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

Abstract

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 1990-2018. 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, timing with anticancer therapy) and the most appropriate endpoint measures.

<p>Emerging Treatment Options For Cancer-Associated Cachexia: A Literature Review</p>

“…Although cancer cachexia cannot be treated with nutritional therapy alone,70,71 optimum nutrition is an important part of any multimodal intervention aimed at increasing energy intake39 and alleviating psychosocial stress 72. In addition, nutritional supplements enriched with n-3 polysaturated fatty acids, such as EPA, might have benefits in cancer cachexia patients 73,74.…”

Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆

“…emotional functioning, loss of appetite and global QoL) but noted that evidence was weak due to the poor methodological quality of included trials. 30,47 In cancer cachexia, n-3 fatty acids have been studied, particularly for their anti-inflammatory properties, and are available as a component of specialised ONSs, usually also enriched in protein (N3P-ONSs). Several randomised trials have been published on the effects of N3P-ONSs in cancer patients.…”

“…emotional functioning, loss of appetite and global QoL) but noted that evidence was weak due to the poor methodological quality of included trials. 30 , 47 …”

Impact of Early Incorporation of Nutrition Interventions as a Component of Cancer Therapy in Adults: A Review

“…Search results were limited to research in the adult population published from developed countries between 1 January 2010 and 1 April 2020 and written in the English language. This specific date range was chosen because past reviews [20][21][22][23][24] have already evaluated nutrition interventions from studies dated previously and because early nutrition intervention specifically is a more modern practice due to evidence-based position papers and clinical guidelines [14][15][16][25][26][27] that have raised awareness and provided guidance for nutrition interventions. Manual searches were also performed on existing systematic reviews and studies recommended for consideration from clinical nutrition experts.…”

“…Multiple nutrition interventions, including dietary counseling or advice, oral nutritional supplements (ONS), and enteral nutrition, have shown positive outcomes in malnourished hospitalized and community-dwelling adults with cancer [17][18][19]. Furthermore, systematic reviews have underscored the strength of evidence of such nutrition interventions on nutrition and health outcomes for oncology patients [20][21][22][23][24]. In addition to the positive effects of nutrition interventions on malnutrition, nutrition interventions have also been documented to improve outcomes such as quality of life (QoL) [18] and possibly survival [19] in cancer patients.…”