Best practices for home nutritional management in postoperative gastric cancer patients: an evidence summary

Abstract

Objective

To review and summarize the most compelling evidence on home nutritional management for postoperative gastric cancer patients, with the aim of providing a reference to improve patients’ nutritional status at home.

Methods

A comprehensive search was conducted across both Chinese and English-language databases according to the ‘6S’ evidence resource model to identify relevant literature on home nutritional management for postoperative gastric cancer patients. The selected studies were screened, evaluated, and synthesized to extract high-quality evidence.

Results

A total of 19 articles were included in the final review, including 6 evidence-based guidelines, 4 expert consensus, 2 systematic reviews, 1 evidence summary, 1 qualitative study, 1 class experiment, and 4 RCTs. Through induction and integration, 27 best evidences were formed, which was cat-egorized into seven key areas: nutritional monitoring and assessment, multidisciplinary teamwork, home nutritional management, home nutritional support, health promotion, symptom management, and post-discharge follow-up. These evidences provide clear practical recommendations, such as the selection of home nutrition assessment tools (NRS-2002), the frequency of nutrition assessment (Every two weeks for the first three months), the order of home nutrition during rehabilitation (Diet-ONS-HEN), and the treatment of postoperative adverse nutritional symptoms.

Conclusion

This study presents a systematic compilation of the best available evidence on home nutritional management for postoperative gastric cancer patients. The findings provide a scientifically grounded framework for healthcare professionals and patients to optimize nutritional care at home. In the future, investigations should focus on translating these evidences into practice through implementation science methodologies, while systematically evaluating the contextual barriers of the implementation of theoretical evidence and the gap between it and the real demand.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-025-14608-9.

Introduction

Gastric cancer remains one of the leading causes of cancer-related mortality worldwide, with a high incidence of malnutrition following surgical intervention [1]. Postoperative malnutrition in gastric cancer patients is common due to factors such as reduced stomach volume, surgical trauma, and symptoms like nausea and vomiting [2]. Studies show that the incidence of postoperative malnutrition in gastric cancer patients can reach as high as 80%, the highest among all cancers [3], and approximately 30% of patients continue to experience malnutrition one year or even longer after surgery [4], which significantly impacts both their prognosis and survival [5].

Current research on postoperative nutrition for gastric cancer patients primarily focuses on perioperative period and chemoradiotherapy, neglecting home-based nutrition. In reality, the challenge of family nutrition is even more severe. Following discharge, 40.5%~57.8% of post-gastrectomy patients gastric cancer patients typically experience a notable decline in weight and BMI compared to their admission levels [6]. With the increasing promotion of the Enhanced Recovery After Surgery (ERAS) concept, which results in shorter hospital stays, patients may not meet the necessary nutritional standards upon discharge. This situation transfer complex nutritional responsibilities to unprepared households. Furthermore, in contrast to the supportive nutritional conditions in hospitals, including tailored nutritional regimens and oversight by healthcare professionals, patients at home often face constraints due to limited knowledge, insufficient self-management skills, and inadequate familial nutritional support. These factors compound the difficulties associated with managing nutrition at home, consequently heightening the risk of malnutrition.

Despite the existence of guidelines for home-based nutritional management, such as those provided by the European Society for Clinical Nutrition and Metabolism (ESPEN)l [7] and the Australian Society for Parenteral and Enteral Nutrition (AUSPEN) [8], which offer detailed technical specifications and implementation protocols for home enteral nutrition (HEN) and home parenteral nutrition (HPN), there is a lack of comprehensive and systematic practical guidance, particularly regarding patient self-management and family involvement.

Given these challenges, this study aims to summarize the best available evidence on the home nutritional management of postoperative gastric cancer patients, guided by evidence-based nursing practices. The goal is to provide both patients and healthcare professionals with evidence-based recommendations and framework for practice to improve the nutritional status and overall well-being of patients after discharge.

Data and methods

Reporting method

This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature’s quality evaluation, the summary and grading of evidence and the formation of practical suggestions.

