A Randomized Study of Nutritional Support in Patients With Colorectal and Gastric Cancer

Abstract

Involuntary weight loss is often seen among patients with gastrointestinal (GI) cancer. Weight loss may influence quality of life (QoL) and is a predictor of survival. The present study is an attempt to improve body weight development in GI cancer patients by individual support (IS), including nutritional measures. Patients were randomized in a 2 x 2 design between 1) IS, including nutritional support, 2) group rehabilitation (GR), 3) IS + GR (ISGR), or 4) standard care (SC). Data concerning dietary intake (24-h recalls), body weight, and QoL (EORTC-QLQ C-30) were collected over 2 yr for 67 patients with colorectal or gastric cancer, randomized to IS or ISGR. Data on weight and QoL were collected for 70 patients with the same diagnoses randomized to GR or SC. Despite a tendency to greater weight loss at inclusion, the IS + ISGR group managed to gain weight significantly more rapidly and to a greater extent than the GR + SC group. The differences became statistically significant at 12 and 24 mo (P < 0.05). Patients with weight loss at baseline increased their energy intake and weight more than those without weight loss. No differences were seen in QoL ratings between randomization groups, but there was a positive correlation between weight development and QoL and a negative correlation between fatigue and weight development. There was a numerical difference, not statistically significant (P = 0.3), indicating a shorter time of survival in patients in the GR + SC group. IS, including nutritional support, leads to more rapid weight gain than SC in patients with newly diagnosed GI cancer.

Dietary treatment of weight loss in patients with advanced cancer and cachexia: A systematic literature review

“…After excluding duplicate studies, and studies that did not meet the inclusion criteria based on reading title and abstract, 23 papers were selected for full-text examination. Eighteen papers were excluded; nine in which the target population was not clearly defined as patients with advanced cancer and/or treatment with curative intent was given [9,[14][15][16][17][18][19], four in which there was not given enough information to classify cachexia [20][21][22][23] and five in which the effect of other interventions than dietary counselling were evaluated [24][25][26][27][28]. The present review is thus based on two non-randomized studies and three RCT's.…”

Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: Effects on survival, metabolism, and function

“…Based on these findings, palliation of patients with malignant disease using treatments that attenuate systemic inflammation, 10,30 prevent anemia, 9 and improve energy balance via the provision of nutritional support 19 appears to be justified. The current study was designed to test the hypothesis that specialized, nutrition-focused patient care would provide added benefit for weight-losing patients with malignant disease who were receiving treatment for systemic inflammation as well as anemia prophylaxis.…”

“…Consequently, in upcoming studies, it probably would be more rewarding to focus on improving the effectiveness of nutritional support using additional interventions, such as appetite stimulation and interactive hormonal therapy, 42 perhaps in combination with palliative lowdose chemotherapy. 19,43 …”

“…Although our previous investigations have confirmed that thermogenesis increases in response to intravenous feeding in patients with malignant disease, 18 the magnitude of this increase is such that the long-term beneficial effects of nutritional support should not be jeopardized. 11,19 It has, however, been difficult to confirm that nutrition has a significant role in the supportive care of patients with malignant disease, despite the fact that nutritional support is a simple concept. Most attempts have been restricted to establishing the role of nutritional support in perioperative strategies 20,21 or as an adjunct to chemotherapy.…”

Health-related quality of life and distress in cancer patients: results from a large randomised study

“…Involuntary weight loss is another well-recognised problem affecting HRQOL in cancer patients (Persson et al, 2002). This problem may be decreased through early nutritional assessment and subsequent interventions for risk patients (Ravasco et al, 2005).…”