The statistic is shocking: Severe malnutrition and weight loss play a role in at least one in five cancer deaths. Yet nutrition too often is an afterthought until someone's already in trouble.

A move is on to change that, from hospitals that hire gourmet chefs to the American Cancer Society's dietitians-on-call phone service.

With cancer, you've got to ''bring a lot more nutrients to each spoonful of food,'' certified master chef Jack Shoop is learning. A former restaurateur, he's newly in charge of the kitchen at the Cancer Treatment Centers of America in Philadelphia.

Don't underestimate the added temptation should the result resemble Bon Appetit: ''The visual heartiness, and the actual heartiness, of these foods has to be understood for them to embrace it,'' Shoop says.

Tempting the palate is a huge hurdle: At diagnosis, up to a quarter of patients already have their appetite sapped, and most treatments can bring side effects that worsen the problem. Aside from the well-known nausea, vomiting and diarrhea, some cancers inhibit absorption of the nutrients patients force down. Not to mention strangely altered taste, mouth sores, dry mouth, difficulty swallowing and constipation.

About half of all cancer patients eventually suffer serious weight loss and malnutrition, a wasting syndrome called cachexia where they don't just lose excess fat but vital muscle. A healthy person's body adjusts when it doesn't get enough calories, slowing metabolism to conserve nutrients. A cancer patient's body doesn't make that adjustment; metabolism even may speed up.

The National Cancer Institute estimates cachexia is the immediate cause of death for at least 20 percent of cancer patients, although advanced cancer might have eventually claimed many of them.

How much weight loss is too much? The institute defines patients as at-risk when they've lost more than 10 percent of their usual weight. Other research suggests that patients who lose more than 5 percent of their precancer weight have a worse prognosis than people who can hang onto the pounds.

For their best shot at doing that, the American Cancer Society urges patients to ask to be assessed by a registered dietitian up front, right at diagnosis. While that's common at designated cancer centers where dietitians work on-staff, it's not routine elsewhere and surveys suggest just a third of patients have access to cancer nutritionists where they're being treated.

''Patients who are well-nourished as they're going through treatment have shorter hospital stays, are better able to tolerate treatment,'' not to mention have better quality of life, says Colleen Doyle, nutrition chief at the society, which offers nutrition advice through its hot line at 800-ACS-2345.

Desperate patients often hunt their own nutrition advice on the Internet but can't tell the good from the bad. The No. 1 Web-perpetuated myth: that sugar feeds tumor cells. Not true, says Maureen Huhmann, who chairs the American Dietetic Association's oncology nutrition group. In fact, protein-packed milkshakes and smoothies can literally be lifesaving for some patients.

''I don't want people to start losing weight because they cut foods out of their diet when they don't really need to,'' Huhmann says.

Then there are people overweight when diagnosed who delight at shedding pounds -- until they learn they're not just losing fat but muscle, too.

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