Clinicians often consider nutritional care as a non-essential step in patients’ evaluation and treatment. This also happens in oncology, even though it is well known that an altered nutritional status has a disastrous impact on patients’ response to treatment, quality of life, and survival. Overall, it has been estimated that up to 57% of patients with stage IV cancer are malnourished or at risk of malnutrition at the time of diagnosis.
Many factors contribute to the development of malnutrition in cancer patients, with several differences according to cancer type and setting. In all patients, especially in advanced stages, the deregulation of systemic inflammation pathways leads to metabolic derangements including increase in muscle catabolism and switch to acute-phase protein synthesis. In patients with gastrointestinal cancer, mechanical (e.g., bowel obstruction) or functional factors (e.g., exocrine insufficiency) contribute to the impairment of nutritional status. Moreover, anticancer treatment often cause anorexia, mucositis, nausea, diarrhea, or other nutrition-related side effects. Finally, psychological effects can promote the reduction of food intake and physical activity.
A large number of clinical studies have demonstrated the deleterious effects of poor nutritional status. In particular, in the hospital setting malnutrition is associated with prolonged length of stay, increased post-surgical complication rates, higher susceptibility to infections, increased mortality, and higher hospital costs.

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