Nutrition & Cancer – A Major Challenge for Dietitians in France
  • In oncology, nutritional status is one of the essential elements in prognosis of the disease and the effectiveness of the treatment.  However, these patients face the risk of malnutrition, especially those with digestive cancer (80%) and women with breast cancer (36%).  In this context, and on the occasion of World Cancer Day, which takes place each year on the 4th of February, AFDN (The French Association of Nutritionist Dietitians) emphasizes the importance of the dietitians' role in overall nutritional care.
    For patients with cancer, malnutrition is a serious risk for many reasons.  Firstly, malnutrition can reduce effectiveness of therapy; it can also reduce the response of chemotherapies and increase their toxicity.  Secondly, it may have two important consequences for the clinical state of the patient – a) it can result in loss of immunity, which increases the risk of infection and digestive disorders, or result in loss of muscular mass which can cause phlebitis, bedsores or loss of independence (with a major impact on the quality of life), b) it can cause bad scarring and/or slackening of stitchesFinally, some tumors may be directly at the origin of malnutrition, such as the digestive tract, which cause appetite loss and alter deglutition. Such effects worsen the prognosis and increase the mortality risk for patients affected by cancer.
    The French dietitian plays an important role in prevention, care and nutritional education for malnourished cancer patients.  The aim of nutritional assessment that dietitians carry out as soon as a patient is admitted is to identify malnutrition in its earliest stage and to increase the effectiveness of treatment.  This is done before hospitalization, in association with city networks, whenever possible. In this assessment, all parameters of malnutrition are systematically inquired into, and then sent to the doctor who decides the prescription.
    It is then the responsibility of the dietitian to translate the prescription into daily menus for each patient – in terms of quantity and type of food, food supplements and nutritional supplements – based on the assessed needs. 

    Dietitians also learn different feeding techniques, ranging from oral feed to follow-up care of enteral nutrition (by probe in the digestive tract), or parenteral nutrition (intravenous route) to oral supplements (prescribed as medication).  Another important role of the dietitian is the patient education to make him adhere to his nutritional plan as soon as cancer is diagnosed and also being involved throughout his care.
    Outside the health care facility dietitians play an important partnership role in ensuring continuity of care, upstream and downstream, with the relay-hospitals, medical networks, city medical staff and home services.
    On the occasion of the World Cancer Day on February 4, 2014, the AFDN reminded patients and healthcare professionals in oncology that since 2012 there is a reference on nutritional care for adults with cancer. Ten Personalized Care Plans have been prepared by experts of the French Society for Clinical Nutrition and Metabolism (SFNEP) and the Food Network National Cancer Research (NACRe), in pathological and therapeutic contexts.  They are planning tools for caregivers, and to provide information to patients.                                               
    Isabelle Parmentier
    PrĂ©sidente de l’AFDN