The integrating nutritional therapy in oncology (INTO) project: rationale, structure and preliminary results

Malnutrition is a frequent problem in patients with cancer, which leads to prolonged hospitalisation, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse prognosis. The attitude towards this issue varies considerably among oncologists, and many malnourished patients still receive inadequate nutritional support. This could be related to the insufficient awareness of nutritional problems among healthcare professionals and the lack of structured collaboration between oncologists and clinical nutritionists. Recently, the Italian Society of Medical Oncology (AIOM), the Italian Society of Artificial Nutrition and Metabolism (SINPE) and the Italian Federation of Volunteer-based Cancer Organisations (FAVO) have initiated a structured collaborative project named ‘integrating nutritional therapy in oncology (INTO)’, with the aim to increase the awareness of nutritional issues among oncologists and, consequently, improve the nutritional care of patients with cancer. A working group, composed of a panel of experts and representatives from AIOM, SINPE and FAVO listed in the online Supplementary file 1, was instituted with the assignment of elaborating and realising a series of initiatives. Initially, a national web-based exploratory survey was conducted to investigate the attitude of oncologists towards malnutrition and the management of nutritional support. The results showed that of the 2375 AIOM members, only 135 (5.7%) participated in the survey. This very low response rate confirmed the lack of awareness and consideration of nutritional issues among Italian oncologists. Then, an intersociety consensus document was published in order to provide suitable, concise and practical recommendations for the appropriate nutritional approach in patients with cancer. Education is a key issue to improve awareness and implement clinical practices. Accordingly, a series of courses focused on the nutritional care in oncology was planned around the country and a specific session on nutritional support was permanently introduced in the national AIOM congress. Two further surveys are currently ongoing: the first regard the modification of nutrition habits among patients with cancer during treatment and the other one is addressed to all the national oncology centres’ referees and aims at addressing the nutritional support management. Disinformation is a critical point with regard to nutrition for patients with cancer. Despite the lack of evidence-based data, hundreds of books and websites promote anticancer diets and nutritional supplements. Hence, the working group decided to plan a press campaign and a web-based communication strategy in order to provide patients with correct and verifiable information. Another key initiative has been the elaboration of a bill of rights of patients with cancer for appropriate and prompt nutritional support, which aims first at making patients with cancer aware of their rights with regard to nutritional care, then at sensitising the public opinion and the institutions on the problem of malnutrition in oncology. The bill of rights has been submitted to the European Cancer Patient Coalition for subsequent international promotion. Finally, the project implies the elaboration of multicentre trials investigating the role of nutritional support in different oncological settings, the new instrumental methods of nutritional assessment in patients with cancer and of standardised diagnostic-therapeutic protocols for the appropriate nutritional support management in different cancer types. The integrating nutritional therapy in oncology (INTO) project: rationale, structure and preliminary results