Nutritional Support in Patients with Cancer of the Esophagus: Impact on Nutritional Status, Patient Compliance to Therapy, and Survival

Bozzetti, Federico; Cozzaglio, Luca; Gavazzi, Cecilia; Bidoli, Paolo; Bonfanti, G.; Montalto, Fabrizio; Parra, Héctor Soto; Valente, Maurizio; Zucali, R

doi:10.1177/030089169808400614

Cited by 60 publications

(27 citation statements)

References 39 publications

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“…There were 17 eligible studies on patients undergoing chemotherapy or radiotherapy for inclusion in the review, including 8 RCTs (77,79,87,94,95,97,107,109) and 6 non-RCTs (78,81,92,105,121,128) comparing nutritional support with routine care, 2 RCTs comparing EPA supplementation (capsules) with routine care (47,74), and 1 RCT comparing ETF with PN (108). The majority of studies (n=12) utilised ONS, with only 5 studies using ETF (78,81,92,108,121). The type of cancer varied widely and included head/neck (77,109,121,128), abdominal/ pelvic (79,87,94,97), lung (128), breast (95,105), gastrointestinal (81), leukaemia (47,74,92), or a variety of sites (78,107,108).…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, a CCT reported no significant difference in white blood cell count following ETF (nasogastric) vs. routine care in oesophageal cancer patients undergoing radiotherapy (81).…”

Section: Haematological and Biochemical Outcomesmentioning

confidence: 87%

“…Two RCTs using ONS, one with pelvic cancer patients undergoing radiotherapy (97) and the other with breast cancer patients undergoing chemotherapy (95), and a CCT using a nasogastric route (81) in oesophageal cancer patients undergoing radiotherapy were combined to investigate the effect of nutritional support on serum albumin concentrations. Meta-analysis suggested no significant effect from nutritional support (effect size -0.06, 95% CI -0.47 to 0.34; Table III).…”

Section: Haematological and Biochemical Outcomesmentioning

confidence: 99%

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Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Elia

Schueren

Garvey³

et al. 2006

Int J Oncol

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Abstract. The aim of this systematic review was to determine the efficacy and potential benefits of enteral nutritional support [oral nutritional supplements (ONS) or enteral tube feeding (ETF)], and eicosapentaenoic acid (EPA, free acid, ethyl esters or fish oil; provided as capsules or enriched ONS or ETF) in patients with cancer. Clinical studies were identified using electronic databases, and studies were selected according to predetermined criteria. For each treatment modality (chemo/radiotherapy, surgery, and palliative care), the comparisons of interest were nutritional support vs. routine care (no nutritional support), EPA supplement (capsule or enriched ONS or ETF) vs. routine care (no supplement or standard supplement), ETF vs. parenteral nutrition (PN). The reviewed outcomes were dietary intake, anthropometry, clinical (mortality, length of hospital stay, complications, and quality of life) and haematological/biochemical (white blood cell count, serum transferrin and albumin, CD3-positive lymphocytes, and inflammatory markers). Meta-analyses were performed where possible. In patients undergoing radiotherapy, meta-analysis showed that ONS significantly increase dietary intake (381 kcal/day, 95% CI 193 to 569 in 3 RCTs) compared to routine care. In patients undergoing surgery, meta-analyses showed that ETF results in a significantly shorter length of hospital stay (1.72 fewer days, 95% CI 0.90 to 2.54 in 8 RCTs), lower incidence of any complications (OR 0.62, 95% CI 0.50 to 0.77 in 4 RCTs) and infectious complications (OR 0.67, 95% CI 0.55 to 0.82 in 11 RCTs) and lower sepsis scores (2.21 points, 95% CI 1.49 to 2.92 in 2 RCTs), but no difference in mortality (OR 0.72, 95% CI 0.40 to 1.29 in 7 RCTs) compared to PN. There was also no difference in mortality between ONS or ETF vs. routine care in patients undergoing chemotherapy/radiotherapy (OR 1.00, 95% CI 0.62-1.61 in 4 RCTs) or surgery (OR 2.44, 95% CI 0.75 to 7.95 in 4 RCTs). Individual studies of EPA supplementation as capsules showed improvements in survival, complications and inflammatory markers in patients undergoing bone marrow transplant (BMT). In palliative care patients receiving EPA-enriched ONS or capsules, there were inconsistent positive effects on survival and quality of life. In those undergoing surgery, EPA-enriched ETF had no effect. Further research is required to elucidate the clinical efficacy of enteral nutrition support, including the potential benefits of EPA supplementation, in patients with cancer.

