Mapping Nutritional Assessment and Management in Oncology: Challenges and Perspectives from a Regional Survey.

BACKGROUND: Malnutrition is common among patients with cancer and is associated with poorer clinical outcomes and increased healthcare costs. However, nutritional care remains suboptimal in routine oncology practice. This study aimed to assess the implementation of nutritional screening, assessment and management across oncology centers in Lombardy (Italy) and to identify critical areas to support the development and implementation of a regional Diagnostic-Therapeutic Care Pathway (PDTA). METHODS: A 21-item questionnaire developed by the Oncology Commission of the Clinical Nutrition Network of Lombardy Region was administered to all regional oncology centers. Data were collected via the Welfare General Directorate platform from 13 November 2024 to 31 December 2024, and analyzed in aggregate form. RESULTS: In total, 55 out of 59 centers responded (93.2%). Nutritional care was available in 78% of centers. Systematic nutritional risk screening was reported by 42% of centers, while 51% performed a comprehensive nutritional assessment in all patients with a positive screening result. Nutritional assessment was scheduled at both initial and follow-up visits in 53% of centers. In the perioperative setting, prehabilitation programs were available in 49% of centers, and preoperative immunonutrition was administered in 35%. Tools for assessing patient-reported outcomes and quality of life were available in only 15% and 20% of centers, respectively. CONCLUSIONS: The survey suggests some improvements compared to previous Italian surveys but highlights persistent gaps in the organization and delivery of nutritional care for patients with cancer.