Nutritional management practices and perspectives of radiation oncologists: outcomes of an international atomic energy agency survey

Abstract Background Radiation therapy (RT) commonly leads to nutrition‑related adverse effects. Poor nutritional status is associated with worse outcomes, yet nutrition support remains underprioritized. This study explores Radiation Oncologists (ROs) perspectives and practices in nutrition management in RT settings across diverse global contexts. Methods An electronic survey developed by the IAEA was distributed globally through a mailing list and social media. The questionnaire comprised 38 items on hospital practices and professional perspectives. Data were analysed using descriptive statistics, Chi-squared or Fisher's exact tests and post‑hoc pairwise comparisons. Results The survey respondents included 209 ROs from 65 countries. Most participants (82%) regarded nutrition as extremely important in RT, and 98% believed it influences clinical outcomes. Common symptoms reported were weight loss, mucositis, dysphagia, loss of appetite, nausea, and taste changes. Barriers to nutrition care included financial constraints, lack of access to nutrition tools and dietitian time constraints and insufficient training, varying across country income groups. Only 35.9% of hospitals had a dietitian dedicated to oncology, and routine dietetic assessment for patients undergoing RT only occurred in 26.5% of hospitals. Weight and clinical judgement were the most used indicators of nutritional status and only 18.2% of hospitals assessed body composition in patients undergoing RT. Conclusion Nutrition is recognized as essential in RT, yet significant gaps remain in workforce capacity, resources, and utilisations of body composition assessments. Coordinated international efforts to integrate nutrition into routine cancer care are critical to improving patient outcomes