Clinical and economic value of oral nutrition supplements in cancer patients: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer.

Abstract Malnutrition is a common clinical and public health problem that can frequently affect subjects in hospital and community settings. In particular, cancer-related malnutrition results from a combination of metabolic dysregulation and anorexia, caused both by the tumor itself and by its treatment. Patients with head-neck cancer, or with gastroesophageal, pancreatic, lung and colorectal cancer, are particularly at risk of developing malnutrition, with a prevalence varying between 30% and 50% since the early disease phases, according to the tumor location and anti-cancer treatment complications. Prevention and adequate management of malnutrition is now considered an essential key point of therapeutic pathways of cancer patients, with the aim to enhance their quality of life, reduce complications and improve clinical outcomes. Oral nutritional supplements (ONS) are part of the nutritional therapy and represent an effective tool to deal with cancer-related malnutrition, as supported by growing literature data. However, patients’ access to ONS - which is regulated by different national and regional policies in terms of reimbursement - is quite heterogeneous. This narrative review aims to summarize the current knowledge about the role of ONS in terms of cost-effectiveness in the management of actively treated cancer patients, following surgery and/or radiotherapy/chemotherapy treatment and to present the position on this issue of Alliance Against Cancer, the Italian National Oncology Network.