Registration statement

This evidence summary was registered with the Fudan University Center for Evidence-Based Nursing (No. ES20232465).

Problem establishment

The PIPOST tool from the JBI Nursing Centre of Fudan University was used to define the evidence-based question [9]. This tool was employed to clarify the evidence-based problem, using the following components: Population (P): Postoperative gastric cancer patients discharged from the hospital who require home nutritional care. Intervention (I): Postoperative home nutritional management strategies. Personnel (P): Researchers, healthcare professionals, nutritionists, dietitians, patients, and caregivers. Outcome (O): Primary nutritional outcomes, including nutritional risk, malnutrition, body mass index (BMI), weight, muscle mass, albumin, and hemoglobin levels. Secondary health-related outcomes include quality of life, complications, survival, and survival rates. Setting (S): Out-of-hospital settings, including community and home environments. Study Types (T): Clinical decision-making, clinical guidelines, evidence summaries, systematic reviews, expert consensus, qualitative studies, and randomized controlled trials (RCTs) strongly relevant to the topic.

Literature screening

Search datebases

According to the ‘6S’ pyramid model [10], a comprehensive search was conducted in multiple databases, including BMJ best practice, UpToDate, NICE, GIN, NGC, RNAO, SIGN, AuSPEN, CMA, NZGG, EBMR, ASPEN, ESPEN, JSCN, Cochrane, ACP Club, PubMed, Web of Science, Embase, CBM, OVID, CNKI, VIP, and WanFang, in order of priority.

Search terms

Search terms included combinations of: “gastric”, “stomach”, “cancer”, “carcinoma”, “tumor”, “neoplasms”, “gastrectomy”, and “nutrition”, “diet”, “food”, “oral”, and “home”, “house”, “family”, “out-of-hospital”, “discharged”, “rehabilitation”.

Search time

The search period covered the time from the establishment of the databases to 30 December 2024.

Inclusion of literature

Inclusion Criteria: Studies that conform to the components outlined in the PIPOST framework. Studies published in Chinese or English. Exclusion Criteria: Studies with unavailable full text. Duplicate publications or multiple language versions of the same study. Studies rated as quality level B or below. Studies with content unrelated to the topic. Outdated versions of studies that have been updated.

Screening steps: Chinese articles were translated using Deep L translation software, and duplicate articles were eliminated using Endnote software. Primary screening: the primary screening according to the literature title and abstract, eliminate the literature, patent literature, case reports, animal tests, etc., unrelated to the research content. Screening again: carefully read and evaluate the literature left by the initial screening, exclude the full text, poor quality, incomplete report information, the content of the full text is not consistent with the theme. Two graduate students trained in evidence-based methodologies independently screened literature, with exclusion reasons documented in a standardized form. After completion, the screened results were compared. If there is any conflict, discrepancies were resolved through re-evaluation and consensus discussions between the two reviewers. Unresolved conflicts were adjudicated by an associate professor (third reviewer) based on predefined inclusion criteria. Finally, list all outcomes, extract the basic information of the extracted literature, includes: author, literature source, year of publication, research type, and literature topic.

Literature’s quality evaluation

Quality evaluation tools

Guideline literature quality was assessed using AGREE-II (Appraisal of Guidelines for Research and Evaluation II) [11]. Systematic review literature was evaluated using AMSTAR 2 (A Measure Tool to Assess Systematic Reviews 2) [12]. Clinical decision-making tools, expert consensus, qualitative studies, and RCTs were evaluated according to the criteria provided by the JBI Centre for Evidence-Based Health Care (2016 version) [13]. The quality of evidence summaries was determined by tracing the original literature and applying the corresponding evaluation criteria based on the original source.

