Abstract
Purpose
Recent guidelines by the European Society for Clinical Nutrition and Metabolism (ESPEN) have advocated increased attention to nutritional support in all patients with cancer; however, little is known about the optimal type of nutritional intervention. The aim of this review was to assess the current evidence for nutrition support in patients with incurable cancer.
Methods
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Embase, MEDLINE and CINAHL were searched from 1990 to 2018. Evidence was appraised using a modified risk of bias table, based on guidance from the Cochrane Handbook for Systematic Reviews of Interventions.
Results
Sixty studies were assessed of which twelve met the eligibility criteria. Eleven studies examined body composition, with six studies reporting improvements in weight. Six studies examined nutritional status with three studies reporting an improvement. Nine studies examined nutritional intake with six showing improvements including significant improvements in dietary and protein intake. Ten studies examined quality of life, with six studies reporting improvements following intervention. The most common nutritional interventions examined were nutrition counselling and dietary supplementation.
Conclusions
There is moderate quality evidence to support the need for increased attention to nutrition support in patients with incurable cancer; however, despite some statistically significant results being reported, the clinical effects of them were small. Key questions remain as to the optimal timing for these interventions to be implemented (e.g. cachexia stage, illness stage and timing with anticancer therapy) and the most appropriate endpoint measures.
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References
Katz AM, Katz PB (1962) Diseases of the heart in the works of Hippocrates. Br Heart J 24:257–264
Argiles JM et al (2014) Cancer cachexia: understanding the molecular basis. Nat Rev Cancer 14(11):754–762
Ross PJ, Ashley S, Norton A, Priest K, Waters JS, Eisen T, Smith IE, O'Brien MER (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 90(10):1905–1911
Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495
Fearon KC (2008) Cancer cachexia: developing multimodal therapy for a multidimensional problem. Eur J Cancer 44(8):1124–1132
Solheim TS, Laird BJA, Balstad TR, Stene GB, Bye A, Johns N, Pettersen CH, Fallon M, Fayers P, Fearon K, Kaasa S (2017) A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer. J Cachexia Sarcopenia Muscle 8(5):778–788
Solheim TS, Laird BJA, Balstad TR, Bye A, Stene G, Baracos V, Strasser F, Griffiths G, Maddocks M, Fallon M, Kaasa S, Fearon K (2018) Cancer cachexia: rationale for the MENAC (Multimodal-Exercise, Nutrition and Anti-inflammatory medication for Cachexia) trial. BMJ Support Palliat Care 8:258–265
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36(1):11–48
Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, Erickson N, Laviano A, Lisanti MP, Lobo DN, McMillan DC, Muscaritoli M, Ockenga J, Pirlich M, Strasser F, de van der Schueren M, van Gossum A, Vaupel P, Weimann A (2017) ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 36(5):1187–1196
Acreman S (2009) Nutrition in palliative care. Br J Community Nurs 14(10):427–428 430-1
Nourissat A, Vasson MP, Merrouche Y, Bouteloup C, Goutte M, Mille D, Jacquin JP, Collard O, Michaud P, Chauvin F (2008) Relationship between nutritional status and quality of life in patients with cancer. Eur J Cancer 44(9):1238–1242
Moher D, Liberati A, Tetzlaff J, Altman DG, for the PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535
Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56(8):779–785
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376
The cochrane collaboration, The Cochrane handbook for systematic reviews of interventions. 2008
Baldwin C, Spiro A, McGough C, Norman AR, Gillbanks A, Thomas K, Cunningham D, O’Brien M, Andreyev HJN (2011) Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial. J Hum Nutr Diet 24(5):431–440
Bauer J et al (2005) Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer. Clin Nutr 24(6):998–1004
Breitkreutz R, Tesdal K, Jentschura D, Haas O, Leweling H, Holm E (2005) Effects of a high-fat diet on body composition in cancer patients receiving chemotherapy: a randomized controlled study. Wien Klin Wochenschr 117(19–20):685–692
Casas F, León C, Jovell E, Gómez J, Corvitto A, Blanco R, Alfaro J, Seguí MÁ, Saigí E, Massanés T, Sala C, Librán A, Arcusa A (2012) Adapted ice cream as a nutritional supplement in cancer patients: impact on quality of life and nutritional status. Clin Transl Oncol 14(1):66–72
Fearon KC, von Meyenfeldt M, Moses AG, van Geenen R, Roy A, Gouma DJ, Giacosa A, van Gossum A, Bauer J, Barber MD, Aaronson NK, Voss AC, Tisdale MJ (2003) Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut 52(10):1479–1486
Jatoi A, Qin R, Satele D, Dakhil S, Kumar P, Johnson DB, Thomas SP, Stella PJ, Castillo J, Li M, Fernandez-Zapico M (2016) "Enjoy glass of wine before eating:" a randomized trial to test the orexigenic effects of this advice in advanced cancer patients. Support Care Cancer 24(9):3739–3746
Kapoor N, Naufahu J, Tewfik S, Bhatnagar S, Garg R, Tewfik I (2017) A prospective randomized controlled trial to study the impact of a nutrition-sensitive intervention on adult women with cancer cachexia undergoing palliative care in India. Integr Cancer Ther 16(1):74–84
Read JA, Beale PJ, Volker DH, Smith N, Childs A, Clarke SJ (2007) Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial. Support Care Cancer 15(3):301–307
Sanchez-Lara K et al (2014) Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomised trial. Clin Nutr 33(6):1017–1023
Tan-Shalaby JL, Carrick J, Edinger K, Genovese D, Liman AD, Passero VA, Shah RB (2016) Modified Atkins diet in advanced malignancies - final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System. Nutr Metab (Lond) 13:52
Trabal J, Leyes P, Forga M, Maurel J (2010) Potential usefulness of an EPA-enriched nutritional supplement on chemotherapy tolerability in cancer patients without overt malnutrition. Nutr Hosp 25(5):736–740
National Institute for Clinical Excellence (NICE). Nutrition support in adults: oral supplements, enteral tube feeding and parental nutrition. 2006 [cited 2018 August]. Available from: http://www.nice.org.uk
Davies M (2005) Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs 9(Suppl 2):S64–S73
Baldwin C, Weekes CE, Campbell KL (2008) Measuring the effectiveness of dietetic interventions in nutritional support. J Hum Nutr Diet 21(4):303–305
Hickson, M, Smith S, Advanced nutrition and dietetics in nutrition support. 2018
Hui D, Glitza I, Chisholm G, Yennu S, Bruera E (2013) Attrition rates, reasons, and predictive factors in supportive care and palliative oncology clinical trials. Cancer 119(5):1098–1105
Hearn J, Higginson IJ (1997) Outcome measures in palliative care for advanced cancer patients: a review. J Public Health Med 19(2):193–199
Hearn J, Higginson IJ (1999) Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group. Qual Health Care 8(4):219–227
Horn SD, DeJong G, Deutscher D (2012) Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies. Arch Phys Med Rehabil 93(8 Suppl):S127–S137
Acknowledgements
The authors thank Marie Smith, Library and Knowledge Service Co-ordinator of NHS Fife, for undertaking the systematic search.
Funding
This work was financially supported by the Nancie Massey Charitable Trust, Miss M B Reekie’s Charitable Trust and the P F Charitable Trust.
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Blackwood, H.A., Hall, C.C., Balstad, T.R. et al. A systematic review examining nutrition support interventions in patients with incurable cancer. Support Care Cancer 28, 1877–1889 (2020). https://doi.org/10.1007/s00520-019-04999-4
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DOI: https://doi.org/10.1007/s00520-019-04999-4