counseling improves patient outcomes: A prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Journal of Clinical Oncology, 23(7), 1431–1438. https://doi.org/10.1200/JCO.2005.02.054.

Ross, P. J., Ashley, S., Norton, A., Priest, K., Waters, J. S., Eisen, T., ... O’Brien, M. E. R. (2004). Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? British Journal of Cancer, 90(10), 1905–1911.

Saheed, E. S. (2024). Anticancer potentials of bioactive compounds in some locally available spices in Nigeria. Discover Plants, 1, 49.

Sasanfar B, Toorang F, Nemati S, Djazayery A, Zendehdel K. Development and validation of a knowledge, attitude, and practice questionnaire on nutrition-related cancer prevention for Iranian women. J Res Med Sci. 2019 Oct 25;24:87. doi: 10.4103/jrms.JRMS_777_18. PMID: 31741659; PMCID: PMC6856541.

Sasanfar B, Toorang F, Rostami S, Yeganeh MZ, Ghazi ML, Seyyedsalehi MS, Zendehdel K. The effect of nutrition education for cancer prevention based on health belief model on nutrition knowledge, attitude, and practice of Iranian women. BMC Womens Health. 2022 Jun 7;22(1):213. doi: 10.1186/s12905-022-01802-1. PMID: 35672814; PMCID: PMC9175379.

Shachar, S. S., Williams, G. R., Muss, H. B., and Nishijima, T. F. (2016). Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis. European Journal of Cancer, 57, 58–67.

Shachar, S. S., Williams, G. R., Muss, H. B., and Nishijima, T. F. (2016). Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. European Journal of Cancer, 57, 58–67. https://doi.org/10.1016/j.ejca.2015.12.030.

Siddiqui Muhammad Tayyab H, Khan Muhammad Rizwan, Jawaid Adnan, Shaukat Fatima, Zahid Nida (2023) Evaluation of quality of life of gastrointestinal cancer patients presenting to a tertiary care hospital in Pakistan ecancer 17 1527.

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., and Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide. CA: A Cancer Journal for Clinicians, 71(3), 209–249.

Vay Liang W. Go, Debra A. Wong, Ritva Butrum, Diet, Nutrition and Cancer Prevention: Where Are We Going from Here?,The Journal of Nutrition, Volume 131, Issue 11, 2001, Pages 3121S-3126S, ISSN 0022-3166, https://doi.org/10.1093/jn/131.11.3121S.

Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., Laviano, A., Ljungqvist, O., Lobo, D. N., Martindale, R., Waitzberg, D., Bischoff, S. C., and Singer, P. (2017). ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 36(3), 623–650. https://doi.org/10.1016/j.clnu.2017.02.013

Yee, L. D., Young, D. C., Rosol, T. J., et al. (2013). Omega-3 fatty acid consumption and breast tissue composition in women. Journal of Clinical Oncology, 31(24), 3069–3076.