A recent retrospective analysis showed that the rate of malnutrition in cancer patients is greater than 55% with 5% weight loss [1] . This is directly associated to cancer cachexia [1] . The role of nutritional counselling by dieticians is therefore essential to improve the quality of life of the patient at home and for reducing the risk of cancer cachexia, exacerbated by malnutrition due to the side effects of treatments. In addition, dieticians are also directly in touch with caregivers, so that the involvement of all actors allows optimizing the dietary compliance [2] .

Cancer, as once fatal disease has become a chronic condition, because chemotherapy can today stabilize the disease advancement, even in metastatic stages [1] . As a consequence, the nutritional approach, which has been initially considered as secondary treatment has gained considerably importance, as stated Hébutern [1] .

According to the individual situations, patients can experience olfacto-gustatory distortions, swallowing difficulties, dental receding, canker sores, gingivitis, a drying mouth, bowel and stomach pain, nausea, cognitive problems, constipation, or conversely a diarrhea [1] [3] . The patients need to learn to live with these symptoms which are impacting the food act. Furthermore, these side effects are source of discomfort, fatigue or pain and are directly or indirectly related to the state of malnutrition [2] - [4] . In the NEODIA program we started in 2010 (learning to live with a cancer on a day-to-day basis), we have shown that patients are excluded from their kitchen while the food act is more than ever crucial to optimize the benefit of treatments [5] . Cytotoxic chemotherapy creates an energy expenditure which is a factor of additional risk of malnutrition [6] , in addition to the cachexia induced fatigue, anorexia, early satiety, and anemia. Clinicians believe that the effectiveness of chemotherapy in these patients is affected, increased toxicity and the prognosis as many aggravated [7] - [15] . This essentially iatrogenic undernutrition is questioned in 25% of deaths [6] .

The observational program NEODIA is focused on the dietary and cooking behaviour of cancer patients. Going beyond the recommendations of the French Society of Clinical Nutrition and Metabolism (SFNEP), the program is the first study interested in promoting the reappropriation of the “cooking space” by the patients in their homes, considering that this is a crucial setting to prevent and reduce malnutrition.

Data were collected in 197 cancer in- or out-patients (31.6% colorectal cancer, 27.6% breast cancer, 7.9% non-Hodgkinien lymphoma, 7.5% esophageal/gastric cancer, 6.6% liver cancer, 5% lung cancer, and others) who were receiving treatment at the Department of Oncology of the Beauvais City Hospital, France. The validated 145-item questionnaire inquired the occurrence and frequency of treatment-induced side effects, making correlations with frequency and consumption of food and beverages as well as culinary habits [5] . We observe that 60% of the participants have reported at least one treatment-induced side effect and expressed a desire to be accompanied over the long-term caregiving along the journey. Thus, NEODIA translational research group designed a culinary education program that has been developed through workshops for patients and their families. The data-driven deployment of the culinary practices was monthly evaluated by 3 scientists and 10 female patients for perceived ease of use and acceptability of the culinary solutions. In the end, NEODIA has set up the website “Vite fait bienfaits^®” which literally means “right cooking for a right life” focused for oncology. Its smartphone application is downloadable in the stores Apple and Android.

This free multi-display medium is certified by the regional agency of health (ARS Hauts de France), the French National Program of Diet (PNA) power through the initiative “eating is everybody’s business”, and the French league against cancer (departmental committee of Oise).

The web site allows inquiring about major side effects, promotes the use of appropriate culinary techniques, and the use of specific spices and aromatic plants as well as dietary recommendations. Internet user can ask their questions, geo-locate charities or associations promoting health. In addition, patients and caregivers can offer their own recipe suggestions to enrich the library of existing recipes that are subject to the validation by the NEODIA research group before online publication.

Culinary education regular workshops for cancer patients were firstly implemented in the Beauvais hospital in early 2015. A standardized ongoing training dedicated for caregiver’s staffs was also established to transfer this knowledge. Numerous meetings and conferences in France involving 160 hospitals to facilitate local initiatives have been held by the NEODIA experts.

Despite this success to improve the quality of life of the patient at home, the program tries in particular to answer the question if the culinary advising is transposable to the offer of restoration proposed by institutions of care in Oncology. To answer this question, we first conducted an investigation on the determinants of dietary behaviour in patients currently treated in a hospital service. In a second step, we are collecting information on the food supply itself.

To do this, we have worked in a sensory analysis laboratory with a panel of trained patients followed in the same hospital. We know that each medical institution possess a specific restauration system, directly managed or granted a catering operator, homemade or coming from a central kitchen, or even resorting to the agri-food industry that provides ready-made solutions. According to the data emerging from our survey, we’ve evaluated the adequacy of the “healthy catering card” (HCC) being developed by the agri-food group DAVIGEL for other pathologies or specific nutritional situations to the needs of cancer care units. This model of supply, based on products made by the agri-food industry offers highly standardized dishes, frozen and ready-made, which is likely to reduce the day-to-day dietary variability in our study and secures our experimental protocol. The palatability tests that we have conducted with the panel of patients may allow completing our innovative culinary approach.

The study of the food supply in a hospital took place in 2014 following two phases. Firstly a specific survey was conducted in Beauvais hospital center (BHC), in which the restoration works in direct management. This monocentric study has been limited to outpatients and week in-patients departments. Indeed, the radiotherapy department offers no catering service. The food supply of palliative care service is very specific since it is tailored to the needs of the patient at the end of life, so was not included in the study. The survey includes major patients treated with chemotherapy for 3 to 6 months. Among them, 17% also received radiation therapy. The sample comprised 44% of retirees, consists of 56% of women and 44% of men between the ages of 45 and 60. Men have been mainly treated for colorectal cancer or lung cancer (Table 1). Women have been predominantly treated for breast cancer (Table 1). A total of 41 patients completed the questionnaire involving a series of closed questions. The interview was conducted by a single investigator to advise the patient if necessary and to ensure the global objectivity. The questionnaire focused on disorders experienced since the beginning of the treatment and collection of meals at home and at the hospital. The time frame of all 107 questions addresses the food intake of one day (i.e. on a “given day”). The questionnaire includes items on the reason for the qualitative and quantitative changes, the preferences of products (nutritional formulations, textures, marks, signs of quality, talking about representations of the food products), the positive and negative connection with experienced symptoms since the implementation of treatments. Patients were asked about their level of knowledge about the dietary recommendations they have received during their course of care and their sources of information. All data was treated anonymously. Data analysis was performed using SPHINX software, then reviewed and summarized by the staff including an expert in therapeutic education, an expert in sensory analysis and a reference nutritionist specializing in oncology. In a second step, we have worked in a sensory analysis laboratory with a group of patients followed in the same hospital and enrolled in the NEODIA translational program since 4 full years. Briefly, this NEODIA trained panel of 8 patients contributing to the present study (42 - 63 years old) was composed of women volunteers regularly entailed by tests of tasting in room of sensory analysis, attends culinary workshops, psychological tests, and works on the improvement of the web site “vite fait bienfaits^®” [5] . All participants have something in common which brings them together, i.e. learning to live with cancer on a day-to-day basis. They are working monthly since 2012 with our research staff. Eligible criteria to participate in the panelin 2012 were: usual cooking practices before their illness, presence of major side effects to investigate, capability to determine taste changes. The women have reported in the initial NEODIA study questionnaire [5] that they had in place specific solutions to alleviate their problems. Developing this expertize, they was able to advise the NEODIA research staff.

In the present study, the 8 cancer bearing women could all participate in 6 working sessions without problems and supervised by our staff.