Addressing malnutrition in cancer care: Where do postgraduate oncology students stand?

Background & aims: Disease-associated malnutrition and cachexia affect a high percentage (between 30 % and 80 %) of cancer patients; appropriate diagnosis and intervention can improve clinical outcomes. We investigated opinions and knowledge of oncology residents towards nutritional care in cancer patients. Methods: Following mapping post-graduate schools in oncology, an invitation was sent to the directors with a link to be transferred to residents willing to participate to the survey anonymously. The survey consisted in a questionnaire including 42 questions related to nutrition in cancer patients exploring the didactic component, the clinical daily activities in the oncology department, attitude and cultural background. Results: 135 residents from 17 universities (54.8 % of total) completed the survey (49 responders were attending the 1st year, 26 the 2nd, 23 the 3rd, 30 the 4th and 7 the 5th or had just finished the specialty). Only 25.9 % of residents reported receiving specific lessons on clinical nutrition during their training, while malnutrition and sarcopenia were covered in 60 % and artificial nutrition in 48.9 %. Nutritional status assessment was routinely performed in 34.3 % of oncology departments, while in 63.5 % it was carried out only if the patient was already (or clearly) malnourished and in 2.2 % it was not performed at all. When performed, the assessment was conducted by oncologists in 53.7 % of cases, whereas 43.4 % relied on the nutritional team. Oral nutritional supplementation was prescribed by oncologists in 41.9 % of cases, and parenteral nutrition in 53 %. However, significant gaps in residents' nutritional knowledge emerged: only 13.3 % of residents correctly answered more than 66 % of nutrition-related questions. A majority (84.5 %) achieved scores between 34 and 66 %, while 2.2 % scored below 33 %. Widespread misunderstanding was observed regarding key nutritional concepts such as routes of nutritional support, metabolic needs in cancer, and malnutrition criteria. Despite these deficiencies, nearly all participants (98.5 %) agreed on the importance of oncologists acquiring basic nutritional competencies. Conclusions: The results of this survey indicate that malnutrition in cancer patients remains an undervalued clinical condition and the teaching of clinical nutrition in oncology residency programs remains inadequate and needs to be strengthened. These findings underscore the urgent need to integrate comprehensive nutritional education into oncology curricula and promote interdisciplinary collaboration to ensure early identification and management of malnutrition in cancer patients.