• (i)Guidelines: Guideline literature quality was assessed using AGREE-II (Appraisal of Guidelines for Research and Evaluation II) [11](updated in 2017), including 6 domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity, Applicability, Editorial Independence). According to the degree of consent, each item is scored from 1 to 7 and standardized percentage scores were calculated as: [(obtained score - minimum score)/(maximum score - minimum score)] ×100%. After standardizing the total score of each item in a certain field, the final score obtained is the score in this field.Guidelines scoring ≥ 60% in ≥ 3 domains were classified as Grade A, the rest as Grade B.
• (ii)Systematic Reviews: AMSTAR 2 was applied to evaluate 16 items, focusing on 7 critical domains (Items 2, 4, 7, 9, 11,13 and 15). Reviews meeting all critical items were rated A; those with partial unmet non-critical items were rated B.
• (iii)Clinical decision-making, expert consensus, qualitative studies, and RCTs were evaluated according to the criteria provided by the JBI Centre for Evidence-Based Health Care (2016 version) [13]. Studies fulfilling all criteria were rated A; those with unmet critical dimensions were rated B. The JBI RCT checklist evaluated 11 items. RCTs with ≥ 80% “Yes” responses were rated A; 60–79% were rated B.
• (iv)Evidence summary: The quality of evidence summaries was determined by tracing the original literature and applying the corresponding evaluation criteria based on the original source.

Quality evaluation process

The evaluation team consisted of an associate professor of nursing and two graduate nursing students, all trained in evidence-based skills.The evaluation process was conducted strictly according to the instructions for each tool. Only studies rated A or B quality were included, with AMSTAR 2 results categorizing high-quality studies as level A and medium-quality studies as level B. The graduate students independently completed the literature’s quality evaluation, with the results compared and harmonized. In cases of disagreement, the associate professor made the final judgment and consolidated the results.

Evidence extraction, grading and summarisation

The synthesis process involved structured steps to ensure rigor: (i)Content Extraction— After thoroughly reviewing the literature, we extracted relevant information and identified valid evidence, which have practical guidance value; (ii)Evidence Grading—Evidence was graded and recommended according to the JBI Evidence Pre-grading (1a-5b) and Evidence Recommendation Level System (2014 version) [14]. Using the FAME evaluation principle to evaluate the feasibility, suitability, clinical significance and effectiveness of the evidence, and give recommendations (A is a strong recommendation, and B is a weak recommendation); (iii)Evidence Synthesis— Recurring themes were identified through review, and the evidence was organized and summarized in accordance with the subject’s practice and logical framework. Similar content was distilled into concise, easily understandable evidence, and complementary content was merged. In cases of conflicting content, guidelines were prioritized, with a preference given to high-quality, authoritative, and recent evidence. (iv) Visualization—Finally, clear evidence recommendations were tabulated by domain with evidence grades and recommendation (Table 3), and a home nutrition management flow chart was produced and presented (Fig. 2).

Table 3.

Summary of best evidence for home nutrition management of postoperative gastric cancer patients

