The importance and integration of nutrition into the surgical treatment plan has always been a keystone in my oncology armamentarium; particularly in Pancreatic and Liver cancer which are known to be associated with significant malnutrition. This focus stems from my early post surgical residency training 35 years ago as a Surgical Fellow at the UPenn’s Harrison Department of surgical research while studying both Tumor Immunology and “The Nutritional Management of the Cancer Patient.”
Penn has always been at the center of both clinical and basic medical science nutrition universe; being the place TPN- Total Parenteral Nutrition or IV nutrition was developed during the 1960’s. At that time nutrition was almost exclusively the domain of surgeons and essentially limited to Peri-operative IV nutrition. It was a major contribution to enabling Pancreatic surgery (Whipple) to enter a new era in safety reducing infections by improving immunity.
In the decades since and despite both many more convenient enteral and oral nutritional formulations emerging to provide a better “holistic” nutritional approach and despite over 30 years of clinical research demonstrating how essential “good” nutrition is in impacting improved surgical recovery, better tolerance of chemotherapy/Radiation as well as overall quality of life, I am constantly amazed at how little attention is focused toward it in the average everyday “Oncology” practice; regardless of whether the patient is treated at the large cancer center or the smaller private based practices. Though some exceptions exist, it is far from what is needed. It is simply impossible to achieve oncologic success in the malnourished and cachectic patient if no attempt is made to rectify this condition from the very outset of diagnosis.
This recently published article (Dec28,2018) in the Oncologist highlights many of these points and is a nice starting point for a discussion on how to improve your outcome and quality of life all at the same time with your Oncology Team!