Guideline / position statementindependent cross-checkabstract checked I-SRC-108 standard review
ESMO guideline on weight loss in cancer
Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆.
Overview
Arends J et al. (ESMO Guidelines Committee). ESMO Open 2021 · PMID 34144781 · DOI 10.1016/j.esmoop.2021.100092
Cancer patients on treatment should be screened for malnutrition and get at least 25-30 kcal per kg body weight per day.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Guide cachexia care
- How was the study done?
Guideline
- How many people, animals or samples were studied?
not applicable
- What was actually found?
Screen and feed adequately; escalate nutrition when intake is low
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Cancer patients need enough food, not fasting regimes
- What are the study's limitations?
Low evidence levels for some points
- What does it say about Elawady's specific claim?
Contradicts fasting as treatment
- Do the results apply to Germany and Europe?
High
Scientific in-depth review
1. Full reference
- Authors
- Arends J et al. (ESMO Guidelines Committee)
- Journal
- ESMO Open
- Year
- 2021
- Identifier
- PMID 34144781 DOI 10.1016/j.esmoop.2021.100092
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works record checked; recommendation sections read in Europe PMC full text PMC8233663
- Retracted
- no
- Corrections
Erratum published: ESMO Open. 2022 Dec;7(6):100614. doi: 10.1016/j.esmoop.2022.100614.
- Extent checked
- abstract only
- Conflicts of interest and funding
Several authors declared industry honoraria/consultancy (nutrition companies); erratum published 2022.
2. Research question
How should cancer cachexia be screened, assessed and managed in adults?
3. Study design and population
- Study design
- Guideline / position statement – ESMO Clinical Practice Guideline
- Population
Adults with cancer
- Country
International (ESMO)
- Period
2021
- Sample size
not applicable
- Inclusion and exclusion criteria
not applicable
4. Methods and endpoints
- Exposure / intervention
Nutrition, exercise, drugs
- Comparator
not applicable
- Endpoints
Recommendations
- Statistical methods
ESMO levels of evidence and grades
5. Actual results
- Results
Recommends regular nutritional screening and nutritional support in all patients receiving anticancer treatment with expected survival over a few months [V, B]; at least 25-30 kcal/kg body weight/day to maintain nutritional status [V, B]; protein of at least 1.2 and possibly up to 2 g/kg/day may be required; nutritional interventions for inadequate intake, escalated during anticancer therapy [II, A].
- Absolute risks
not applicable
- Authors' conclusion
Multimodal management with adequate energy and protein intake is recommended for patients at risk of or with cachexia.
6. Strengths
- International guideline
- Current reference in Europe
7. Weaknesses
- Evidence levels for nutrition mostly low (V)
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Guideline; COIs declared.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Contradicts using repeated fasting and reduced solid food as cancer treatment: guidance is to secure adequate energy and protein during cancer therapy.
11. Independent contrary findings
Short supervised fasting around chemotherapy is being studied (I-SRC-109, I-INTA-08).
12. Transferability to Germany and Europe
European guideline.
13. Overall methodological judgement
Reference standard.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- In his practice he treats cancer with fasting (fasting every other day) and by reducing solid foods; he himself can go for days without food, on sugar-cane juice only. – Studies contradicting or limiting the claim
- Cancer patients do not die of cancer itself but of wasting and cortisone (hormonal disturbance). – Studies contradicting or limiting the claim