{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:06:19Z","timestamp":1790885179101,"version":"4.1.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p>Malnutrition is common in cancer patients and can occur throughout a patient\u2019s disease course. The contributors to the clinical syndrome of cancer cachexia are often multifactorial, and produced by the cancer and associated pro-inflammatory response. Since cancer cachexia is a multifactorial syndrome, a multimodal therapeutic approach is ideal. A key component of therapy is identifying and managing symptom barriers to adequate oral intake, known as nutritional impact symptoms (NIS). NIS are associated with reduced intake and weight loss in patients with advanced cancer, and aggregate NIS are a predictor of survival in patients with Head and Neck Cancer and in patients undergoing surgery for esophageal cancer. Currently, there are no guidelines regarding the specific management of NIS in oncology patients. Experience from specialist centers suggest relatively simple assessments and inexpensive interventions are available for the diagnosis and treatment of NIS. We present three patient cases from a cachexia clinic, where NIS management decreased symptom burden and improved clinical outcomes such as weight and physical performance.<\/jats:p>","DOI":"10.3389\/fnut.2022.831934","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T05:21:43Z","timestamp":1646284903000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":33,"title":["Managing Nutrition Impact Symptoms in Cancer Cachexia: A Case Series and Mini Review"],"prefix":"10.3389","volume":"9","author":[{"given":"Adam","family":"Khorasanchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinidhi","family":"Nemani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudeep","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egidio","family":"Del Fabbro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: an international consensus.","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.clnu.2016.09.004","article-title":"ESPEN guidelines on definitions and terminology of clinical nutrition.","volume":"36","author":"Cederholm","year":"2017","journal-title":"Clin Nutr."},{"key":"B3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.critrevonc.2019.08.006","article-title":"Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members.","volume":"143","author":"Amano","year":"2019","journal-title":"Crit Rev Oncol Hematol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s13539-012-0099-x","article-title":"Nutrition impact symptoms in advanced cancer patients: frequency and specific interventions, a case-control study.","volume":"4","author":"Omlin","year":"2013","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0241305","article-title":"Malnutrition and nutrition impact symptoms (NIS) in surgical patients with cancer.","volume":"15","author":"Viana","year":"2020","journal-title":"PLoS One."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2438","DOI":"10.1200\/JCO.20.00611","article-title":"Management of cancer cachexia: ASCO guideline.","volume":"38","author":"Roeland","year":"2020","journal-title":"J Clin Oncol."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2021.100092","article-title":"ESMO guidelines committee. Electronic address: clinicalguidelines@esmo.org Cancer cachexia in adult patients: ESMO clinical practice guidelines?.","volume":"6","author":"Arends","year":"2021","journal-title":"ESMO Open."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: clinical Nutrition in cancer.","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin Nutr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1136\/bmjspcare-2017-001382","article-title":"A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life.","volume":"7","author":"Parmar","year":"2017","journal-title":"BMJ Support Palliat Care."},{"key":"B10","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s00520-008-0472-7","article-title":"The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients.","volume":"17","author":"Tong","year":"2009","journal-title":"Support Care Cancer."},{"key":"B11","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1111\/1747-0080.12631","article-title":"Clinical Oncology Society of Australia: position statement on cancer-related malnutrition and sarcopenia.","volume":"77","author":"Kiss","year":"2020","journal-title":"Nutr Diet."},{"key":"B12","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1002\/jcsm.12490","article-title":"Defining barriers to implementation of nutritional advice in patients with cachexia.","volume":"11","author":"Nasrah","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/nu13103349","article-title":"On behalf of the nourish point prevalence study group. assessment of nutritional status and nutrition impact symptoms in patients undergoing resection for upper gastrointestinal cancer: results from the multi-centre NOURISH point prevalence study.","volume":"13","author":"Deftereos","year":"2021","journal-title":"Nutrients."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.56.1894","article-title":"Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015 Jan 1;33(1):90-9.","volume":"33","author":"Martin","year":"2015","journal-title":"Erratum J Clin Oncol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1089\/jpm.2011.0098","article-title":"Clinical outcomes and contributors to weight loss in a cancer cachexia clinic.","volume":"14","author":"Del Fabbro","year":"2011","journal-title":"J Palliat Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/j.jpainsymman.2016.10.370","article-title":"The edmonton symptom assessment system 25 years later: past, present, and future developments.","volume":"53","author":"Hui","year":"2017","journal-title":"J Pain Symptom Manage."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3390\/nu12082287","article-title":"Malnutrition screening and assessment in the cancer care ambulatory setting: mortality predictability and validity of the patient-generated subjective global assessment short form (PG-SGA SF) and the GLIM criteria.","volume":"12","author":"De Groot","year":"2020","journal-title":"Nutrients."