How To Choose Oral Nutritional Supplements For Cancer Patients

Malnutrition is a common concern among people with cancer. It may be associated with reduced appetite, adverse effects of anticancer treatment, and disease-related metabolic changes, potentially leading to weight loss, muscle loss, and declining physical function.

Adequate nutritional support is therefore an important part of comprehensive cancer care.

Drawing on established clinical nutrition guidelines, DengYueMed explains how to choose oral nutritional supplements for cancer patients and outlines the basic principles of nutritional support during cancer care.

1. Why Should Cancer Patients Consider Oral Nutritional Supplements?

Cancer and its treatment can affect nutritional intake in several ways.

For example, chemotherapy, radiotherapy, and surgery may cause nausea, vomiting, changes in taste, oral mucositis, difficulty swallowing, or diarrhea, making it harder for patients to eat enough.

When nutritional intake remains below the body’s needs, patients may experience weight loss, skeletal muscle loss, fatigue, and reduced physical capacity. In more severe cases, these problems may also affect quality of life and tolerance of cancer treatment.

What Are Oral Nutritional Supplements (ONS)?

Oral nutritional supplements (ONS) are products designed to supplement the regular diet. They typically provide energy, protein, fat, carbohydrates, and varying amounts of vitamins and minerals. Common formats include ready-to-drink nutritional beverages and powders.

The primary purpose of ONS is to fill nutritional gaps rather than completely replace regular meals.

According to the European Society for Clinical Nutrition and Metabolism (ESPEN) practical guideline on clinical nutrition in cancer, interventions for patients who can eat orally but are malnourished or at risk may include dietary counseling, symptom management, and ONS.^[1]

2. Which Cancer Patients Should Consider Oral Nutritional Supplements?

ONS may be considered when a regular diet cannot meet a patient’s nutritional needs.

The following situations deserve particular attention: 🔽

Persistent appetite loss or reduced food intake: The patient is eating significantly less than usual and struggles to obtain enough energy and protein.
Unintentional weight loss: Body weight has been declining, particularly when accompanied by muscle loss, fatigue, or reduced physical function.
Treatment-related symptoms that interfere with eating: Nausea, vomiting, oral mucositis, changes in taste, difficulty swallowing, or early satiety reduce food intake.
Gastrointestinal cancer or recovery after surgery: Food intake, digestion, absorption, or nutritional requirements may change.
Older age or muscle loss: Malnutrition or muscle depletion may be present even when the body mass index (BMI) is within the normal range.
Treatment associated with a high risk of inadequate intake: Some combination regimens and highly emetogenic treatments may significantly reduce food intake.

ESPEN, ESMO, and ASCO recommend early nutritional risk assessment, regular monitoring of dietary intake and weight, and timely dietitian support to address nutritional concerns during cancer care.^[1-3]

3. How to Choose Oral Nutritional Supplements for Cancer Patients?

The key to how to choose oral nutritional supplements for cancer patients is to match the formula to the individual’s nutritional requirements, digestive function, and coexisting conditions.

how to choose different types of oral nutritional supplements for cancer patients

3.1 Standard Intact-Protein Formulas: A Common Starting Point for Basic Nutritional Support

Standard intact-protein formulas generally contain whole proteins and provide fat, carbohydrates, vitamins, and minerals.

For patients with relatively normal gastrointestinal function and no significant malabsorption, these formulas are often a starting point when considering ONS.

Key factors to check include: 👇

Energy content: How much energy does each serving provide?
Protein content: Can the formula help fill the gap between daily protein intake and nutritional requirements?
Daily intake: How much supplementation may be needed to meet the nutritional target?
Taste and tolerance: Can the patient comfortably tolerate the flavor, volume, and ingredients?

Patients who can continue eating regular meals may take ONS between meals to supplement their usual diet.

3.2 High-Energy-Density Formulas: For Patients With Limited Food Intake

Poor appetite, early satiety, nausea, and other treatment-related symptoms may prevent patients from obtaining enough energy from regular meals.

High-energy-density formulas provide more energy in a relatively small volume, making them useful for patients who cannot tolerate large servings but still have substantial energy requirements.

These formulas may also be advantageous for people who need to restrict fluid intake.

When comparing products, consider both energy density per milliliter and protein content. A formula that supplies plenty of calories may still leave a protein gap if its protein content is insufficient.

3.3 Elemental and Peptide-Based Formulas: For Specific Digestive or Absorptive Problems

Elemental formulas generally contain free amino acids, while peptide-based formulas contain partially hydrolyzed proteins.

These products are intended for selected digestive or absorptive problems rather than being the routine first choice for every cancer patient.

For some patients with short bowel syndrome, extensive intestinal resection, or severe malabsorption, a physician or clinical dietitian may consider these formulas based on gastrointestinal function and tolerance.

3.4 Diabetes-Specific Formulas: Balancing Nutritional Intake and Blood Glucose Management

Cancer patients with diabetes or impaired glucose tolerance need to consider both energy and protein intake and blood glucose management.

Diabetes-specific formulas generally modify carbohydrate composition and may also adjust the proportion of fat to help manage postprandial glucose responses.

Blood glucose can be monitored as clinically appropriate, while the healthcare team coordinates nutritional support with glucose-lowering treatment. Maintaining glycemic control should not come at the expense of adequate nutritional intake.

3.5 Formulas for Patients With Impaired Kidney Function: Consider Renal Status and Nutritional Needs

Cancer patients with chronic kidney disease need to pay particular attention to protein, sodium, potassium, phosphorus, and fluid content when selecting ONS.

Requirements vary considerably between individuals. Some patients need to limit certain electrolytes or fluids, while others—particularly those experiencing malnutrition or muscle loss, or receiving dialysis—may require adequate protein support.