Evidence items	Content of evidence	Level of evidence	Recommended level
Nutrition monitoring and assessment	1. All patients need to receive regular nutritional screening and assessment beginning with a cancer diagnosis.l [16, 23].	1b	A
	2. Nutritional screening every 2 weeks for 3 months postoperatively [21, 24].	5b	A
	3. Nutritional risk screening tool recommendation NRS-2002. [19, 21, 23].	1a	A
	4. For those at nutritional risk, further nutritional assessment, which can be combined with the PG-SGA scale [23, 24].	2b	A
	5.Nutritional screening should be performed before surgery, and nutritional therapy is recommended 7 to 14 days before surgery for patients with moderate or severe malnutrition [23].	5b	A
Multidisciplinary teamwork	6. Recommend the formation of a multidisciplinary nutrition management team [4].	5b	A
	7. The team will customise a personalised home nutrition plan for the patient. [29] The family nutrition manual is given at the time of discharge from the hospital.	1a	A
Home nutriti-on coordinated management	8. Establishment of the “Internet +” hospital-community-family linkage model [29].	1a	B
	9.Establish a family-centred care model that encourages patients and their families to participate in nutritional management. [29, 33].	1a	A
	10. Encourage patients to keep a “diet diary” to provide feedback on weight, intake and output, adverse symptoms and nutritional problems [31].	1b	B
Home nutrition support	11. The nutritional sequence in recovery is diet + nutritional education [24], then escalate upwards to select ONS, HEN, HPN in that order.	5b	A
	12.ONS is based on whole proteins, and those with gastrointestinal insufficiency are based on amino acids and short peptides, with a daily intake of at least 400 to 600kcal [26].	5a	A
	13.HEN recommends feeding via nasogastric or enteral tube [32], nocturnal enteral nutrition is recommended when the duration of feeding is > 4 weeks. Continuous nutritional support through a jejunostomy or gastrostomy for 8–10 h at night [28].	5b	B
	14. Calculation of energy requirement is based on 25-30 kcal/(kg-d) and protein starts at 1.0–1.5 g/(kg-d) [16].	5a	A
	15. Continuous ONS nutrition is required for 3 to 6 months or more after discharge from the hospital. [23, 26].	5b	A
	16. Patients undergoing major or total gastrectomy are regularly monitored for vitamin, folate, iron and calcium levels [21] When insufficient timely replenishment as prescribed by the doctor [16].	5b	A
	17. Patients with subtotal pylorectomy should be alert to dumping syndrome.	4c	A
	18. There are differences in dietary frequency between different reconstruction methods.Roux-en-Y: Patients are more likely to consume less than 300 ml per meal and require more than 5 meals per day; Interposition Loop: Patients generally have larger meal sizes and eat less frequently than those with RY reconstruction [37].	1c	B
Home nutrition education	19. Eat small meals, chew slowly, low oil, low sugar, light and easy-to-digest diet, avoid cold, hard and stimulating food. [22] Avoid raw, cold, hard and stimulating foods.	3b	A
	20. Increase dietary diversity during the recovery period by eating more fruits, vegetables and fruits, dairy products and whole grains, and increasing fish, poultry, eggs, milk and legumes intake [24].	5a	A
	21. Quit smoking, alcohol, tea and coffee. Exercise moderately. [30, 31] Exercise moderately.	3d	B
Symptom management	22. Postoperatively, they are prone to adverse reactions such as gastroparesis, dumping syndrome, gastric reflux, loss of appetite, early satiety, and nausea, vomiting, pain, diarrhoea and other symptoms [30, 31].	2b	A
	23. People with dumping syndrome should eat drier foods and avoid diets high in sugar. Meals should be taken in a semi-sitting position, with lying down for half an hour after the meal. [31, 34].	4c	A
	24. People with gastroparesis should eat less high-fat food, eat regularly [31] If necessary, consider gastric stimulants.	1d	A
	25. Gastric reflux patients stand or walk slowly within half an hour after eating, elevate the upper half of the body when sleeping, and do not eat for 3 h before bedtime. [31].	1c	B
	26. For nausea and vomiting, choose warm, cool, light and dry foods, and avoid greasy and irritating foods. [31].	1d	A
	27. Patients with diarrhoea should have a low-fat, low-fibre, low-lactose diet and be careful to stay hydrated. [25, 31].	1c	B
	28. People with a poor appetite should increase the colour, aroma and nutrition of food, and a walk 1 h before a meal can help to increase the appetite. [16].	1b	A
Discharge Follow-up	26. Follow-up visits were made on days 3, 7 and 21 after discharge for postoperative recovery, nutritional status and guidance [30].	2b	B
	27. Remind patients of the importance of outpatient review, at least every 3 months [20].	1c	A

Fig. 2.

Home nutrition management flow chart for postoperative gastric cancer patients

Results

Results of the literature search

A total of 19 articles were included in the final review. These consisted of 6 evidence-based guidelines [15–20], 4 expert consensus articles [21–24], 2 systematic reviews [25, 26], 1 evidence summary [4], 1 qualitative study [27], 1 class experiment [28], and 4 RCTs [29–32]. The specific search process is shown in Fig. 1, and the basic information for the included studies is provided in Table 1.

