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Oral nutritional supplements in oncology

consulting ONS
Oral nutritional supplements are part of a supportive nutrition therapy.

Nutrition is a crucial topic in oncology, but often underestimated or overlooked. Many patients suffer from malnutrition or cachexia even at the very beginning of their cancer diagnose. As a healthcare professional clinical evidence is crucial to provide the best nutritional support possible for your patient.

Do you ask yourself…?

...What kind of malnutrition does my patient have?
...How can I check the nutritional status of cancer patients?
...What’s new in the field of supplementation?
...What does my patient need?

Questions like these are common and we provide valuable information for healthcare professionals like you.

Discover our supportive ONS (oral nutritional supplement) products in the fight against malnutrition and the nutritional management of cancer cachexia and find out how to combine products.

Quick product overview

What are oral nutritional supplements?

ONS belong to enteral nutrition and are commonly known as sip feeding and protein or energy supplementation by a powder. It makes sense that ONS should be part of the nutrition counseling process and in a frame of a standardized counseling process it can be more effective than given alone.

Nutrition with ONS
ONS as part of nutrition counseling.

Why and when?

A recent study of head and neck cancer patients undergoing radiotherapy shows that nutritional counseling and the systematic use of ONS leads to lower loss of body weight, higher protein calorie intake and improvement in QoL over time than nutrition counseling alone.1

Additionally, a reduced need for changes in scheduled anticancer treatments has been seen in the treatment group (i.e., for RT and / or systemic treatment dose reduction or complete suspension).1

In a post hoc analysis with advanced pancreatic cancer patients, was observed that only patients with ONS and weight stabilization experienced improvement in survival.2 Nutrition counseling and simultaneous intake of ONS and megestrol acetate in colorectal cancer patients also showed longer survival in the intervention group (19,1 months vs 12,4 months, p=0.022).3

But even without nutrition counseling, the intake of ONS in cancer patients is beneficial. In a systematic review of oral nutritional interventions in malnourished cancer patients, statistically significant improvements in emotional functioning and global QoL, dyspnea and loss of appetite symptom scales were shown.4


Compliance with ONS is a challenge for cancer patients in the presence of the burden of many symptoms due to illness or therapy2 and can be achieved with higher energy-density ONS.5 Consideration of patient’s preferences regarding flavor, style and presentation are also important to support compliance. ONS should not decrease or replace a voluntary intake or normal food.6

The ESPEN guidelines recommend offering oral nutritional supplements in combination with dietary advice to increase oral intake in cancer patients who are able to eat but are malnourished or at risk of malnutrition.7

How to offer?

Patient drinking Remune (ONS)
ONS in different flavors for maintaining compliance.

Types of ONS

ONS belong to enteral nutrition and are liquid, semi-solid or powder products that provide macronutrients and micronutrients, and refer to a particular category of foods defined by European law8,9 as Foods for Special Medical Purposes (FSMP).10 A wide variety of ONS are available but insurance companies do not always reimburse patients for these kinds of products.

ONS can be:

  • high in protein, omega-3 from fish oil and carbohydrates
  • clear liquids, fruit-based or milk-based on milk or soy
  • consumed cold or hot
  • presented in different consistencies from totally liquid to thickened form to help patients with swallowing disorders
  • partially or fully balanced

Hospitals should provide a broad variety of products (with each product in different flavors). At home, patients can be more creative, like converting ONS into shakes, ice cream or use them as a basis for making soups or desserts.6


Description Document Link
Clinical study with Remune™ Laviano et al. Safety and Tolerability of Targeted Medical Nutrition for Cachexia in Non-Small-Cell Lung Cancer: A Randomized, Double-Blind, Controlled Pilot Trial
pdf (358.9 KB)

1 Cereda E, Cappello S, Colombo S, Klersy C, Imarisio I, Turri A, et al. Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy. Radiother Oncol. 2018;126(1):81-8.

2 Davidson W, Ash S, Capra S, Bauer J. Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr. 2004;23(2):239-47.

3 Dobrila-Dintinjana R, Trivanovic D, Zelic M, Radic M, Dintinjana M, Petranovic D, et al. Nutritional support in patients with colorectal cancer during chemotherapy: does it work? Hepatogastroenterology. 2013;60(123):475-80.

4 Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis.J Natl Cancer Inst. 2012;104(5):371-85.

5 Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clin Nutr. 2012;31(3):293-312.

6 Jonkers-Schuitema CF, Dardai E. Oral nutritional supplements. In: Sobotka L, editor. ESPEN Book: Basics in Clinical Nutrition. 4 th ed: GALEN; 2011:312-4.

7 Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48.

8 Regulation (EU) No 609/2013 of the European parliament and of the council of 12 June 2013 on food intended for infants and young children, food for special medical purposes, and total diet replacement for weight control.

9 Commision delegated regulation (EU) 2016/128 of 25 September 2015 supplementing Regulation (EU) No 609/2013 of the European Parliament and of the Council as regards the specific compositional and information requirements for food for special medical purposes.

10 MNI (Medical Nutrition Industry). Better care through better nutrition: Value and effects of Medical Nutrition: A summary of the evidence base. 2018. Available at https://medicalnutritionindustry.com/files/user_upload/documents/medical_nutrition/MNI_Summary_Booklet_2018_FINAL_HR.pdf on 9. September 2020.