Formula selection should therefore reflect the stage of kidney disease, dialysis status, and overall nutritional condition. Restricting protein without an appropriate assessment may worsen nutritional deficiencies and muscle loss.

3.6 Immunonutrition Formulas: Consider Specific Perioperative Settings

Some immunonutrition formulas contain ingredients such as arginine, nucleotides, and omega-3 fatty acids.

Research has examined their role in perioperative nutritional support for selected patients undergoing cancer surgery, including outcomes such as postoperative infectious complications and recovery.

For patients scheduled for major surgery, particularly certain gastrointestinal cancer procedures, the suitability of immunonutrition should be assessed according to the type of surgery, nutritional risk, and the hospital’s perioperative nutrition protocol.

3.7 Formulas With Specialized Nutritional Ingredients: Match Ingredients to Specific Needs

Some ONS products contain additional ingredients such as omega-3 fatty acids, glutamine, arginine, or branched-chain amino acids.

These nutrients have different levels of research support in different disease states and clinical settings, and their potential uses are not interchangeable.

When comparing these products, first determine whether the formula provides sufficient total energy and protein. Then consider whether the specialized ingredients are relevant to the patient’s specific nutritional needs.

👩‍⚕️ Overall, standard intact-protein formulas suit many patients who need basic nutritional supplementation. High-energy-density formulas can help when intake volume is limited, while elemental, disease-specific, and immunonutrition formulas are intended for more specialized clinical needs.

4. How Much Energy and Protein Do Cancer Patients Need?

ons intake should be based on daily nutritional needs and regular dietary intake

The amount of ONS required depends on the patient’s total daily nutritional needs and how much energy and protein they already obtain from regular food.

The ESPEN practical guideline on clinical nutrition in cancer suggests that, when individual measurements are unavailable, energy requirements for adults with cancer can initially be estimated at 25–30 kcal/kg of body weight per day. ^[1]

Protein intake should generally exceed 1 g/kg of body weight per day and may be increased to approximately 1.5 g/kg per day, where appropriate.

For an adult weighing 60 kg, this corresponds to:

Daily energy: Approximately 1,500–1,800 kcal.
Daily protein: More than 60 g, potentially reaching approximately 90 g when appropriate.

When determining how to choose oral nutritional supplements for cancer patients, consider weight changes, nutritional status, treatment stage, kidney and liver function, and other clinical factors, as these estimates are not fixed targets for everyone.

5. How to Use Oral Nutritional Supplements Correctly

5.1 Assess Dietary Gaps First

Record usual food intake, weight changes, and relevant symptoms to identify energy and protein gaps. Use these findings to guide ONS type, amount, and timing.

5.2 Adjust Intake to Individual Tolerance

Poor appetite or early satiety: Take smaller portions between meals.
Personal preferences: Adjust flavor, temperature, and serving size to improve tolerance.

5.3 Manage Symptoms That Affect Eating

Nausea, pain, oral mucositis, difficulty swallowing, and diarrhea may reduce nutritional intake. Symptom management and adjustments to food texture or eating methods can help.

5.4 Monitor Nutritional Status Regularly

Track the following indicators:

Body weight and energy and protein intake
Muscle status and physical activity
Gastrointestinal tolerance
Blood glucose, kidney function, and electrolyte levels, when appropriate

If oral intake remains inadequate, reassess the nutritional support plan.

6. Common Misconceptions About Oral Nutritional Supplements for Cancer Patients

Misconception 1: Patients With a Normal Body Weight Do Not Need Nutritional Support

Body weight and BMI do not fully reflect nutritional status. Some patients may experience muscle loss or inadequate protein intake even before substantial changes in body weight become apparent. Recent weight changes, dietary intake, and muscle status should also be considered.

Misconception 2: Higher-Calorie Formulas Always Provide Better Nutritional Support

High-energy-density formulas can help patients obtain more calories in a smaller volume, but protein and other nutrient requirements still matter. The formula should match the actual nutritional gap rather than simply provide the highest possible calorie content.

Misconception 3: Formulas With More Specialized Ingredients Are Always Better

Different ingredients have different levels of evidence and are intended for different clinical settings. Adequate energy and protein intake should be the priority, followed by consideration of whether specialized ingredients offer a relevant benefit.

Misconception 4: ONS Can Completely Replace Regular Meals

For patients who can continue eating, ONS is generally intended to supplement the usual diet rather than automatically replace meals. Regular food and nutritional supplements can work together to improve overall intake.

Misconception 5: Nutritional Status Does Not Need to Be Reassessed After Starting ONS

Nutritional requirements can change with treatment stage, symptoms, and overall health. Regularly monitoring body weight, dietary intake, muscle status, and tolerance helps identify when the nutritional plan needs adjustment.

Conclusion

How to choose oral nutritional supplements for cancer patients depends on individual needs. Standard formulas suit general supplementation, high-energy formulas help when intake is limited, and specialized formulas address specific nutritional needs.

Choosing oral nutritional supplements for cancer patients involves early nutritional risk assessment, symptom management, adequate energy and protein intake, and regular monitoring, as recommended by ESPEN, ESMO, and ASCO.^[1-3]

As a global pharmaceutical distributor, DengYueMed continues to follow developments in oncology-related medicines and specialized healthcare products, providing international partners with information about China’s pharmaceutical supply chain and related product resources.

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FAQ about How to Choose Oral Nutritional Supplements for Cancer Patients

What Are Oral Nutritional Supplements for Cancer Patients?

Oral nutritional supplements (ONS) are products that help cancer patients meet their energy, protein, vitamin, and mineral needs when regular food intake is insufficient.