Oncology Nurses Are the ‘Frontlines to Nutritional Deficiencies’

Nurses are on the forefront of identifying cancer-related malnutrition.

Patients with cancer tend to spend more time with their oncology nurses than anyone else on their health care team, putting them in the position to identify and intervene if patients are experiencing cancer-related malnutrition, explained Manda DiRubbo, BSN, BA, RN.

DiRubbo, a research nurse clinician at the Rutgers Cancer Institute of New Jersey, and her colleague, Aggie Wong, MA, BSN RN, OCN, an infusion nurse from Rutgers, recently sat down with Oncology Nursing News to discuss malnutrition in patients with cancer—and the important role oncology nurses play in addressing this issue.

Malnutrition Has Clinical and Quality-of-Life Implications

“We [as oncology nurses] end up establishing good rapports with our patients, and we’re basically the frontlines to nutritional deficiencies,” DiRubbo said. “So assessing nutritional needs from the get go is really important.”

Malnutrition can impact quality of life and outcomes for patients with cancer. In fact, a 2023 study found that severe malnutrition was a risk factor for death within 30 days of elective surgery for gastrointestinal cancers.¹

READ MORE: Dispelling Nutrition Myths for Patients With Cancer

“Research showed that more than 50% of the patients before they start their treatment journey, already have malnutrition²” Wong said. “Sometimes [patients will] need to stop treatment because they’re severely malnourished … When they’re malnourished, that’s going to affect their wound healing, their treatment outcomes, … [and] their strength.”

Nurse Recognition and Intervention of Cancer-Related Malnutrition

DiRubbo mentioned that nutrition assessments must go beyond simply asking the patient if he or she is eating enough. Nurses should look at weight changes and ask patients if they are experiencing any appetite or taste changes. Involving caregivers in the conversation can be beneficial, too, as they may offer insight as to how much a patient is eating, Wong said.

Other lab work or symptoms that may point toward malnutrition, according to DiRubbo, include:

• Change in muscle mass
• Change in energy
• Decrease in albumin levels
• Skin changes

Nurses may be able to offer practical solutions, such as utilizing protein shakes or high-calorie snacks for someone who is experiencing weight loss.

Comorbidities and patient preference must be considered as well. For example, DiRubbo mentioned that if a patient has diabetes, the oncology nurse should ensure that the protein drink they are using is not high in sugar. Or, if they have aversions to milk-based or creamy drinks, finding a clear alternative may be the solution, she said.

“I recently found a clear protein drink that has 20 grams of protein and zero sugars, so it’s ideal for a patient who is diabetic and cannot tolerate milk-like substances,” DiRubbo said. “It’s really all about finding practical solutions.”

Coordinate With the Nutrition Team

Additionally, oncology nurses can—and should—refer patients to nutritionists or dieticians, when necessary, DiRubbo and Wong said.

“We know the resources [available]. We have to ask the doctor for a referral for the nutritionist, call the nutritionists and then give them the background [on the patient] … and the different regimens they had,” Wong said.

“Overall, we have to remember that 1 size doesn’t fit all when it comes to nutrition, so we really need to think about individualized nutrition plans so that each patient is being treated like their own, individual person,” DiRubbo said.

References

1. Riad AM, Knight SR, Ghosh D, et. al. Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study. Lancet Glob Health 2023; 11: e341–49
2. Muscaritoli M, Lucia S. Farcomeni A, et. al. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget. 2017 Oct 3. doi: 10.18632/oncotarget.20168