Abstract
Pancreatic cancer carries poor overall survival. A high percentage of patients with pancreatic cancer experience a significant amount of weight loss at the time of diagnosis even before starting treatments. Nutritional status and maintaining proper nutrition can be extremely challenging due to multiple factors. Malnutrition can lead to a poorer quality of life, worsening of symptoms, and inability to complete planned treatments, leading to worse clinical outcomes. Evaluating nutritional status and implementing a plan early is essential. Having a good multidisciplinary team and partnering with a registered dietitian should be an integral part of patient care. Nutrition education for clinical teams, patients, and caregivers can help keep patients feeling better and on track with care. Patients should be screened early and routinely for malnutrition, dehydration, and exocrine pancreatic insufficiency. Managing side effects of the disease and engaging patients’ caregivers are important to maintaining good nutrition and improving quality of life.
References
Abbott Laboratories. (2013). Malnutrition Screening Tool (MST). https://aging.sc.gov/sites/default/files/documents/AAANutrition/Malnutrition%20Screening%20Tool%20(MST).pdf
Baker, J. P., Detsky, A. S., Wesson, D. E., Wolman, S. L., Stewart, S., Whitewell, J., Langer, B., & Jeejeebhoy, K. N. (1982). Nutritional assessment: A comparison of clinical judgment and objective measurements. New England Journal of Medicine, 306(16), 969–972. https://doi.org/10.1056/NEJM198204223061606
Barkin, J. A., Harb, D., Kort, J., & Barkin, J. S. (2024). Real-world patient experience with pancreatic enzyme replacement therapy in the treatment of exocrine pancreatic insufficiency. Pancreas, 53(1), e16–e21. https://doi.org/10.1097/MPA.0000000000002273
Bauer, J. M., Pattwell, M., Barazzoni, R., Battisti, N. M. L., Soto-Perez-de-Celis, E., Hamaker, M. E., Scotté, F., Soubeyran, P., & Aapro, M. (2024). Systematic nutritional screening and assessment in older patients: Rationale for its integration into oncology practice. European Journal of Cancer, 209, 114237. https://doi.org/10.1016/j.ejca.2024.114237
Bonvissuto, D. (2022). What medicine can cause dehydration? WebMD. https://www.webmd.com/drug-medication/medicines-can-cause-dehydration
Bossi, P., Delrio, P., Mascheroni, A., & Zanetti, M. (2021). The spectrum of malnutrition/cachexia/sarcopenia in oncology according to different cancer types and settings: A narrative review. Nutrients, 13(6), 1980. https://doi.org/10.3390/nu13061980
Brunner, M., Flessa, M., Jacobsen, A., Merkel, S., Krautz, C., Weber, G. F., & Grützmann, R. (2024). Recurrence pattern and its risk factors in patients with resected pancreatic ductal adenocarcinoma – A retrospective analysis of 272 patients. Pancreatology, 24(6), 930–937. https://doi.org/10.1016/j.pan.2024.07.017
Bundred, J., Kamarajah, S. K., & Roberts, K. J. (2019). Body composition assessment and sarcopenia in patients with pancreatic cancer: A systematic review and meta-analysis. HPB, 21(12), 1603–1612. https://doi.org/10.1016/j.hpb.2019.05.018
Canadian Malnutrition Task Force. (2017). Subjective global assessment (SGA) form. https://nutritioncareincanada.ca/resource-library/subjective-global-assessment-sga