Fig. 1.

Flow chart of literature search

Table 1.

Basic information of the included literature

No.	Authors	Literature subject	Source	Year	Type of Literature	Quality
1	ESPEN [16]	ESPEN practical guidelines: clinical nutrition in cancer	ESPEN	2021	Guideline	A
2	ESPEN [17]	ESPEN Guidelines on Parenteral Nutrition: Home Parenteral Nutrition (HPN) in adult patients	ESPEN	2009	Guideline	A
3	ESPEN [15]	ESPEN guideline on home enteral nutrition	ESPEN	2020	Guideline	A
4	AUSPEN [18]	AUSPEN clinical practice guidelines for home parenteral nutrition patients in Australia and New Zealand	AUSPEN	2008	Guideline	B
5	CSPEN [19]	Guidelines for Nutritional Support in Oncology Patients	CNKI	2017	Guideline	A
6	Shi Hanping [20]	Guidelines for Nutritional Therapy in Gastric Cancer Patients	CNKI	2015	Guideline	B
7	Ping-I.Hsu et al. [21]	Taiwan nutritional consensus on the nutrition management for gastric cancer patients receiving gastrectomy	PubMed	2021	Expert consensus	A
8	Li ZY et al. [23]	Chinese expert consensus on perioperative nutritional therapy for gastric cancer	CNKI	2020	Expert Consensus	B
9	Yu Kang et al. [24]	Expert consensus on nutritional management for malignant tumour patients during rehabilitation	CNKI	2017	Expert Consensus	B
10	Li Zenning et al. [22]	Expert Consensus on Dietary and Nutritional Prescription for Patients with Malignant Tumours	CNKI	2017	Expert Consensus	A
11	Sharon Carey et al. [25]	Long-term nutrition support in gastrointestinal disease–a systematic review of the evidence	PubMed	2012	Systematic review	B
12	He Xueting et al. [26]	Home enteral nutrition and oral nutritional supplements in postoperative patients with upper gastrointestinal malignancy: A systematic review and meta-analysis	PubMed	2021	Systematic review	A
13	Fei, Chao-Nan et al. [4]	Summary of the best evidence for perioperative nutritional management in gastric cancer patients	CNKI	2022	Summary of evidence	A
14	Fariba Taleghan et al. [27]	Nutritional challenges in gastric cancer patients from the perspectives of patients, family caregivers, and health professionals: a qualitative study	PubMed	2021	A qualitative study	B
15	Komatsu S. et al. [28]	Night home enteral nutrition as a novel enforced and physiologically effective nutrition therapy following total gastrectomy for gastric cancer.	PubMed	2022	Class experiment	A
16	Liu J. et al. [29]	Effects of the “H2H” nutritional management model on the nutritional status and quality of life of patients after radical gastrectomy for gastric cancer.	CNKI	2022	RCT	B
17	Zhou Yuling et al. [30]	Problem classification-based health education on home nutritional support for postoperative gastric cancer patients	CNKI	2020	RCT	B
18	Wang F et al. [31]	Effects of dietary modification and symptom management on nutritional status in patients after gastrectomy	CNKI	2019	RCT	B
19	Cecilia Gavazzi et al. [32]	Impact of home enteral nutrition in malnourished patients with upper gastrointestinal cancer: a multicentre randomised clinical trial	PubMed	2016	RCT	A

Results of quality assessment of the included literature

Quality evaluation of guideline literature

Six evidence-based guidelines were included [15–20], with 4 rated as Grade A and 2 as Grade B. The detailed evaluation results are presented in Table 2.

Table 2.

