Nutritional Interventions during Chemotherapy for Pancreatic Cancer: A Systematic Review of Prospective Studies

Abstract

Background: Pancreatic cancer incidence is growing, but the prognosis for survival is still poor. Patients with pancreatic cancer often suffer from malnutrition and sarcopenia, two clinical conditions that negatively impact oncological clinical outcomes. The aim of this systematic review was to analyze the impact of different nutritional interventions on clinical outcomes in patients with pancreatic cancer during chemotherapy. Methods: A systematic review of MedLine, EMBASE, and Web of Science was carried out in December 2022, identifying 5704 articles. Titles and abstracts of all records were screened for eligibility based on inclusion criteria, and nine articles were included. Results: All nine articles included were prospective studies, but a meta-analysis could not be performed due to heterogenicity in nutritional intervention. This Systematic Review shows an improvement in Quality of Life, nutritional status, body composition, oral intake, and Karnofsky Performance Status, following nutritional interventions. Conclusions: This Systematic Review in pancreatic cancer patients during chemotherapies does not allow one to draw firm conclusions. However, nutritional support in pancreatic cancer patients is advisable to ameliorate oncological care. Further well-designed prospective studies are needed to identify nutritional support’s real impact and to establish a reliable way to improve nutritional status of pancreatic cancer patients during chemotherapy.

Fat malabsorption in pancreatic cancer: Pathophysiology and management

“…25 Systematic reviews and meta-analyses evaluating the impact of EPI treatment with PERT have associated improved survival, quality of life, nutrition status, body composition, tolerance to treatment including chemotherapy, and gastrointestinal symptoms in PDAC with PERT being optimized, whereas untreated EPI has been associated with high mortality specifically after pancreatic surgery. 25,[31][32][33] Despite these reports, several randomized controlled trials fail to support these findings. 34 Indeed, a recent survey of surgical oncologists suggests that most prescribe PERT as part of multimodality treatment of PDAC, although <20% believe this has an effect on overall survival.…”

“…11,48 However, despite the importance of this approach, there is limited evidence to guide individual management decisions. Evidence supports that PERT can improve fat absorption, decrease maldigestion and associated symptoms, increase survival, and improve quality of life in patients with EPI 25,32,49,50 ; however, the impact on nutrition outcomes is inconsistent. In 2017, Saito et al conducted a retrospective analysis of PERT use in a cohort of those with unresectable PDAC and found a higher body mass index was associated with PERT use (P < 0.001), but when they performed a prospective randomized controlled trial a year later, the authors found no differences in body weight 51 (P = 0.780) and even some weight loss reported with PERT use.…”

“…Furthermore, independent of the indication, PERT is often underdosed for treating EPI. 25,[30][31][32]52 It is important for clinicians to not only start at a proper dose but also titrate the dose to resolution of symptoms (particularly for those with steatorrhea). Consideration of other dietary interventions in addition to PERT may improve the overall nutrition status and fat malabsorption in this population.…”

“…In a subgroup analysis from this study, dietitian referral was associated with PERT prescription, indicating the value of multidisciplinary management. Furthermore, independent of the indication, PERT is often underdosed for treating EPI 25,30–32,52 . It is important for clinicians to not only start at a proper dose but also titrate the dose to resolution of symptoms (particularly for those with steatorrhea).…”

Can Nutrition Contribute to a Reduction in Sarcopenia, Frailty, and Comorbidities in a Super-Aged Society?

“…Nutritional interventions were performed in patients with several types of cancer or diseases, including pancreatic cancer [67], gastrointestinal cancer [68], liver cirrhosis [69], and CKD [70], to reduce sarcopenia and its complications.…”