Oral nutritional supplements prescribed under clinical supervision for malnourished patients with cancer should be fully covered: narrative review

Abstract

Background: When dietary intakes are insufficient, oral nutritional supplements (ONS) are valuable allies to ensure effective nutritional care for patients with cancer. ONS benefits in preventing and treating malnutrition, improving clinical outcomes and quality of life and reducing healthcare costs are well supported by the literature. Moreover, the advent of novel ONS formulas, enriched with additional components (eg immune system modulation), might further improve outcomes in patients with cancer. Yet, a critical question remains: why are ONS, under clinical supervision, not fully covered for malnourished patients with cancer as part of their standard care?

Objective: This narrative review aims to summarise the clinical and economic benefits of ONS in order to analyse the barriers that limit access to clinically supervised ONS for malnourished patients with cancer and their bioethical implications.

Methods: To address this aspect, we conducted a comprehensive literature search on PubMed, Web of Science and Scopus, including articles published in the last 30 years.

Findings: Several barriers hinder the full coverage of ONS as part of a supervised clinical plan, including lack of proper healthcare professional training and standardised protocols for nutritional care and fragmented healthcare policies. These obstacles not only negatively affect patient outcomes but also place a significant economic burden on healthcare systems. At a deeper level, this issue also raises bioethical questions. In our society, healthcare aims to preserve life. Nutrition is essential for recovery in cancer, and making its access dependent on patients' financial capacity, with the risk of failing to provide adequate nutrition, seems to betray this goal.

Conclusion: Bringing together ethical imperatives, proven clinical benefit and economic rationale, there is strong evidence supporting full coverage of ONS for malnourished patients with cancer.

Keywords: Cancer; Ethics; Prognosis; Supportive care.