Carrato, A., Cerezo, L., Feliu, J., Macarulla, T., Martín-Pérez, E., Vera, R., Álvarez, J., & Botella-Carretero, J. I. (2022). Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: An expert consensus. Clinical & Translational, 24(1), 112–126. https://doi.org/10.1007/s12094-021-02674-x
Dominguez-Muñoz, J. E., Vujasinovic, M., De La Iglesia, D., Cahen, D., Capurso, G., Gubergrits, N., Hegyi, P., Hungin, P., Ockenga, J., Paiella, S., Perkhofer, L., Rebours, V., Rosendahl, J., Salvia, R., Scheers, I., Szentesi, A., Bonovas, S., Piovani, D., Löhr, J. M., & European PEI Multidisciplinary Group. (2025). European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations. United European Gastroenterology Journal, 13(1), 125–172. https://doi.org/10.1002/ueg2.12674
Ferguson, M., Capra, S., Bauer, J., & Banks, M. (1999). Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition, 15(6), 458–464. https://doi.org/10.1016/S0899-9007(99)00084-2
Ferlay, J., Ervik, M., Lam, F., Laversanne, M., Colombet, M., Mery, L., Pineros, M., Znaor, A., Soerjomataram, I., & Bray, F. (2024). Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer. https://gco.iarc.who.int/today
Ghodeif, A., & Azer, S. (2023). Pancreatic insufficiency. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK555926
Guan, M., Shinde, A. M., & Hendifar, A. E. (2017). Pancreatic cancer cachexia: Current concepts and clinical management. In Y. Dionyssiotis (Ed.), Frailty and Sarcopenia—Onset, Development and Clinical Challenges. InTech. https://doi.org/10.5772/68047
HCA Healthcare. (2024). Pancreatic cancer diet and nutrition. https://sarahcannon.com/for-patients/learn-about-cancer/pancreatic-cancer/nutrition
Helm, J. (2023). How to calculate how much water you should drink in a day. https://health.usnews.com/wellness/food/articles/how-much-water-should-i-drink-in-a-day
Howlader, N., Noone, A., Krapcho, M., Garshell, J., Neyman, N., Aktekruse, S., Kosary, C., Yu, M., Ruhl, J., Tatalovich, Z., Cho, H., Mariotto, A., Lewis, D., Chen, H., Feuer, E., & Cronon, K. (2023). SEER Cancer Statistics Review 1975-2010. National Cancer Institute. http://seer.cancer.gov/csr/1975_2010/
Hui, C., Dhakal, A., & Bauza, G. (2023). Dumping syndrome. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470542
Johns Hopkins Medicine. (2024). Proper nutrition for a pancreatic cancer diagnosis [Video recording]. Johns Hopkins School of Medicine. https://www.hopkinsmedicine.org/video/proper-nutrition-for-a-pancreatic-cancer-diagnosis-video
Kennedy, S. K. F., Goodall, S., Lee, S. F., DeAngelis, C., Jocko, A., Charbonneau, F., Wang, K., Pasetka, M., Ko, Y.-J., Wong, H. C. Y., Chan, A. W., Rajeswaran, T., Gojsevic, M., Chow, E., Gralla, R. J., Ng, T. L., & Jerzak, K. J. (2024). 2020 ASCO, 2023 NCCN, 2023 MASCC/ESMO, and 2019 CCO: A comparison of antiemetic guidelines for the treatment of chemotherapy-induced nausea and vomiting in cancer patients. Supportive Care in Cancer, 32(5), 280. https://doi.org/10.1007/s00520-024-08462-x
Latenstein, A. E. J., Dijksterhuis, W. P. M., Mackay, T. M., Beijer, S., Van Eijck, C. H. J., De Hingh, I. H. J. T., Molenaar, I. Q., Van Oijen, M. G. H., Van Santvoort, H. C., De Van Der Schueren, M. A. E., De Vos-Geelen, J., De Vries, J. H. M., Wilmink, J. W., Besselink, M. G., Van Laarhoven, H. W. M., & Dutch Pancreatic Cancer Group. (2020). Cachexia, dietetic consultation, and survival in patients with pancreatic and periampullary cancer: A multicenter cohort study. Cancer Medicine, 9(24), 9385–9395. https://doi.org/10.1002/cam4.3556
