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Nutrition and physical activity: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS)
  1. Cindy Neuzillet1,
  2. Amélie Anota2,3,
  3. Aude-Marie Foucaut4,
  4. Anne-Laure Védie5,
  5. Sami Antoun6,
  6. Didier Barnoud7,
  7. Carole Bouleuc8,
  8. Frédéric Chorin9,
  9. Vanessa Cottet10,
  10. Eric Fontaine11,
  11. Valérie Garabige8,
  12. Xavier Hébuterne12,
  13. Florence Huguet13,
  14. Astrid Lièvre14,
  15. Timothée Marchal8,
  16. Thomas Mouillot15,
  17. Frédérique Peschaud16,
  18. Didier Quilliot17,
  19. Bruno Raynard6,
  20. Stéphane Schneider9,
  21. Florian Scotté18,
  22. Damien Vansteene19,
  23. Pascale Mariani20,
  24. Olivier Bouché21,
  25. Francisca Joly22,
  26. Société Nationale Française de Gastroentérologie (SNFGE),
  27. Fédération Francophone de Cancérologie Digestive (FFCD),
  28. Groupe Coopérateur multidisciplinaire en Oncologie (GERCOR),
  29. Fédération Nationale des Centres de Lutte Contre le Cancer (UNICANCER),
  30. Société Française de Chirurgie Digestive (SFCD),
  31. Société Française d’Endoscopie Digestive (SFED),
  32. Société Française de Radiothérapie Oncologique (SFRO),
  33. Association de Chirurgie Hépato-Bilio-Pancréatique et Transplantation (ACHBT),
  34. Association Française de Chirurgie (AFC),
  35. Société Française des Professionnels en Activité Physique Adaptée (SFP-APA),
  36. Société Francophone de Nutrition Clinique et Métabolisme (SFNCM)
  37. Association Francophone pour Soins Oncologiques de Support (AFSOS)
  1. 1 Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University (UVSQ) – Paris Saclay University, Saint-Cloud, France
  2. 2 Methodology and Quality of Life Unit in Oncology, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Hospital of Besançon, University Bourgogne Franche-Comté, Inserm, EFS BFC, Besançon, France
  3. 3 Biostatistics Unit, DRCI, Centre Léon Bérard, Lyon, France
  4. 4 Laboratoire Educations et Pratiques de Santé UR 3412, Université Sorbonne Paris Nord, Bobigny, France
  5. 5 Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris 7 Diderot University, Clichy La Garenne, France
  6. 6 Nutrition and Readaptation Unit, Gustave Roussy Institute - Cancer Campus, Villejuif and Chevilly-Larue, France
  7. 7 Department of Intensive Clinical Nutrition, Hospices Civils de Lyon (CHU Lyon), Lyon, France
  8. 8 Department of Supportive Care, Curie Institute, Paris, France
  9. 9 Plateforme Fragilité, Université Côte d’Azur, CHU Nice, LAMHESS, Nice, France
  10. 10 INSERM UMR1231 CIC 1432, CHU Dijon, NACRe National Network, University of Burgundy Franche-Comté, Dijon, France
  11. 11 University of Grenoble Alpes, INSERM, LBFA, Grenoble, France
  12. 12 Gastroenterology and Clinical Nutrition, CHU of Nice and University Côte d’Azur, Nice, France
  13. 13 Service d’Oncologie Radiothérapie, CHU Tenon, IUC, AP-HP, Sorbonne Université, Paris, France
  14. 14 Department of Gastroenterology, INSERM U1242 "Chemistry Oncogenesis Stress Signaling", University Hospital Pontchaillou, Rennes 1 University, Rennes, France
  15. 15 Service d’Hépato-gastro-entérologie, CHU F. Mitterrand, Dijon, France
  16. 16 Department of Surgical Oncology, CHU Ambroise Paré, APHP, UVSQ – Paris Saclay University, Boulogne-Billancourt, France
  17. 17 Nutritional Assistance Department and Transversal Nutrition Unit, University Hospital of Nancy, University of Lorraine, Nancy, France
  18. 18 Department of Supportive Care (Département Interdisciplinaire d'Organisation des Parcours Patients - DIOPP), Gustave Roussy Institute - Cancer Campus, Villejuif, France
  19. 19 Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
  20. 20 Department of Digestive Surgery, Curie Institute, Paris, France
  21. 21 Department of Digestive Oncology, CHU Reims, Reims, France
  22. 22 Department of Gastroenterology, IBD and Nutrition Support, CHU Beaujon, AP-HP, Paris 7 Diderot University, Clichy La Garenne, France
  1. Correspondence to Dr Cindy Neuzillet, Department of Medical Oncology, Curie Institute, 92210 Saint-Cloud, France; cindy.neuzillet{at}gmail.com