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e229","DOI":"10.14694\/EdBook_AM.2015.35.e229","article-title":"Current and future care of patients with the cancer anorexia-cachexia syndrome.","author":"Del Fabbro","year":"2015","journal-title":"Am Soc Clin Oncol Educ Book."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.1016\/j.clnu.2018.05.010","article-title":"Malnutrition associated with nutrition impact symptoms and localization of the disease: results of a multicentric research on oncological nutrition.","volume":"38","author":"de Pinho","year":"2019","journal-title":"Clin Nutr."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-021-02662-4","article-title":"Investigation on nutrition status and its clinical outcome of common cancers (INSCOC) group. PG-SGA SF in nutrition assessment and survival prediction for elderly patients with cancer.","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Geriatr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/01635581.2021.1910320","article-title":"Malnutrition and the survival of cervical cancer patients: a prospective cohort study using the PG-SGA tool.","volume":"24","author":"Argefa","year":"2021","journal-title":"Nutr Cancer."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.2251","article-title":"Validation of the scored patient-generated subjective global assessment short form as a prognostic tool for patients with incurable cancer.","author":"Cunha","year":"2021","journal-title":"JPEN J Parenter Enteral Nutr."},{"key":"B23","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.oraloncology.2014.06.009","article-title":"Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival.","volume":"50","author":"Farhangfar","year":"2014","journal-title":"Oral Oncol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1200\/JCO.2010.30.7173","article-title":"Trajectory of performance status and symptom scores for patients with cancer during the last six months of life.","volume":"29","author":"Seow","year":"2011","journal-title":"J Clin Oncol."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/cancers10090318","article-title":"Nutrition impact symptoms are prognostic of quality of life and mortality after surgery for oesophageal cancer.","volume":"10","author":"Anandavadivelan","year":"2018","journal-title":"Cancers."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1038\/sj.bmt.1704963","article-title":"Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay.","volume":"35","author":"Horsley","year":"2005","journal-title":"Bone Marrow Transplant."},{"key":"B27","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1080\/01635580903305276","article-title":"Nutritional status and information needs of medical oncology patients receiving treatment at an Australian public hospital.","volume":"62","author":"Isenring","year":"2010","journal-title":"Nutr Cancer."},{"key":"B28","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1002\/hed.22972","article-title":"Effect of an interdisciplinary rehabilitation program on quality of life in patients with head and neck cancer: review of clinical experience.","volume":"35","author":"Eades","year":"2013","journal-title":"Head Neck."},{"key":"B29","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1002\/cncr.32437","article-title":"High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: results of a Brazilian multicenter study.","volume":"126","author":"de Pinho","year":"2020","journal-title":"Cancer."},{"key":"B30","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1016\/S1470-2045(09)70200-1","article-title":"Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials.","volume":"10","author":"Quinten","year":"2009","journal-title":"Lancet Oncol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s00520-017-3821-6","article-title":"The value of physical performance measurements alongside assessment of sarcopenia in predicting receipt and completion of planned treatment in non-small cell lung cancer: an observational exploratory study.","volume":"26","author":"Collins","year":"2018","journal-title":"Support Care Cancer."},{"key":"B32","doi-asserted-by":"publisher","first-page":"4287","DOI":"10.1182\/blood-2012-12-471680","article-title":"Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia.","volume":"121","author":"Klepin","year":"2013","journal-title":"Blood."},{"key":"B33","doi-asserted-by":"publisher","first-page":"5623","DOI":"10.1007\/s00520-021-06171-3","article-title":"Physical function predicts mortality in patients with cancer: a systematic review and meta-analysis of observational studies.","volume":"29","author":"Nakano","year":"2021","journal-title":"Support Care Cancer."},{"key":"B34","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1002\/jcsm.12126","article-title":"Espindolol for the treatment and prevention of cachexia in patients with stage III\/IV non-small cell lung cancer or colorectal cancer: a randomized, double-blind, placebo-controlled, international multicentre phase II study (the ACT-ONE trial).","volume":"7","author":"Stewart Coats","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B35","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/S1470-2045(15)00558-6","article-title":"Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials.","volume":"17","author":"Temel","year":"2016","journal-title":"Lancet Oncol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"59","DOI":"10.21037\/apm.2018.08.05","article-title":"Combination therapy in cachexia.","volume":"8","author":"Del Fabbro","year":"2019","journal-title":"Ann Palliat Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/s11764-018-0687-7","article-title":"Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review.","volume":"12","author":"Crowder","year":"2018","journal-title":"J Cancer Surviv."