The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study

Bauersfeld, Stephan P.; Kessler, Christian S.; Wischnewsky, Manfred; Jaensch, Annette; Steckhan, Nico; Stange, Rainer; Kunz, Barbara Lopez; Brückner, Barbara; Sehouli, Jalid; Michalsen, Andreas

doi:10.1186/s12885-018-4353-2

Cited by 204 publications

(290 citation statements)

References 19 publications

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“…Thus, we also conducted a systematic review of experimental studies investigating the effect of dietary interventions, alone or in combination with other recommendations, on the QoL of breast cancer survivors. Although all the studies underlined significant improvements in QoL after the interventions, only a trial evaluated the sole and exclusive effect of dietary intervention [47]. The rest of studies, instead, combined the promotion of dietary recommendations with programs aiming to increase exercise and physical activity among breast cancer survivors.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, only the single-arm trial by Bauersfeld and colleagues evaluated the effect of an intervention based exclusively on dietary recommendations. They demonstrated that short-term fasting followed by normo-caloric diet counteracted the reduction of QoL in the first half of chemotherapy [47]. Specifically, the reduction in QoL after chemotherapy was less than the minimally important difference with short-term fasting but greater than the minimally important difference for non-fasted periods.…”

Section: Findings From the Systematic Reviewmentioning

confidence: 99%

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The Effects of Diet and Dietary Interventions on the Quality of Life among Breast Cancer Survivors: A Cross-Sectional Analysis and a Systematic Review of Experimental Studies

Barchitta

Maugeri

Lio

et al. 2020

Cancers

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There is an ongoing need for solid evidence about the effects of healthy behaviors, and particularly diet, on the quality of life (QoL) among breast cancer survivors. We first conducted a cross-sectional study on 68 Italian stage I-III breast cancer survivors, to investigate the association of adherence to the Mediterranean diet (MD), physical activity and weight status with QoL. Adherence to MD and physical activity was assessed using structured questionnaires. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality-of-Life tools. We showed that low consumption of red meat and carbonated beverages, daily consumption of wine and high consumption of dishes seasoned with sofrito had beneficial effects on several QoL subscales. By contrast, using olive oil as the main culinary fat, low consumption of commercial sweets and high consumption of nuts were associated with negative effects. Overall, these findings resulted in a null effect of adherence to MD on QoL. Furthermore, we observed better QoL sub-scores among women who performed moderate physical activity (i.e., diarrhea) and those who were underweight/normal weight (i.e., physical functioning and dyspnea) if compared with their counterparts (p-values ≤ 0.003 after correction for multiple comparison). Next, we performed a systematic review of nine experimental studies to summarize whether dietary interventions might improve QoL among breast cancer patients. All the studies demonstrated significant improvements in overall QoL and/or its subscales after the interventions. However, differences in study design, interventions and tools used for QoL assessment did not allow us to provide an overall estimate. Moreover, only a single-arm trial evaluated the effect of an exclusive dietary-based intervention, while others combined dietary recommendations with physical activity and weight loss programs. For these reasons, our study encourages more efforts to improve the robustness of current evidence, through more homogenous tools, larger population-based studies and further randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

Section: Findings From the Systematic Reviewmentioning

confidence: 99%

The Effects of Diet and Dietary Interventions on the Quality of Life among Breast Cancer Survivors: A Cross-Sectional Analysis and a Systematic Review of Experimental Studies

Barchitta

Maugeri

Lio

et al. 2020

Cancers

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“…Some studies have suggested a short-term but more extreme food restriction, especially prior to treatment with chemotherapy, immunotherapy, or other targeted agents, with the goal of enhancing the anti-cancer effects of the therapy to allow patients to benefit from the diet without the negative effects associated with long-term exposure to that diet 12,69,70 . Indeed, several clinical trials have been initiated to explore these dietary strategies [71][72][73][74] . Whether changes to lipid availability and metabolism, as well as other metabolic alterations, contribute to the effects of these short-term dietary interventions is an area for further exploration.…”

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confidence: 99%

Caloric restriction alters lipid metabolism to contribute to tumor growth inhibition

