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A systematic review examining nutrition support interventions in patients with incurable cancer

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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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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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Authors and Affiliations

  1. St Columba’s Hospice, Centre for Education and Research, Edinburgh, UK

    Honor A. Blackwood, Charlie C. Hall, Erna Haraldsdottir & Barry J. Laird

  2. Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK

    Charlie C. Hall, Marie Fallon & Barry J. Laird

  3. Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Trude R. Balstad & Tora S. Solheim

  4. Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, Trondheim, Norway

    Trude R. Balstad & Tora S. Solheim

  5. Queen Margaret University, Edinburgh, UK

    Erna Haraldsdottir

  6. School of Health Sciences, University of Iceland, Reykjavík, Iceland

    Erna Haraldsdottir

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  1. Honor A. Blackwood
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  2. Charlie C. Hall
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  3. Trude R. Balstad
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  4. Tora S. Solheim
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Correspondence to Honor A. Blackwood.

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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

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