AGREE-II quality evaluation results of guideline literature

Included literature	Percentage of standardisation in each field (%)						≥ 60% Numb	≥ 30% Numb	Quality
	Scope Purpose	Participants	Rigour	Clarity	Applicability	Independence
ESPEN, 2021 [16]	92.2	64.1	92.5	98.5	77.2	98.1	6	6	A
ESPEN, 2009 [17]	80.1	82.3	86.4	65.0	89.0	73.1	6	6	A
ESPEN, 2022 [15]	89.2	77.8	83.1	75.5	60.3	85.4	6	6	A
AUSPEN, 2008 [18]	82.5	72.6	57.5	67.1	50.3	70.3	4	6	B
Chinese Medical Association, 2017 [19]	87.3	85.2	70.5	93.2	62.7	83.1	6	6	A
Shi Hanping, 2015 [20]	93.2	73.3	51.3	65.7	70.2	63.3	5	6	B

Quality evaluation results of expert consensus literature

Four expert consensus articles were included [21–24]. Among these, Li Zengning [22] and Ping I. Hsu [21] received “Yes” for all evaluation criteria and were rated as Grade A. The remaining two articles [23, 24] were rated as “No” for the sixth criterion (heterogeneity of viewpoints), leading to their Grade B classification.

Quality assessment of systematic evaluation literature

Two systematic reviews were included [25, 26]. The two systematic evaluations, He Xueting et al. [26] received “No” for the non-critical entry 10, but all other entries were rated “Yes,” resulting in a Grade A rating. The second review [25] received “No” for the non-critical entries 10 and 12, resulting in a Grade B rating.

Quality assessment of RCT literature

Four RCTs were included [29–32]. The study by Cecilia Gavazzi [32] was rated ‘No’ for entry 5 and ‘Unclear’ for entry 6, receiving a Grade A overall. The remaining three studies were evaluated as ‘Unclear’ for entries 2, 5, and 6, and were rated Grade B.

Quality assessment of the remaining types of literature

The remaining included 1 evidence summary [4], 1 class experiment [28] and 1 qualitative study [27] Taleghan [27] was evaluated as “No” for entry 6 and entry 8, and was rated B. The remaining two papers were rated ‘Yes’ for all entries and were graded ‘A’.

Summary of evidence and practice recommendation results

The summarized evidence see Table 3, and the home nutrition management flow chart see Fig. 2.

Discussion

Post-operative discharged patients still require regular nutritional screening and assessment

All postoperative gastric cancer patients remain at risk of developing malnutrition after discharge from the hospital [7] and require regular nutritional screening and assessment [16, 23]. Currently, there is no unified international consensus on the nutritional screening tools for patients with gastric cancer who are discharged home after surgery. Dr. Annalynn Skipper from the United States conducted an evidence analysis of these tools and concluded that the NRS-2002 received a Grade I rating, while four other tools—Simple Two-Part Tool, Mini-Nutritional Assessment Short Form (MNA-SF), Malnutrition Screening Tool (MST), and Universal Screening Tool for Malnutrition (MUST)—received a Grade II rating [37]. She summarized that the NRS-2002 is suitable for emergency and surgical patients, whereas the AIWW is more appropriate for cancer patients, offering high sensitivity and the ability to predict survival. In China, the Chinese Expert Consensus on Perioperative Nutritional Therapy for Gastric Cancer [23] recommends that all patients diagnosed with gastric cancer undergo nutritional risk screening to identify any potential nutritional risks. It is recommended to use the Nutritional Risk Screening 2002 (NRS-2002) as the primary tool for nutritional risk screening. The NRS-2002 (Nutritional Risk Screening 2002) tool is recommended for this purpose, as it effectively identifies patients at nutritional risk [19]. It is suggested that patients undergo nutritional screening and assessment every two weeks for the first three months post-surgery, and then at intervals of one to three months thereafter. If any nutritional issues are detected, reassessment should be performed following treatment [21, 24]. If the NRS-2002 score is ≥ 3, a more comprehensive nutritional assessment should be conducted, encompassing the patient’s medical history, food intake, BMI, weight changes, muscle mass, physical fitness, and biochemical indicators [22]. If available, the Patient-Generated Subjective Global Assessment (PG-SGA) can be used in conjunction with the NRS-2002 for a more comprehensive evaluation of nutritional status [23].

