Nutrition in Cancer Care: Closing the Gap Between Awareness and Action

A EUROPEAN WHITE PAPER ON NUTRITIONAL SUPPORT FOR CANCER PATIENTS AND SURVIVORS

EXECUTIVE SUMMARY

This survey gathered responses from 2,505 cancer patients across 12 European countries to explore challenges in nutritional care during and after cancer treatment. The questions were design to understand the implementation of nutritional support for cancer patients in the national health care systems.

The main findings highlight systemic gaps in nutritional assessment, guidance, and integration into health care systems (HCS). While awareness of the importance of nutritional care is relatively high among patients (70%), practical access to information, monitoring, and professional dietary counselling remains very limited.

Despite the existence of guidelines and recommendations about the relevance of nutritional support during and after cancer treatment, cancer patients do not receive a standard and harmonized nutritional support.

Significant regional disparities also exist, with Southern and Eastern Europe offering more support than Northern and Western Europe.

We have detected a number of key findings that had been used to define a Call to Action, led to induce legal and protocol changes, targeting policy makers, clinical personnel and patient groups, in order to promote nutrition as a key part of the cancer patients’ support to improve their quality of life.

CALL TO ACTION SUMMARY

For Policymakers

Mandate nutritional screening at diagnosis and during treatment
Set EU minimum standards for dietitian access and follow-up
Monitor implementation of evidence-based national guidelines

For Healthcare Professionals

Treat nutrition as a core therapeutic component of oncology care
Systematically inform patients about nutritional management
Integrate structured nutrition follow-up into survivorship pathways
Share best practices to reduce regional inequalities

For Patients and Patient Organizations

Request early and regular nutritional assessment
Advocate for access to dietitians and nutrition programs
Promote education and awareness on nutrition in survivorship

WHY THIS WHITE PAPER MATTERS?

Cancer treatment is not only about drugs and surgery.

Nutrition directly affects:

Treatment tolerance

Side effects

Recovery

Survival

Yet across Europe, nutritional care is inconsistent, underused, and often missing.

This white paper shows:

Where systems fail

What patients experience

What can be fixed now

1. BACKGROUND AND PURPOSE

Cancer-related problems with nutrition affect 1 in 3 cancer patients and up to 80% of patients at later stages of the disease¹. It leads to treatment interruptions, poorer outcomes, and reduced survival. Yet, ensuring that cancer patients receive adequate nutritional support remains a low priority in most care pathways.

The purpose of this survey was to identify current barriers cancer patients face regarding nutritional support in Europe and to provide evidence-based recommendations for policymakers and healthcare leaders.

1 Casir Casirati A, Da Prat V, Cereda E, Serra F, Perrone L, Corallo S, De Lorenzo F, Pedrazzoli P, Caccialanza R. The key role of patient empowerment in the future management of cancer-related malnutrition. Nutrients. 2023 Jan 1;15(1):235. doi: 10.3390/nu15010235.

MALNUTRITION² IS NOT A SIDE ISSUE

1 in 3

cancer patients experience nutrition-related problems.

up to 80%

at advanced stages

Consequences include:

Treatment interruptions

Increased toxicity

Lower survival

Nutrition is a clinical issue — not a lifestyle choice.

2 https://www.medicalnutritionindustry.org/content/uploads/2025/02/mni-general-malnutrition-infographic.pdf

2. SURVEY OVERVIEW

Respondents: 2,505 cancer patients and survivors

Countries: 12 European nations (Denmark, Finland, France, Germany, Italy, Norway, Poland, Portugal, Romania, Spain, Sweden, UK). We grouped the countries into regional areas: Southern (France, Italy, Portugal), Eastern Europe (Poland, Romania), Western Europe (Germany, Spain, UK), Northern Europe (Denmark, Finland, Norway, Sweden).

Method: 31-question online survey, translated into 12 languages, ensuring anonymity.

Respondent profile:

88% women, 75% aged 49–69
60% breast cancer, 12% colon, 3% prostate, 4% pancreatic, 22% other
50% with advanced-stage cancer

This strong predominance of women and breast cancer patients may limit the representativeness of the sample, yet it also underscores the acute nutritional challenges in this particular patient group.

WHAT THIS STUDY LOOKED AT

Content:

2,505 patients

12 European countries

Multiple cancer types

31 questions

12 languages

This is one of the largest patient-reported datasets on nutrition in cancer care in Europe.

Predominantly women and breast cancer patients — acknowledged and transparent.

3. RESULTS

3.1 Nutritional Challenges During Treatment

Fatigue/weakness (76%), nausea (39%), and loss of taste (38%) were the most reported side effects.
Only 1 in 5 underwent nutritional assessment, despite clear clinical need.
37% said nutritional issues moderately or severely affected quality of life.
25% required nutritional guidance due to nutritional problems, particularly in Italy, France, and Romania.
From those that received nutritional guidance the dietary patterns were:
- 31% maintained normal diet — lower in the UK and Germany
- 34% had dietary restrictions or fortification — higher in Northern Europe (Denmark, Norway, Sweden)
- 18% used oral supplements — higher in the UK, France, and Spain
- UK reported notably high use of enteral liquid nutrition (16%)

Implication: A significant mismatch exists between clinical needs and available nutritional care. Medical teams lack systematic screening and intervention protocols.