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Section: Resultsmentioning

confidence: 99%

“…In contrast, a CCT reported no significant difference in white blood cell count following ETF (nasogastric) vs. routine care in oesophageal cancer patients undergoing radiotherapy (81).…”

Section: Haematological and Biochemical Outcomesmentioning

confidence: 87%

Section: Haematological and Biochemical Outcomesmentioning

confidence: 99%

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Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Elia

Schueren

Garvey³

et al. 2006

Int J Oncol

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“…TPN support is considered beneficial to improve the patients' nutritional status and immune function, and to lower the surgical complications, and to improve the quality of life [22][23][24][25][26][27][28] . But, TPN can also stimulate proliferation of the tumor cells [29,30] .…”

Section: Discussionmentioning

confidence: 99%

Influence of L-methionine-deprived total parenteral nutrition with 5-fluorouracil on gastric cancer and host metabolism

Xiao¹,

Cao²,

Yin³

et al. 2001

WJG

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AIM To investigate the influence of L-methioninedeprived total parenteral nutrition with 5-FU on gastric cancer and host metabolism.METHODS N-methyl-N'-nitro-nitrosoguanidine (MNNG) induced gastric cancer rats were randomly divided into four groups: Met-containing TPN group (n = 11), Metdeprived TPN group (n = 12), Met-containing TPN+5-FU group (n = 11) and Met-deprived TPN+5-FU group (n = 12). Five rats in each group were sacrificed after 7 days of treatment and the samples were taken for examination. The remaining rats in each group were then fed separately with normal diet after the treatment until death, the life span was noted.RESULTS The tumors were enlarged in Met-containing group and shrank in Met-deprived group markedly after the treatment. The DNA index (DI) of tumor cells and the body weight (BW) of rats had no significant change in the two groups, however, the ratio of tumor cells' S phase was increased. The ratio of G2M phase went up in Met-containing group, but down in Metdeprived group. In the other two groups that 5-FU was added, the BW of rats, and the diameter of tumors, the DI of tumor cells, the S and G2M phase ratio of tumor cells were all decreased, particularly in Metdeprived plus 5-FU group. Pathological examination revealed that the necrotic foci of the tumor tissue increased after Met-deprived TPN treatment, and the nucleoli of tumor cells enlarged. In -MetTPN+5-FU group, severe nuclear damage was also found by karyopyknosis and karyorrhexis, meanwhile there was slight degeneration in some liver and kidney cells. The serum free Met and Cysteine decreased markedly (P<0.001), while other amino acids, such as serum free serine and glutamine increased significantly (P<0.005). All the rats died of multiple organ failure caused by cancer metastasis. The average survival time was 18.6 days in Met-containing TPN group, 31 days in Metdeprived TPN group, 27.5 days in Met-containing TPN+5-FU group, and 43 days in Met-deprived TPN+5-FU group (P<0.05).

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“…Besides luminal obstruction, cancer anorexia, chemotherapy induced nausea and vomiting and radiation toxicities (mucositis, esophagitis, xerostomia, dysgeusia) during multimodal treatment may severely restrict oral intake and result in significant weight loss. 1 This leads to dehydration, delayed discharge, re-hospitalization, compromised treatment efficacy and poor quality of life. Wound breakdown and anastomotic disruptions are increased in those undergoing surgery.…”

Section: Introductionmentioning

confidence: 99%

Feeding Tube Enterostomies in Upper Aerodigestive Tract Cancers

Saha¹,

Bose²,

Pankaj³

2010

International Journal of Head and Neck Surgery

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Establishment and maintenance of safe access is crucial for long-term enteral nutrition in patients with head-neck and esophagogastric cancers. Tube enterostomies such as gastrostomy and jejunostomy are being increasingly used with wider use of chemoradiation and adjuvant therapy following surgery. This article reviews the currently available enteral access techniques by the open and percutaneous route and their indications, safety, effectiveness and role in modern oncological practice.

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Nutritional Support in Patients with Cancer of the Esophagus: Impact on Nutritional Status, Patient Compliance to Therapy, and Survival

Abstract: EN in patients with cancer of the esophagus undergoing chemotherapy and radiotherapy is well tolerated, feasible even in the home setting, prevents further nutritional deterioration and achieves the same oncological results in dysphagic patients as those achieved in non-dysphagic patients.

Cited by 60 publications

References 39 publications

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Influence of L-methionine-deprived total parenteral nutrition with 5-fluorouracil on gastric cancer and host metabolism

Feeding Tube Enterostomies in Upper Aerodigestive Tract Cancers

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