Establishment of a multidisciplinary team model with multi-party assistance for patient nutritional management

Multiple lines of evidence [4] clearly recommend the establishment of a multidisciplinary teamwork model for nutritional management, which should include clinicians, dietitians, specialist nurses, and community healthcare workers. Community nurses, particularly Clinical Nurse Specialists (CNS) in nutrition, are pivotal in bridging hospital-home gaps. As demonstrated internationally [38], CNS competencies in assessment and telehealth mitigate readmission risks. This team collaborates to formulate personalized nutrition plans that meet the individual needs of each patient. It is essential that the nutrition team designs these plans based on various factors, such as the patient’s nutritional status, digestive and absorption capabilities, physical condition, and preferences, while also considering the patient’s progression through different recovery stages. Furthermore, it is advised to relax dietary restrictions when appropriate to enhance patient compliance and improve overall nutritional management [27].

Attaching importance to home nutrition management and cultivating patients’ self-nutrition management ability

The trial [29] demonstrated that the establishment of a hospital-community-family nutritional management model, powered by ‘Internet Plus’, strengthens the connection between doctors and patients in home settings and enhances patient mobility. There are problems of unequal health resources in both the world and Chinese area, eHealth models are increasingly recognized as tools to reduce regional health disparities by improving access to care, especially in underserved or rural areas. However, their effectiveness depends on addressing barriers such as digital literacy, socioeconomic status, and infrastructure limitations [39]. Future policies will need targeted strategies to gradually scale up the proven e-health model, which will help reduce regional disparities and ensure equitable access to and impact of health care. Furthermore, a family-centred nutritional management model has proven effective in increasing patients’ motivation for self-management [33]. For instance, various initiatives, such as organizing ‘family nutritional symposiums’ and establishing ‘nutritional communication groups’, can be implemented to encourage patients and their families to take an active role in nutritional management. This not only helps patients maintain communication with the outside world but also fully mobilizes their motivation for better self-care.

Scientific nutritional support and rational choice of nutritional methods and types

Expert consensus suggests that gastric cancer patients still require nutritional therapy post-discharge, with Oral Nutritional Supplements (ONS) being the first choice [4, 23]. When intake remains insufficient, Home Enteral Nutrition (HEN) is recommended, particularly for patients who cannot swallow properly, or when ONS alone cannot meet the required nutritional intake. Implementing home enteral nutrition should be done with professional guidance, considering the appropriate enteral nutrition modality, site, preparation, and setting after a thorough assessment to minimize complications [35]. Regarding nutritional supplementation, it is advised to start with energy levels of 25–30 kcal/(kg-d) and protein at 1.0–1.5 g/(kg-d), adjusting according to the patient’s metabolic rate, activity level, age, and specific needs [19]. However, micronutrient supplementation should not be done indiscriminately; it should be based on clear identification of deficiencies [24]. Nutritional management during chemotherapy is crucial for patients. Gastric cancer patients often experience nutritional issues such as nausea and vomiting, which can significantly impact treatment outcomes, quality of life, and survival rates. This study did not summarize this evidence, because completed by scholars like Xin Dan [40]. The findings were categorized into five areas: inter-disciplinary collaboration, nutritional screening and assessment, nutritional needs, nutritional therapy, and discharge and follow-up, resulting in the identification of 62 relevant pieces of evidence. It particularly highlighted the timing of nutrition during chemotherapy, the selection and implementation of different nutritional methods. Additionally, in recent years, traditional Chinese medicine (TCM) treatments for chemotherapy-related nausea and vomiting have shown significant effectiveness and are worth promoting, such as acupuncture and TCM incense bags.

