Symptoms potentially influencing weight loss in a cancer population. Correlations with primary site, nutritional status, and chemotherapy administration

Grosvenor, Mary B.; Bulcavage, Linda; Chlebowski, Rowan T.

doi:10.1002/1097-0142(19890115)63:2<330::aid-cncr2820630221>3.0.co;2-u

Cited by 163 publications

(75 citation statements)

References 15 publications

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“…17 Even cancer patients with good performance status have a high incidence of GI symptoms, particularly abdominal fullness. 18 Most of our patients had a normal BMI (median 21) even though the median weight loss at referral (over a period of 100 days) was 9%. Our findings are comparable to those of another palliative care center that reported 71% of patients lost weight (30% with significant muscle mass reduction) in spite of a normal or increased BMI.…”

Section: Discussionmentioning

confidence: 86%

Clinical Outcomes and Contributors to Weight Loss in a Cancer Cachexia Clinic

Fabbro

Hui

Dalal

et al. 2011

Journal of Palliative Medicine

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Background: Cancer cachexia is considered intractable, with few therapeutic options. Secondary nutrition impact symptoms (S-NIS) such as nausea may further contribute to weight loss by decreasing nutrient intake. In addition, treatable metabolic abnormalities such as hypogonadism, vitamin B12 deficiency, hypothyroidism, and hypoadrenalism could exacerbate anorexia and muscle wasting in patients with cancer cachexia. We determined the frequency and type of contributors to appetite and weight loss, and the effect of the cachexia clinic on clinical outcomes. Methods: Review of 151 consecutive patients referred to a cachexia clinic. All received dietary counseling and exercise recommendations. Assessments included weight, body mass index (BMI), S-NIS, resting energy expenditure by indirect calorimetry, serum thyroid stimulating hormone (TSH), cortisol, total testosterone, and vitamin B12. Results: Median weight loss in the 100 days before referral was 9% (4%-13%); median BMI at presentation was 20.8. Median number of S-NIS was 3 (2-4), most commonly treated by metoclopramide, laxatives, and antidepressants. Forty-one percent (24/59) of patients were hypermetabolic and 73% (52/71) of males hypogonadic, whereas hypoadrenalism (0/101, 0%), hypothyroidism (4/113, 4%), and low vitamin B12 (3/107, 3%) were uncommon. Poor appetite and weight loss before referral (r ¼ 0.18, p ¼ 0.036) were associated with increased S-NIS (r ¼ 0.22, p ¼ 0.008). Appetite improved ( p < 0.001) and 31/92 (34%) of patients returning for a second visit gained weight. Conclusions: Patients had a high frequency of multiple S-NIS, hypogonadism, and hypermetabolism. A combination of simple pharmacological and nonpharmacological interventions improved appetite significantly, and increased weight in one third of patients who were able to return for follow-up. Cachexia clinics are feasible and effective for many patients with advanced cancer.

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Section: Discussionmentioning

confidence: 86%

Clinical Outcomes and Contributors to Weight Loss in a Cancer Cachexia Clinic

Fabbro

Hui

Dalal

et al. 2011

Journal of Palliative Medicine

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“…This decrease in alcohol consumption may reflect a proactive change toward healthier behaviors among cancer patients. It may also be related to adverse effects of cancer treatments causing nausea and vomiting and limiting the desire to drink alcohol 43. It was not surprising that a very small part of the subjects did not follow this trend observed at the population level.…”

Section: Discussionmentioning

confidence: 99%

Modifications in dietary and alcohol intakes between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort

