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Nutritional management of cancer patients in clinical practice in Spain: patients’ and multidisciplinary health care professionals’ perceptions




Malnutrition is a prevalent problem in patients with cancer and is associated with poor prognosis. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the provision of nutritional support and evaluation. This study aims to describe the nutritional management of patients with cancer, including assessment of adherence, from the perspective of both patients and healthcare professionals (HCPs).


A cross-sectional descriptive observational study was carried out through two surveys addressed to patients and HCPs.


A total of 230 cancer patients and 461 HCPs completed the questionnaire. The survey found 55.0% of patients experienced eating problems during treatment and 64.0% reported sequelae affecting nourishment. However, 60.1% of patients and 42.6% of HCPs indicated that nutritional status is not generally assessed. While 86.6% of HCPs stated that nutritional information is provided to patients, only 33.5% of patients reported having received it. Regarding nutritional adherence, 87.4% of HCPs stated that it is assessed whereas only 49.2% of patients receiving nutritional supplements confirmed this. General discomfort or gastrointestinal problems were the main issues hampering correct adherence perceived by both patients (41.8%) and HCPs (95.4%).


Our study demonstrate that different perceptions exist between patients and HCPs about nutritional management in cancer and suggests that in Spain nutritional approach is suboptimal in terms of screening/assessment of malnutrition, nutritional information provided to the patient, nutritional intervention and assessment of adherence to nutritional support. Therefore, measure should be taken to foster the adoption of ESPEN recommendations in clinical practice and to promote nutritional education of HCPs.

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Fig. 1: Perceived barriers to proper adherence to nutritional support.
Fig. 2: Strategies for improving adherence to nutritional support.

Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to privacy and ethical concerns but are available from the corresponding author on reasonable request and with permission of the study promoter.


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We thank all scientific societies for the dissemination of the questionnaire and the institutional and/or social endorsement of this study. In addition, we thank the participation of all members of the ONA working group listed in the Supplementary Material. The study was supported by Nestlé Health Science. This funding source was involved in the review of the study design and manuscript, but not in the collection, analysis and interpretation of the data, nor in the writing of the report or the decision to submit the article for publication.

Author information

Authors and Affiliations



EC contributed to designing the protocol, designing the questionnaire, interpreting data, and co-writing the manuscript. ESS contributed to designing the protocol, designing the questionnaire, interpreting data, and co-writing the manuscript. IO contributed to designing the protocol, reviewing the questionnaire, interpreting data, and reviewing the manuscript. JAG contributed to designing the protocol, reviewing the questionnaire, interpreting data, and reviewing the manuscript. MAE contributed to designing the protocol, reviewing the questionnaire, interpreting data, and reviewing the manuscript. BB contributed to reviewing the protocol, reviewing the questionnaire, and reviewing the manuscript. MB contributed to reviewing the protocol and reviewing the manuscript. MC contributed to reviewing the protocol, reviewing the questionnaire, extracting the survey data, and reviewing the manuscript.

Corresponding author

Correspondence to Eduardo Sánchez-Sánchez.

Ethics declarations

Competing interests

MB is an employee in the medical department of Nestlé Health Science. MC works for an independent scientific consultancy (Outcomes’10) that has received honoraria to develop and coordinate the project and write the current manuscript. The other authors declare no conflicts of interest.

Ethics approval

The study followed the international ethical recommendations contained in the Declaration of Helsinki. The Clinical Research Ethics Committee of the Hospital Universitario Puerta de Hierro (Madrid) was consulted before conducting the study. Since the study consisted of an opinion questionnaire, the Clinical Research Ethics Committee considered that ethical approval was unnecessary. All participants received appropriate information on the study and agreed to participate. All documents were duly encoded to ensure data confidentiality complying with the provisions of Organic Law 3/2018, of 5 December, on the protection of Personal Data and guarantee of digital rights.

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Sánchez-Sánchez, E., Orúe, I., Guerra, J.A. et al. Nutritional management of cancer patients in clinical practice in Spain: patients’ and multidisciplinary health care professionals’ perceptions. Eur J Clin Nutr 77, 454–459 (2023).

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