Strengthen the discharge health promotion and pay attention to follow-up and re-examination

Research indicates that patients often have a greater need for nutritional knowledge upon discharge from the hospital [8]. Patient education is the cornerstone of adherence, especially when focused on nutrition, can significantly improve dietary habits and nutritional status in various patient groups. Well-designed nutrition education programs are effective in enhancing dietary compliance, improving clinical outcomes, and supporting recovery in patients with chronic diseases and cancer. A cluster randomized trial showed that nutrition education and counselling can effectively reduce the prevalence of malnutrition (56.0% vs. 70.5%). Nursing staff should not overlook health education due to their busy schedules but should instead patiently provide relevant information, emphasizing the importance of family nutrition. It is essential to guide patients on measures and precautions related to family nutrition. Additionally, healthcare providers should focus on educating patients about nutritional monitoring methods, nutritional support strategies, dietary principles, dietary precautions [22], and managing postoperative adverse symptoms, including the timing of follow-up reviews [30, 31]. In addition to dietary education, ONS is also indispensable. ONS nutrition should be continued for at least 3–6 months after discharge from hospital [4]. However, patient compliance with ONS is often low. Cai Lina et al. [36] highlighted that improvements can be made in areas such as adherence assessment, ONS preparation, and the management of the administration process. After discharge, healthcare professionals should actively monitor patients’ recovery, nutritional status, and adherence to nutritional plans, ensuring regular follow-ups for effective postoperative care [24].

Research limitations

This study aims to summarize the best evidence for home nutritional management of postoperative gastric cancer patients. However, it has several limitations. Firstly, the study focuses solely on gastric cancer patients, neglecting the potential differences in nutritional needs among patients with other diseases. Secondly, the literature search may have missed some grey literature and recent studies published after the search deadline, affecting the comprehensiveness and timeliness of the evidence. Thirdly, the quality evaluation of different types of literature using various tools may not be entirely consistent, and the integration of conflicting or similar evidence might not be precise enough for practical application. Lastly, the influence of social and cultural factors on patients’ dietary habits and family support, which are crucial for nutritional management, is not adequately addressed. In addition, this study conducted a systematic summary of the main nutritional management of patients, but there were some factors affecting nutrition that were not further refined, such as comorbid conditions, psychological factors, drug interaction and changes in taste and smell, and some nutritional details that are not being considered.

Conclusion

This study summarized the best available evidence on home nutritional management for postoperative gastric cancer patients, covering seven key areas: nutritional monitoring and assessment, multidisciplinary teamwork, home nutritional management, principles of home nutritional support, health education, symptom management, and discharge follow-up. This comprehensive evidence base provides healthcare professionals with systematic, evidence-based guidelines for implementing home nutritional management for postoperative gastric cancer patients. It also serves as a reference for improving the nutritional status of patients in the home environment.

Abbreviations

BMJ

British Medical Journal

NICE

National Institute for Health and Clinical Excellence

GIN

Guidelines International Network

NGC

National Guideline Clearinghouse

RNAO

Registered Nurses' Association of Ontario

SIGN

Scottish Intercollegiate Guidelines Network

AuSPEN

Australian Society for Parenteral and Enteral Nutrition

CMA

Certified Management Accountant

NZGG

New Zealand Guidelines Group

EBMR

Evidence-Based Medicine Reviews

ASPEN

American Society for Parenteral and Enteral Nutrition

ESPEN

European Society for Clinical Nutrition and Metabolism

JSCN

Japanese Society of Clinical Nutrition

ACP Club

American College of Physicians Club

CBM

China Biology Medicine disc

OVID

Ovid Technologies

CNKI

China National Knowledge Infrastructure

ONS

oral nutritional supplement

HEN

home enteral nutrition

HPN

home parenteral nutrition

RCT

randomized controlled trial

Authors’ contributions

WSS.contributed to the conceptualization of the topic, provided guidance throughout the research process, and was involved in the writing of the manuscript. WL wrote the main manuscript text manuscript. DL and ZJL were in charge of conducting the literature search 、screening and quality assessment.LLP and LPP was tasked with compiling the evidence and creating the necessary figures and tables. All authors have reviewed the manuscript and provided feedback for its improvement.

Funding

This study has received support National Natural Science Foundation of China for their financial and sponsorship of this research project, under the grant number 72261032.

Data availability

The data is provided within the manuscript.

Declarations

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare no competing interests.