et al. 2017

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Postdiagnosis diet and alcohol consumption may be associated with cancer prognosis, recurrence and mortality. Our aim was to investigate food, nutrient and alcohol intake variations between before and after cancer diagnosis and their determinants in a prospective cohort. Subjects (n = 696) were incident cancer cases diagnosed in the NutriNet‐Santé cohort between 2009 and 2016. Food, nutrient and alcohol intakes were prospectively collected using repeated nonconsecutive 24‐hr dietary records since subjects' inclusion (i.e. an average of 2 y before diagnosis). Mean number of dietary records per subject was 5.9 before and 8.1 after diagnosis. All dietary data before and after diagnosis were compared by mixed models. Factors associated with the main dietary changes observed were also investigated using multivariable logistic regressions. We observed a decrease in intakes of vegetables (mean decrease in intake in patients who decreased their intake=‐102.4 ± 79.8 g/d), dairy products (–93.9 ± 82.8 g/d), meat/offal (–35.5 ± 27.8/d), soy products (–85.8 ± 104.1 g/d), sweetened soft drinks (–77.9 ± 95.4 g/d), and alcoholic drinks (–92.9 ± 119.9 g/d), and an increase in broths (42.1 ± 34.9 g/d) and fats/sauces (18.0 ± 13.4 g/d). We observed a decrease in energy intake (–377.2 ± 243.5 kcal/d) and in intakes of alcohol (–7.6 ± 9.4 g/d) proteins (–17.4 ± 12.5 g/d), and several vitamins (p < 0.05) and micronutrients (p < 0.05). Conversely, lipid (19.4 ± 14.6 g/d), SFA (9.3 ± 7.0 g/d), MUFA (8.3 ± 6.3 g/d) and vitamin E (3.9 ± 3.3 mg/d) intakes increased after diagnosis. This large prospective study suggests that cancer diagnosis is a key period for nutritional changes. It highlights some healthy behaviors such as a decrease in alcohol and sweetened drink consumption, but also less favorable trends, such as a decrease in vegetable consumption and in many vitamin and mineral intakes. These results provide insights to identify and target recommendations to put forward for better nutritional care of cancer survivors.

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“…Sixty-one percent of patients experienced abdominal fullness, 46% experienced taste changes, 41% complained of constipation, 40% experienced dry mouth, 39% complained of nausea, and 27% experienced vomiting. 9 Again, the importance of qualified nutrition consultation for oncology patients cannot be overstated.…”

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confidence: 99%

Integrative Tumor Board: Colon Cancer with Liver Metastases

Dixon¹

2003

Integr Cancer Ther

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connected to their implanted ports. They spend the night at home, or, for patients who come to the center from outside of the Chicago area, in a nearby hotel. To use chronotherapy in an outpatient setting entails much behind-the-scenes planning and working out of details, but previous experience has shown that outpatient clinical use of this technology is quite feasible. 3Nurses function collaboratively with physicians in planning and implementing an individualized protocol for each patient. Patient and family teaching is complex, as both the patient and family need to be assured and feel comfortable about being treated with chemotherapy off-site as well as during sleep. Education needs to include basic trouble shooting for minor problems that may occur with the pump. Patients have access to nursing staff during the day and after clinic hours, through the night. Patients are provided with medications for nausea, vomiting, or diarrhea if needed and are educated thoroughly regarding these medications.Other responsibilities for our oncology nurses include research data collection, compliance with regulatory issues, quality assurance, inventory management, and continuing education on managing the technology and programming the pump. Other factors for the oncology nurse to oversee and be aware of are maintenance of the pumps, supplies, and staffing issues, as more nursing time per patient is needed initially when the patient is beginning a regimen of chronomodulated therapy. Documentation of the chemotherapy flow chart, patient assessments, and nursing care plan must be altered as well for this population of patients. Despite the increased work for nurses, a recent pharmacoeconomic analysis showed that the costs of chronotherapy and standard therapy for colon cancer using 5-FU, leucovorin, and oxaliplatin were equivalent: Although chronotherapy cost more to administer, there were fewer toxic reactions and longer time to progression. 4 Chronomodulated chemotherapy has been validated for the improvement of quality of life while undergoing treatment, including less nausea and vomiting, less diarrhea, less asthenia, and less interruption of daily activities. A growing amount of research demonstrates improved treatment outcomes as well. Family support for using chronotherapy is thus usually very strong, especially since the outpatient setting allows family members to feel more involved in the care of their loved one. Patient satisfaction is enhanced also by less need for hospital admissions and increased feeling of well-being. The initial transition to using outpatient chronotherapy did involve substantial alterations to our nursing procedures; once the new routines were incorporated, they proved to be manageable from the nursing and administrative perspectives. Home chronotherapy in our practice has proven to be a safe and acceptable alternative to traditional methods administering chemotherapy, and has provided many of our patients with a vastly improved quality of life as well as the potential for better outcomes. Refe...

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Symptoms potentially influencing weight loss in a cancer population. Correlations with primary site, nutritional status, and chemotherapy administration

Cited by 163 publications

References 15 publications

Clinical Outcomes and Contributors to Weight Loss in a Cancer Cachexia Clinic

Clinical Outcomes and Contributors to Weight Loss in a Cancer Cachexia Clinic

Modifications in dietary and alcohol intakes between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort

Integrative Tumor Board: Colon Cancer with Liver Metastases

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