},{"key":"B38","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1002\/hed.20221","article-title":"Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy.","volume":"27","author":"Ravasco","year":"2005","journal-title":"Head Neck."},{"key":"B39","doi-asserted-by":"publisher","first-page":"2997","DOI":"10.1007\/s00520-014-2304-2","article-title":"Intensive nutritional counseling improves PG-SGA scores and nutritional symptoms during and after radiotherapy in Korean cancer patients.","volume":"22","author":"Um","year":"2014","journal-title":"Support Care Cancer."},{"key":"B40","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/j.jpainsymman.2010.02.015","article-title":"The deliverability, acceptability, and perceived effect of the Macmillan approach to weight loss and eating difficulties: a phase II, cluster-randomized, exploratory trial of a psychosocial intervention for weight- and eating-related distress in people with advanced cancer.","volume":"40","author":"Hopkinson","year":"2010","journal-title":"J Pain Symptom Manage."},{"key":"B41","doi-asserted-by":"publisher","first-page":"653","DOI":"10.4103\/apjon.apjon-2141","article-title":"Development of a nurse-led educational intervention program in managing the nutrition impact symptom cluster in patients with nasopharyngeal carcinoma following the medical research council framework.","volume":"8","author":"Xiao","year":"2021","journal-title":"Asia Pac J Oncol Nurs."},{"key":"B42","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.avsg.2015.10.036","article-title":"Do medications commonly prescribed to patients with peripheral arterial disease have an effect on nutritional status? A review of the literature.","volume":"32","author":"Fenton","year":"2016","journal-title":"Ann Vasc Surg."},{"key":"B43","doi-asserted-by":"publisher","first-page":"e502","DOI":"10.1634\/theoncologist.2019-0085","article-title":"Polypharmacy, inappropriate medication use, and drug interactions in older korean patients with cancer receiving first-line palliative chemotherapy.","volume":"25","author":"Hong","year":"2020","journal-title":"Oncologist."},{"key":"B44","doi-asserted-by":"publisher","first-page":"8097","DOI":"10.1007\/s00520-021-06437-w","article-title":"MASCC antiemetics in advanced cancer updated guideline.","volume":"29","author":"Davis","year":"2021","journal-title":"Support Care Cancer."},{"key":"B45","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1056\/NEJMoa1515725","article-title":"Olanzapine for the prevention of chemotherapy-induced nausea and vomiting.","volume":"375","author":"Navari","year":"2016","journal-title":"N Engl J Med."},{"key":"B46","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1001\/jamaoncol.2020.1052","article-title":"Olanzapine for the treatment of advanced cancer-related chronic nausea and\/or vomiting: a randomized pilot trial.","volume":"6","author":"Navari","year":"2020","journal-title":"JAMA Oncol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/SPC.0000000000000300","article-title":"Practical approaches to managing cancer patients with weight loss.","volume":"11","author":"Del Fabbro","year":"2017","journal-title":"Curr Opin Support Palliat Care."},{"key":"B48","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1002\/jcsm.12292","article-title":"Megestrol acetate for cachexia-anorexia syndrome. A systematic review.","volume":"9","author":"Ruiz-Garc\u00eda","year":"2018","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1634\/theoncologist.2011-0151","article-title":"Preliminary report: vitamin D deficiency in advanced cancer patients with symptoms of fatigue or anorexia.","volume":"16","author":"Dev","year":"2011","journal-title":"Oncologist."},{"key":"B50","doi-asserted-by":"publisher","first-page":"1586","DOI":"10.1002\/cncr.28619","article-title":"Association between hypogonadism, symptom burden, and survival in male patients with advanced cancer.","volume":"120","author":"Dev","year":"2014","journal-title":"Cancer."},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-014-0378-0","article-title":"When and when not to use testosterone for palliation in cancer care.","volume":"16","author":"Dev","year":"2014","journal-title":"Curr Oncol Rep."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1007\/s00520-021-06532-y","article-title":"Relationship between malnutrition and the presence of symptoms of anxiety and depression in hospitalized cancer patients.","volume":"30","author":"S\u00e1nchez-Torralvo","year":"2022","journal-title":"Support Care Cancer."},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006528.pub2","article-title":"Mirtazapine versus other antidepressive agents for depression.","author":"Watanabe","year":"2011","journal-title":"Cochrane Database Syst Rev."},{"key":"B54","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1016\/j.jpainsymman.2021.05.017","article-title":"Mirtazapine in cancer-associated anorexia and cachexia: a double-blind placebo-controlled randomized trial.","volume":"62","author":"Hunter","year":"2021","journal-title":"J Pain Symptom Manage."},{"key":"B55","doi-asserted-by":"publisher","first-page":"915","DOI":"10.6004\/jnccn.2016.0094","article-title":"Cannabinoids for symptom management and cancer therapy: the evidence.","volume":"14","author":"Davis","year":"2016","journal-title":"J Natl Compr Canc Netw."},{"key":"B56","doi-asserted-by":"publisher","first-page":"310","DOI":"10.3747\/co.20.1612","article-title":"A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer.","volume":"20","author":"Gagnon","year":"2013","journal-title":"Curr Oncol."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2022.831934\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T05:21:45Z","timestamp":1646284905000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2022.831934\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,3]]},"references-count":56,"alternative-id":["10.3389\/fnut.2022.831934"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2022.831934","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,3]]},"article-number":"831934"}}