3.2 Awareness, Information, and Monitoring

70% knew nutrition could support cancer treatment. Awareness was lower in Western Europe (UK, France, Germany) and the Nordic countries (Denmark, Sweden, Norway, Finland).
Only 26% received such information from healthcare providers, typically as a single, non-repeated consultation. Lower routine information was reported in France, Spain, Germany, and the Nordic region.
14% were monitored for nutritional status since diagnosis.
22% accessed a dietitian, but in 40% of cases, only once.

Figure 1. Gap between patient awareness and healthcare system support in nutrition.

Implication: Awareness among patients is high, but healthcare systems fail to operationalise nutrition support as standard care.

EATING BECOMES HARDER DURING TREATMENT

because of fatigue, nausea, and changes in taste.

33+%

For more than 1 in 3 patients this has a real impact on daily life and strength.

Nutrition issues are common.
Systematic support is not.

~70%

Around 7 in 10 patients know nutritional support can help them cope better with treatment.

But only a minority:

receive clear guidance

are followed over time

meet a dietitian more than once

Knowing that nutrition matters does not necessarily mean receiving the support to act on that.

WHAT PATIENTS NEED TO UNDERSTAND

Nutritional care is part of treatment.

Without proper nutritional care:

symptoms worsen

quality of life drops

recovery becomes harder

Nutrition should be checked, discussed, and followed — like any other clinical need.

3.3 Post-Treatment Support

21% requested and therefore received nutritional help after treatment.
41% said nutritional support improved their quality of life.
Nordic and Western European countries showed lowest follow-up rates.

Implication: Survivorship nutrition remains a neglected component of cancer recovery.

3.4 Integration of Nutritional Interventions Into Healthcare Systems

Only 35% perceived that nutrition was integrated into their healthcare system.
52% said nutrition is not considered a key part of care.
Patients’ perception of main barriers:
- Insufficient funding (40%, highest in Finland – 54%)
- Lack of evidence-based guidance for HCPs (35%, highest in Germany – 51%)
Awareness of national nutritional guidelines: 15%; only 17% of those said guidelines were implemented.

Implication: Systemic underfunding, lack of training, and weak policy enforcement hinder integration.

3.5 Regional Disparities

Southern (Portugal, Italy, France) and Eastern Europe (Romania, Poland): More structured approach; higher testing, dietitian access, positive QoL (Quality of Life) impact.

Western Europe (UK, Spain, Germany): Mixed results; Spain – strong in QoL gains, UK – strong in enteral nutrition, Germany – low awareness.

Northern Europe (Denmark, Sweden, Norway, Finland): Least integrated; low information, low funding, weak follow-up.

Figure 2. Regional disparities in nutritional care integration.

Implication: Europe lacks harmonized nutritional care standards, resulting in inequity across regions.

AFTER TREATMENT, SUPPORT FADES

After medical treatment, nutrition problems often continue, but support from the healthcare system drops.

Only

1 in 5

patients receive nutritional help after treatment.

When support is given,

4 in 10

say quality of life improves.

Recovery continues.
Nutrition support often stops.

WHY CARE IS MISSING

Many patients feel nutrition is still treated as optional.

50%+

say it is not considered a real part of cancer care.

The main reasons patients give:

not enough funding

unclear guidance for doctors

existing rules are not applied

Nutritional care is mentioned in policies, but rarely translated into everyday care.

Access to nutrition care varies

Recovery chances are not equal

4. KEY FINDINGS

1. Despite side effects affecting diet and 37% reporting nutritional problems, only 1 in five received nutritional assessment.

2. During treatment, one in four required nutritional guidance; diet patterns varied
regionally.

3. Although 70% were aware of benefits, only 26% received information from HCPs (HealthCare Professionals), and just 14% were monitored.

4. Post-treatment support was limited: ~20% received guidance.

5. 41% felt nutritional support improved quality of life but only 35% believe nutrition is integrated in their HCS (HealthCare System).

6. Over half (52%) considered nutrition not a key part of cancer care due to insufficient financial resources (40%) or lack of evidence-based guidance (35%).

5. CALL TO ACTION

For Policymakers

1. Support mandatory nutritional screening at diagnosis and throughout treatment, as current EU policy recommendations (including Europe’s Beating Cancer Plan) omit nutrition as an essential component of oncology care.

2. Countries such as Portugal and Italy demonstrate that structured screening and dietitian access can be implemented at national level; these practices could inform EU-wide minimum standards.

3. Ensure national guidelines are evidence-based and their implementation is monitored.

For Healthcare Professionals

1. Recognize nutrition as a therapeutic component, equivalent in importance to other established components of oncology care.

2. Inform patients about dietary management.

3. Ensure survivorship pathways include systematic nutrition follow-up.

4. Create platforms for sharing best practices at EU, national and regional levels to address inequalities.

For Patients and Patient Organizations

1. Request nutritional assessment early and regularly.

2. Advocate for access to dietitians and nutrition programs.

3. Empower patients through education and awareness campaigns promoting nutrition in survivorship care.

6. CONCLUSION

The survey confirms a pervasive disconnect between awareness and implementation of nutritional care in European cancer systems. While patients recognize its importance, access to professional guidance, monitoring, and follow-up is inconsistent. Considering the availability of guidelines on nutritional care by medical societies, it seems there is a lack of implementation at clinical practice that needs to be reverted. Regional differences based on clinical or political decisions point to the need for a harmonization of the services and therapeutic support of all EU healthcare systems, reducing inequalities amongst cancer patients.

Addressing problems with nutrition is not merely a matter of improving symptom burden but it is a clinical necessity that can influence treatment success, toxicity, and survival. European policymakers and national health authorities must act urgently to make nutrition a standard, measurable, and funded component of oncology care.