Background and aims: Despite the identification of malnutrition and administration of nutrition therapy being increasingly recognised as integral to the treatment of cancer patients, this is not always translated into routine clinical practice. The aim of this study was to determine medical oncologists’ awareness of, and ability to assess, nutritional status and when to initiate nutrition therapy, to identify their educational status concerning clinical nutrition and their perceived barriers to the routine use of nutrition therapy in their patients through a survey study. Methods: 155 medical oncologists were invited to complete a digital questionnaire. The questionnaire included information regarding the participants demographic and professional information, clinical nutrition education status, attitudes towards malnutrition and nutrition therapy, and barriers to using nutrition therapy. The questionnaire also included two case scenarios designed to assess ability to diagnose malnutrition/assess nutritional status and identify when nutrition therapy might be indicated. Results: Of 109 medical oncologists who agreed to participate, 43.1% declared that they received clinical nutrition education and 33.9% declared that they followed the oncology sections in the European Society of Clinical Nutrition and Metabolism (ESPEN) Guidelines. The medical oncologists were divided into two groups according to their knowledge score (31 medical oncologists with a knowledge score of <3 and 78 medical oncologists with a knowledge score of
۳). The rate of having nutrition education was significantly higher in those with a higher knowledge score (
۳) and the rate of medical oncologists having this education during medical and/or oncology education was also significantly higher. The rate of medical oncologists following the oncology sections in the ESPEN guidelines was higher in those with higher knowledge score. Conclusions: Our results emphasize the association between clinical nutrition education and higher knowledge scores in medical oncologists, but reveal a mis-match between knowledge and awareness and what happens in clinical practice. Nutrition therapy might be used more frequently in routine practice when medical oncologists’ lack of knowledge is resolved.

Introduction

Malnutrition and cachexia are common in oncology patients due to both the disease itself and the applied treatments. Both malnutrition and cachexia, which is a complex syndrome, are indicators of poor prognosis [1]. In addition to the effects of cancer, loss of appetite, nausea, vomiting, diarrhoea, loss of taste, dry mouth, mucositis, dysphagia, early satiety, malabsorption, and depression caused by surgery, chemotherapy, and radiotherapy lead patients to develop undernutrition. This is often accompanied by a catabolic state which further exacerbates a negative energy balance [2,3]. Weight loss is usually the presenting symptom of malnutrition in oncology patients [4e7] and has been reported in 30% to more than 80% of patients depending on the cancer type [1]. However, studies on body composition have revealed that skeletal muscle loss (with or without fat loss) in cancer-related malnutrition is a determinant of physical disability, postoperative complications, chemotherapy toxicity, and mortality risk [8]. In cancer patients, nutrition therapy aims to maintain or improve nutrient intake, mitigate metabolic derangements, maintain skeletal muscle mass and physical performance, reduce the risk of reductions or interruptions of scheduled anticancer treatments, and improve quality of life [8]. Therefore, the recognition of malnutrition and administration of nutrition therapy are integral parts of the treatment of cancer patients [9]. It has been reported that assessment of nutritional status in cancer patients should begin at diagnosis and be repeated at each visit [2]. Malnutrition is usually treated by modification of the patient’s diet to meet needs of energy, protein and other nutrients. This can be achieved by the use of one or more nutrition therapies including dietary counselling, oral nutrition support and, when required, enteral and parenteral nutrition therapies. Pharmacological therapies may be used to counter the effects of malnutrition in some cancer patients, while the use of exercise training in conjunction with optimal nutritional care is recommended to maintain muscle strength and muscle mass [1e3,9]. Although the importance of nutrition in oncology patients is well established, malnutrition is frequently overlooked, screening techniques are not always standardised, and there is no satisfying consensus on malnutrition further assessment criteria [8,10]. Understanding the awareness of, and attitudes towards, malnutrition and nutrition therapies in oncologists may help to understand why the current evidence base is not translated into routine clinical practice. The present study aimed to determine medical oncologists’ awareness of, and ability to assess, nutritional status along with when to initiate nutrition therapy. The study also aimed to identify their educational status concerning clinical nutrition and their perceived barriers to the routine use of nutrition therapy in their patients.