Face-to-Face or App-Based? Study Maps Which Nutritional Counseling Works Best for Gastric Cancer

Gastric cancer is one of the most nutritionally punishing malignancies in medicine. The tumor itself compromises the stomach’s capacity to store and process food, and surgical resection, chemotherapy, and radiotherapy compound the damage, leaving many patients trapped in a downward spiral of weight loss, muscle wasting, and deteriorating tolerance of treatment. Against that backdrop, a new systematic review and meta-analysis published in BMC Cancer offers one of the clearest syntheses yet of how best to deliver individualized nutritional counseling to these patients—and its findings point to a strikingly pragmatic answer: use different delivery modes for different goals.

The research team, led by Xuan Wang and Junwei Li of the Department of Oncology at the First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, together with colleagues including corresponding authors Beibei Yin and Jing Liang, set out to resolve a question that has grown increasingly urgent as mobile health technology has spread through oncology care. Guidelines from bodies such as the European Society for Clinical Nutrition and Metabolism recommend individualized nutritional counseling for cancer patients, but clinicians now face a genuine dilemma: should dietitians sit down with patients face to face, or can smartphone-based mHealth platforms deliver equivalent benefit at lower cost and greater convenience?

To answer that question, the researchers conducted a rigorous search of PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov, covering the literature up to December 31, 2025. They restricted inclusion to randomized controlled trials, the gold standard for judging causal effects, comparing individualized nutritional counseling against usual care in patients with gastric cancer. After screening and quality assessment following PRISMA reporting standards, nine trials encompassing 963 patients made the final cut. The team pooled outcomes using random-effects models, a statistical approach that accounts for heterogeneity between trials, and pre-registered the review’s protocol with PROSPERO under registration number CRD420261290589.

The primary outcomes were carefully chosen to capture both the subjective and objective dimensions of nutritional health. Nutritional status was measured with the Patient-Generated Subjective Global Assessment, or PG-SGA, a validated instrument in which patients and clinicians jointly score weight trajectory, food intake, symptoms, and functional capacity; lower scores indicate better nutritional condition. Body weight served as the second primary endpoint, while secondary outcomes included quality of life, assessed with instruments such as the EORTC QLQ-C30, FACT-G, and EQ-5D questionnaires, and biochemical markers including serum albumin and hemoglobin.

The headline result was unambiguous for nutritional status. Across all nine trials, individualized nutritional counseling significantly improved PG-SGA scores compared with usual care, with a weighted mean difference of −1.16 points (95 percent confidence interval −1.50 to −0.83, P < 0.001). Crucially, this benefit held in both subgroups, meaning that whether counseling was delivered in person or through digital channels, patients reported meaningfully better nutritional condition than those receiving standard care. For a symptom that erodes not only survival but daily quality of life, that consistency across delivery modes is itself a clinically important finding.

Body weight told a more complicated story. When all trials were pooled, the overall effect on weight change did not reach statistical significance (P = 0.129), a result that might have tempted a superficial reading to conclude that counseling does not help patients maintain weight. But the subgroup analysis revealed a sharp divergence hiding beneath that null result. Face-to-face counseling was associated with significant weight preservation, with a weighted mean difference of 2.65 kilograms (95 percent confidence interval 1.62 to 3.68, P < 0.001)—a substantial margin in a population where losing even a few kilograms can tip patients into cachexia and force treatment interruptions. The mHealth subgroup, by contrast, showed no significant effect on weight (P = 0.661).

The pattern inverted for quality of life. Overall, counseling significantly improved QoL compared with usual care, with a standardized mean difference of 0.84 (P < 0.001), a large effect by conventional benchmarks. But when the trials were split by delivery mode, it was the mHealth interventions that demonstrated a statistically significant improvement (SMD = 0.30, 95 percent confidence interval 0.07 to 0.53, P = 0.011), while the face-to-face subgroup narrowly missed significance (P = 0.055). In other words, the digital channel that failed to move the scale was the one that reliably made patients feel better, and the intensive in-person channel that protected body weight did not translate into measurable quality-of-life gains within the available trials.

The authors interpret this divergence through the lens of intervention intensity and mechanism. Face-to-face programs in the included trials often involved higher clinical intensity—more frequent contact, closer monitoring, and hands-on adjustment of oral nutritional supplements—which plausibly explains their superior ability to preserve body mass. Structured mHealth interventions, meanwhile, appear to excel at sustained engagement: continuous messaging, remote check-ins, and long-term symptom management that keep patients connected to care well beyond the walls of the clinic. Notably, neither delivery mode produced significant differences in albumin or hemoglobin levels, suggesting that the biochemical signature of malnutrition shifts more slowly than the subjective and functional measures, or that longer follow-up is needed to detect laboratory-level change.

From these results the team draws a conclusion that is less about crowning a single winner and more about redesigning the care pathway. They recommend a stratified care model in which face-to-face sessions are deployed where they demonstrably work best—weight maintenance during the high-risk perioperative and treatment phases—while structured mHealth platforms take over for long-term symptom management and quality-of-life support. Such a model could concentrate scarce dietitian resources on the patients and time points where intensive contact yields the greatest physical benefit, while digital tools extend the reach of nutritional care to patients who might otherwise be lost to follow-up after discharge.

The findings arrive at a moment when digital health adoption in oncology is accelerating worldwide, and they carry practical weight for hospitals weighing investment in nutrition services. Gastric cancer remains a leading cause of cancer death globally, and malnutrition is among the most modifiable determinants of how well patients tolerate curative-intent therapy. This meta-analysis, funded by the Natural Science Foundation of Shandong Province (Grant Number ZR2023MC054), does not settle every question—the authors acknowledge the inherent limitations of pooling heterogeneous trials, and the nine included studies represent a still-maturing evidence base. But for clinicians, the message is actionable now: individualized nutritional counseling works for gastric cancer patients, the mode of delivery should be matched to the clinical goal, and the future of supportive cancer nutrition likely belongs to a hybrid of the examination room and the smartphone rather than to either alone.

Subject of Research: Comparative efficacy of digital versus face-to-face individualized nutritional counseling for gastric cancer patients

Article Title: Individualized nutritional counseling via digital and conventional modes for gastric cancer: a systematic review and meta-analysis

Article References: Individualized nutritional counseling via digital and conventional modes for gastric cancer: a systematic review and meta-analysis. (n.d.). https://doi.org/10.1186/s12885-026-17054-3

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17054-3

Keywords: gastric cancer, nutritional counseling, mHealth, digital health, meta-analysis, randomized controlled trials, malnutrition, weight preservation, quality of life, PG-SGA, oncology supportive care, telehealth