Abstract

This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently, in addition to anticancer treatments, supportive care including nutritional support and PA plays a central role in the management of digestive cancers. It is crucial to detect malnutrition (diagnostic criteria updated in 2019) early, to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition and PA in digestive oncology for each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). Guidelines for nutrition and PA management aim at increasing awareness about malnutrition in oncology. They are continuously evolving and need to be regularly updated.

  • gastrointestinal (lower)
  • gastrointestinal (upper)
  • pancreatic
  • education and training
  • supportive care
  • symptoms and symptom management

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Footnotes

  • AA, A-MF and A-LV contributed equally.

  • Collaborators Société Nationale Française de Gastroentérologie (SNFGE), Fédération Francophone de Cancérologie Digestive (FFCD), Groupe Coopérateur multidisciplinaire en Oncologie (GERCOR), Fédération Nationale des Centres de Lutte Contre le Cancer (UNICANCER), Société Française de Chirurgie Digestive (SFCD), Société Française d’Endoscopie Digestive (SFED), Société Française de Radiothérapie Oncologique (SFRO), Association de Chirurgie Hépato-Bilio-Pancréatique et Transplantation (ACHBT), Association Française de Chirurgie (AFC), Société Française des Professionnels en Activité Physique Adaptée (SFP-APA), Société Francophone de Nutrition Clinique et Métabolisme (SFNCM), Association Francophone pour Soins Oncologiques de Support (AFSOS).

  • Contributors Coordination of the work: CN and FJ. Review of literature and data collection: CN, A-MF, AA and A-LV. Data analysis: all authors. Manuscript writing: CN, A-MF and A-LV. Review, validation and editing: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CN: Consultancy/honoraria: Pierre Fabre, Servier, Roche, AstraZeneca, Bristol-Myers Squibb, Amgen, Merck, MSD, Novartis, Incyte Biosciences, Mylan, Baxter, Nutricia, Fresenius Kabi; Research funding: Roche; Clinical trials: OSE Immunotherapeutics, AstraZeneca, Bristol-Myers Squibb, Merus. A-MF: Pierre Fabre, Ceformed, MéthodCO. EF: Baxter, Nutricia, Fresenius Kabi, Aguettant, BBraun. XH: clinical research funding from AbbVie; Abivax; Alphasigma; Celgene; Gilead Science, Inc; Eli Lilly; Enterome, Janssen; InDex Pharmaceuticals; Pfizer; Roche; Salix; Takeda; Theravance; advisory boards for AbbVie, Arena Pharmaceuticals, Arkopharma, Astellas, Janssen, Nutricia, Pfizer, Sangano, Takeda; lectures and educational activities for AbbVie, Baxter, Bristol-Myers Squibb, Ferring, Janssen, MSD, Mylan, Nutricia, Pfizer, Sanofi-Advantis, Tillots and Takeda. AL: grants from Bayer Lilly, Merck and Novartis; personal fees from AAA, Amgen, Bayer, Bristol-Myers Squibb, Celgene, HalioDx, Incyte, Ipsen, Lilly, Merck, Novartis, Pierre Fabre, Roche, Sandoz, Sanofi and Servier; non-financial support from AAA, Amgen, Bayer, Incyte, Ipsen, Merck, Novartis, Pierre Fabre, Pfizer, Roche, Sandoz, Servier and Integragen. TM: Baxter, Nutricia, Nestle. BR: honoraria from Fresenius Kabi for Scientific Board (NUTRICANCER2 and SCAN studies). SS: Baxter, B. Braun, Fresenius-Kabi, Laboratoires Grand-Fontaine, Nestlé Health Science and Nutricia. DV: Fresenius Kabi, Nutricia, Nestle Health Science. OB: Merck KGaA, Roche, Bayer, Astra-Zeneca, Grunenthal, MSD, Amgen, Servier and Pierre Fabre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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