Perioperative nutrition-oriented nursing for older women undergoing cancer surgery: frailty screening, enhanced recovery, and survivorship care

Older women undergoing cancer surgery commonly enter the perioperative period with overlapping frailty, malnutrition, sarcopenia, obesity, multimorbidity, and treatment-related symptoms. These vulnerabilities reduce physiologic reserve and amplify the catabolic response to surgery, increasing the risk of complications, functional decline, delayed adjuvant treatment, and persistent nutritional impairment. Nutrition-oriented perioperative nursing provides a practical framework for translating frailty assessment and cancer nutrition guidance into coordinated care before surgery, during enhanced recovery, and after discharge. This Mini Review examines the frailty-malnutrition-surgical stress axis in older women with breast, gynecologic, thoracic, and other cancers requiring surgery. We propose an integrated two-step approach in which brief frailty and nutrition screening triggers multidimensional assessment, dietitian referral, symptom management, protein-energy support, and multimodal pre-habilitation. Within enhanced recovery pathways, nurses can protect nutritional intake by limiting unnecessary fasting, supporting individualized carbohydrate use, preventing postoperative nausea and vomiting, promoting early protein-containing oral feeding, and coordinating early mobilization. Continued reassessment after discharge is required because muscle loss, appetite disturbance, and treatment-related nutritional problems may persist into adjuvant therapy and survivorship. Current evidence supports integrated screening and multimodal care, but women-specific trials in geriatric oncology remain limited. Future studies should evaluate nurse-led implementation using functional, nutritional, treatment-continuity, and patient-reported outcomes rather than length of stay alone.