Lien

Westermark

et al. 2020

Preprint

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Dietary interventions can change metabolite levels in the tumor microenvironment,which may then affect cancer cell metabolism to alter tumor growth 1-6 . Although caloric restriction (CR) and the ketogenic diet (KD) are often thought to inhibit tumor growth through lowering blood glucose and insulin levels 7-12 , only CR inhibits the growth of pancreatic ductal adenocarcinoma allografts in mice, demonstrating that this diet can limit tumor growth in other ways. A change in nutrient availability observed with CR, but not the KD, that can contribute to tumor growth inhibition is lower lipid levels in the plasma and in tumor interstitial fluid. Limiting exogenous lipid availability to cultured cancer cells results in up-regulation of stearoyl-CoA desaturase (SCD), an enzyme that converts saturated fatty acids to monounsaturated fatty acids. Fatty acid desaturation is required to dispose of toxic saturated fatty acids, and not because monounsaturated fatty acids are specifically needed for proliferation. Surprisingly, CR also inhibits tumor SCD activity, and enforced SCD expression confers resistance to the effects of CR. Therefore, CR both limits lipid availability and impairs tumor SCD activity, thereby limiting cancer cell adaptation to a diet-induced change in the tumor microenvironment that results in tumor growth inhibition.How diet affects cancer progression and survival is an important question for many cancer patients. While multiple studies have examined how different diets can influence both whole-body hormone signaling and cancer cell signaling processes 7,8,10,11,[13][14][15][16] , how dietary interventions might impact tumor growth by altering nutrient access to cancer cells in tumors is less studied. Consistent with the notion that the activities of various metabolic pathways in cancer cells can be strongly influenced by nutrient availability in the local environment 17-21 , dietary deprivation of specific amino acids can limit the growth of some tumors 2,4-6 . Whether Biotherapeutics, iTeos Therapeutics, and Auron Therapeutics. E.C.L., A.M.W., Z.L., and K.M.S. declare no competing interests.

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confidence: 99%

“…Similarly to Bauersfeld et al(10), we collected data on QoL, fatigue and additionally CIPN. While Bauersfeld et al(10) observed significant improvements in fatigue and QoL due to STF during chemotherapy, our results were not able to confirm these findings. However, it should be noted, that the informative value of the three above mentioned questionnaires is limited due to an unfavourable point in time for data collection on the day of chemotherapy, reflecting QoL, CIPN and fatigue in the week before chemotherapy.…”

mentioning

confidence: 99%

Impact of modified short-term fasting and the combination with a fasting supportive diet during chemotherapy on the incidence and severity of chemotherapy-induced toxicities in cancer patients – a randomised controlled cross-over pilot study

Zorn

Ehret

Schäuble

et al. 2020

Preprint

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Background This pilot trial aimed to investigate whether modified short-term fasting (mSTF) reduces the incidence of chemotherapy-induced toxicities and whether an initial ketogenic diet (KD) as fasting supportive diet reduces the fasting-related discomfort and increases the compliance. Methods In this randomised controlled cross-over trial, gynaecologic cancer patients receiving chemotherapy with a minimum of 4 cycles were randomised to mSTF for 96 h during half of chemotherapy cycles and to consume a normocaloric diet during the other chemotherapy cycles. The caloric intake during mSTF was restricted to 25% of each patient's daily requirement. In addition, half of the patients should eat a 6-day normocaloric KD prior to each mSTF period to investigate the hunger-suppression effect of a KD. Chemotherapy-induced toxicities, fasting-related discomfort, body composition, quality of life, laboratory values, and compliance were assessed on each chemotherapy. Results Thirty patients (30-74 years) completed the study. During mSTF frequency and severity scores of stomatitis [-0.16 ± 0.06; 95% CI -0.28 - (-0.03); P = 0.013], headaches [-1.80 ± 0.55; 95% CI -2.89 – (-0.71); P = 0.002], weakness [-1.99 ± 0.87; 95% CI -3.72 – (-0.26); P = 0.024] and the score of total toxicities were significantly reduced [-10.36 ± 4.44; 95% CI -19.22 - (-1.50); P = 0.023]. Additionally, significant fewer postponements of the chemotherapy were observed post-mSTF, reflecting an improved tolerance of chemotherapy [-0.80 ± 0.37; 95% CI -1.53 – (-0.06); P = 0.034]. A significant reduction of mean body weight by -0.79 ± 1.47 kg during mSTF could not be compensated and remained until the end of study ( P <0.005). On average, Insulin [-169.4 ± 44.1; 95% CI -257.1 – (-81.8); P <0.001] and Insulin-like growth factor 1 levels [-33.3 ± 5.4; 95% CI -44.1 – (-22.5); P <0.001] significantly decreased during fasting. The KD as fasting supportive diet could neither reduce fasting-related discomfort nor increase compliance of our fasting regime. Conclusion MSTF is safe and feasible in gynaecologic cancer patients. The results indicate that mSTF during chemotherapy can reduce chemotherapy-induced toxicities and increase the tolerance of chemotherapy. Larger clinical trials are required to recommend mSTF for cancer patients.

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The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study

Cited by 204 publications

References 19 publications

The Effects of Diet and Dietary Interventions on the Quality of Life among Breast Cancer Survivors: A Cross-Sectional Analysis and a Systematic Review of Experimental Studies

The Effects of Diet and Dietary Interventions on the Quality of Life among Breast Cancer Survivors: A Cross-Sectional Analysis and a Systematic Review of Experimental Studies

Caloric restriction alters lipid metabolism to contribute to tumor growth inhibition

Impact of modified short-term fasting and the combination with a fasting supportive diet during chemotherapy on the incidence and severity of chemotherapy-induced toxicities in cancer patients – a randomised controlled cross-over pilot study

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