🤝 When you need professional help

The ESPEN guideline (2021) recommends that food intake, weight change and body mass index are assessed regularly from diagnosis onwards, and that medical nutrition (nutritional supplements, tube feeding) is used when you cannot eat enough — for example, less than 50% of your requirement for more than one week, or only 50–75% of it for more than two weeks. Also ask for a nutritional assessment if you have lost weight without trying, if you have severe symptoms that prevent you from eating (uncontrolled vomiting, difficulty swallowing, severe mucositis) or if you are scheduled for major abdominal surgery.

A cancer dietitian can assess your current nutritional status, set up an individualised plan tailored to your treatment, recommend specific supplementation or enteral nutrition (through a tube), and monitor your progress. The Canadian Cancer Society recommends including the dietitian in the multidisciplinary cancer team from diagnosis, not only when problems arise.

In hospitals and cancer centers, clinical nutrition is provided by dietitians or nutritionists. There are also outpatient services, including at some cancer charities. If access to a specialist dietitian is not immediately available, your GP or oncologist can offer basic guidance and referrals. Do not let access barriers stop you from asking for help.

• ✓Unplanned weight loss or eating much less → ask for a nutritional assessment
• ✓The cancer dietitian is part of the multidisciplinary treatment team
• ✓Enteral or parenteral nutrition may be needed in severe cases
• ✓Do not hesitate to ask for a referral if eating is a persistent problem