Dietary Supplements in People with Metastatic Cancer Who Are Experiencing Malnutrition, Cachexia, Sarcopenia, and Frailty: A Scoping Review

Abstract

Cancer-associated malnutrition, or cachexia, stemming from cancer or its treatments, is particularly prevalent in metastatic cancers, and is often interrelated with sarcopenia and frailty. Evidence suggests that dietary supplements play a role in managing these conditions. As metastatic cancer cells are associated with notable genomic and phenotypic alterations, response to dietary supplements may differ between metastatic and non-metastatic cancers. However, research in this area is lacking. This scoping review aims to identify the dietary supplements that have been studied in patients with metastatic cancers and malnutrition-related conditions, along with their proposed effects, mechanisms, outcome measures, and tools used. A systematic search was conducted across databases, including MEDLINE, EMBASE, CINAHL, and clinical trial registries. Of the initial 6535 records screened, a total of 48 studies were included, covering a range of dietary supplements—vitamins, minerals, antioxidants, proteins, amino acids, fatty acids, fiber, and others. While the types of dietary supplements included varied across cancer types, omega-3 and carnitine were investigated most often. Proposed relevant attributes of dietary supplements included their antioxidant, anti-inflammatory, anti-cancer, and immunomodulatory properties. Overall, there was a paucity of interventional studies, and more randomized controlled trials are warranted.

Nutraceuticals in Personalized and Precision Medicine – a preliminary scoping review indicates efficacy for disease treatment, general wellbeing, and defense against Covid-19

“…The nutraceuticals covered were broad; vitamins, minerals, antioxidants, proteins, amino acids, and fatty acids among them. The authors concluded that overall a consistent positive impact for multimodal treatments, and for omega-3-fatty acid supplementation was observed, but it was difficult to obtain as clear a picture for the other nutraceuticals primarily due to insufficient data [17]. The fourth paper in this series was published much earlier -in 2013 -and is an SR of reports on nutritional intervention roles for head and neck squamous cell cancer patients' who are undergoing radiotherapy or chemotherapy [18].…”

“…A paper published this year (2022) attempted a more ambitious screen. Johal et al, reviewed reports on the impact of nutritional interventions for patients with metastatic cancer experiencing cancer-associated malnutrition, sarcopenia and frailty [17]. Of over 8000 initial records they selected, 48 papers (18 RCTs among them) met their inclusion criteria for this scoping review.…”

Treatment of Cachexia in Gastric Cancer: Exploring the Use of Anti-Inflammatory Natural Products and Their Derivatives

“…It was also noted that cancer patients had markedly altered circulating amino acids, especially EAAs, and this varied depending on patients’ weight loss, nutrition and metastasis, which is why plasma amino acids could play a potential role as biomarkers for diagnosis and screening cancer patients [ 46 ]. Miyagi et al demonstrated that gastric cancer had reduced plasma amino acids [ 34 , 47 ]. Over time, however, anabolic resistance is seen in cancer cachexia in advanced disease—this is where the body’s tissues become less responsive to anabolic stimuli such as external amino acids.…”

“…Over time, however, anabolic resistance is seen in cancer cachexia in advanced disease—this is where the body’s tissues become less responsive to anabolic stimuli such as external amino acids. This process contributes to muscle wasting and is one of the reasons that nutritional support alone cannot reverse cancer cachexia [ 33 , 47 ].…”

Nutrition and Cancer Care – American and European Context

“…Diet-related unmet care needs, including poor appetite and gas­trointestinal symptoms, are common among those with cancer [6]. Malnutrition is common in cancer patients and is caused by an impaired ingestion or assimilation of nutrients, which is connected either to the cancer itself or its specific treatments [4].…”