Lewis, D. M., Rieke, J. G., Almusaylim, K., Kanchibhatla, A., Blanchette, J. E., & Lewis, C. (2024). Exocrine pancreatic insufficiency dosing guidelines for pancreatic enzyme replacement therapy vary widely across disease types. Digestive Diseases and Sciences, 69(2), 615–633. https://doi.org/10.1007/s10620-023-08184-w
McDermott, D., & Quinn, J. (2024). Approach to the adult patient with syncope in the emergency department. Uptodate.com
Mękal, D., Sobocki, J., Badowska-Kozakiewicz, A., Sygit, K., Cipora, E., Bandurska, E., Czerw, A., & Deptała, A. (2023). Evaluation of nutritional status and the impact of nutritional treatment in patients with pancreatic cancer. Cancers, 15(15), 3816. https://doi.org/10.3390/cancers15153816
Muscaritoli, M., Lucia, S., Farcomeni, A., Lorusso, V., Saracino, V., Barone, C., Plastino, F., Gori, S., Magarotto, R., Carteni, G., Chiurazzi, B., Pavese, I., Marchetti, L., Zagonel, V., Bergo, E., Tonini, G., Imperatori, M., Iacono, C., Maiorana, L.,…Marchetti, P. (2017). Prevalence of malnutrition in patients at first medical oncology visit: The PreMiO study. Oncotarget, 8(45), 79884–79896. https://doi.org/10.18632/oncotarget.20168
Muscaritoli, M., Modena, A., Valerio, M., Marchetti, P., Magarotto, R., Quadrini, S., Narducci, F., Tonini, G., Grassani, T., Cavanna, L., Di Nunzio, C., Citterio, C., Occelli, M., Strippoli, A., Chiurazzi, B., Frassoldati, A., Altavilla, G., Lucenti, A., Nicolis, F., & Gori, S. (2023). The impact of NUTRItional status at first medical oncology visit on clinical outcomes: The NUTRIONCO study. Cancers, 15(12). https://doi.org/10.3390/cancers15123206
National Comprehensive Cancer Network. (2025). Palliative Care. https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf
NHS Services. (2023). Malnutrition overview. https://www.nhs.uk/conditions/malnutrition/#:~:text=unintentional%20weight%20loss%20%E2%80%93%20losing%205,interest%20in%20eating%20and%20drinking
Poulia, K.-A., Antoniadou, D., Sarantis, P., & Karamouzis, M. V. (2022). Pancreatic cancer prognosis, malnutrition risk, and quality of life: a cross-sectional study. Nutrients, 14(3), 442. https://doi.org/10.3390/nu14030442
Ringer, M., & Lappin, S. L. (2023). Orthostatic hypotension. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK448192/
Sande, T. A., Laird, B. J. A., & Fallon, M. T. (2019). The management of opioid-induced nausea and vomiting in patients with cancer: A systematic review. Journal of Palliative Medicine, 22(1), 90–97. https://doi.org/10.1089/jpm.2018.0260
Sikkens, E. C. M., Cahen, D. L., Van Eijck, C., Kuipers, E. J., & Bruno, M. J. (2012). The daily practice of pancreatic enzyme replacement therapy after pancreatic surgery: A northern European survey. Journal of Gastrointestinal Surgery, 16(8), 1487–1492. https://doi.org/10.1007/s11605-012-1927-1
Walsh, C. (2024). Pancreatic cancer nutrition: 12 pancreatic diet tips. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatic-cancer/pancreatic-cancer-nutrition
World Health Organization. (n.d.). Malnutrition. World Health Organization.
Yang, H.-Y., Shun, S.-C., Lee, Y.-H., Liou, Y.-T., Chou, Y.-J., Kuo, H.-J., Tien, Y.-W., Lai, S.-R., & Hung, H. (2024). Trajectories of perioperative nutritional status in patients with pancreatic tumor after surgery in six months. European Journal of Oncology Nursing, 72, 102687. https://doi.org/10.1016/j.ejon.2024.102687
