Impact of Nutritional Status on Chemotherapy Response and Adverse Drug Reactions in Gastrointestinal Cancers: A Systematic Review

Sarika B, Chouhan D, Harshitha E, Manish K and Siddhartha S

Published on: 2025-12-31

Abstract

Gastrointestinal (GI) cancers are strongly associated with malnutrition because the tumour itself and the treatment both affect eating, digestion and nutrient absorption. Chemotherapy often worsens weight loss and muscle wasting due to side effects such as nausea, vomiting, diarrhoea, mucositis and loss of appetite.[1-5] Poor nutritional status can lead to reduced treatment tolerance, more frequent and severe adverse drug reactions (ADRs), dose reductions and poorer survival.[3,6-10]

This systematic review aims to summarise the evidence on how nutritional status influences chemotherapy response and ADRs in patients with GI cancers. Electronic databases including PubMed, Scopus, Google Scholar and ScienceDirect were searched for studies from 2015-2025 involving adult GI cancer patients receiving chemotherapy, in whom nutritional status was assessed using tools such as PG-SGA, GLIM, MUST, PNI, BMI or serum albumin, and where treatment response or ADRs were reported.[1,2,9-13]

Across the included studies, malnutrition and high nutritional risk were very common at baseline and often worsened during treatment.[9,14-18] Malnourished patients showed lower chemotherapy dose intensity, more treatment interruptions, higher rates of grade 3-4 toxicities and poorer overall and progression-free survival compared with well-nourished patients.[3,16,18-22] Several studies reported that indices like PG-SGA score, GLIM-defined malnutrition, low PNI or low albumin were independent predictors of severe ADRs such as neutropenia, mucositis and gastrointestinal toxicity.[16,18-21,23-25]

Early nutritional screening, regular reassessment and timely interventions including oral nutritional supplements, diet counselling, enteral or parenteral nutrition and prehabilitation programmes improved treatment tolerance and sometimes clinical outcomes.[4,5,7,8,11-13,22,26]  Overall, the findings support making nutritional assessment and care a routine part of chemotherapy planning for GI cancer patients to improve both safety and effectiveness of treatment.[1-3,18-22].