Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial

Obling, Sine R; Wilson, Benedicte; Pfeiffer, Per; Kjeldsen, Jens

doi:10.1016/j.clnu.2017.12.011

Cited by 58 publications

(80 citation statements)

References 45 publications

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“…For ethical reasons the benefit of HPN has not been investigated in RCTs. However, over the last ten years several prospective and retrospective observational studies in advanced cancer patients with inadequate oral intake receiving chemoradiotherapy showed that HPN improves QoL [48][49][50][51][52][53][54] and prolongs survival [46,[55][56][57][58].…”

Section: Parenteral Nutritionmentioning

confidence: 99%

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

Cotogni¹,

Pedrazzoli²,

Waele³

et al. 2019

J. Cancer

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One of the challenges during chemotherapy and radiotherapy is to complete the planned cycles and doses without dose-limiting toxicity. Growing evidence clearly demonstrates the relationship between dose-limiting toxicity and low muscle mass. Moreover, malnutrition leads to low performance status, impaired quality of life, unplanned hospital admissions, and reduced survival. In the past, the lack of clear and authoritative recommendations and guidelines has meant that oncologists have not always fully appreciated the importance of nutritional therapy in patients receiving anticancer treatments. Therefore, collaboration between oncologists and clinical nutrition specialists needs to be urgently improved. Recent guidelines from scientific societies and practical recommendations by inter-society consensus documents can be summarized as follows: 1) timely nutritional therapy should be carefully considered if patients undergoing anticancer treatments are malnourished or at risk of malnutrition due to inadequate oral intake; 2) if oral intake is inadequate despite counseling and oral nutritional supplements, supplemental enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition should be considered; 3) home artificial nutrition should be prescribed and regularly monitored using defined protocols developed between oncologists and clinical nutrition specialists; 4) appropriate nutritional management in the context of simultaneous care should become a guaranteed right for all patients with cancer. The purpose of this review is to provide oncologists with an overview of the aims and current evidence about nutrition in oncology, together with updated practical and concise recommendations on the application of nutritional therapy in cancer patients receiving chemoradiotherapy.

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Section: Parenteral Nutritionmentioning

confidence: 99%

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

Cotogni¹,

Pedrazzoli²,

Waele³

et al. 2019

J. Cancer

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“…Data were analysed from a prospective cohort of patients with incurable gastrointestinal cancer who were consecutively screened and offered participation in a RCT [17]. Patients were recruited in relation to the clinical randomized study of parenteral nutrition, in which they declined to participate.…”

Section: Methodsmentioning

confidence: 99%

“…Results from the RCT were not the scope of this work, and therefore these data are reported elsewhere [17].…”

Section: Methodsmentioning

confidence: 99%

Assessment of muscle mass with computerised tomography in patients with incurable gastrointestinal cancer. A prospective single centre study

Wilson¹,

Kjeldsen²,

Pfeiffer³

et al. 2019

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Body composition is often affected in patients with incurable cancer, but the prevalence of sarcopenia is unknown. Our aim was to evaluate sarcopenia as predictor of overall survival in a cohort of patients with incurable gastrointestinal cancer and furthermore to evaluate if this cohort had different characteristics than patients, from an identical cohort who accepted participation in a RCT. Design and methods In this single centre study, we prospectively included a cohort of patients with incurable gastrointestinal cancer nutritionally at risk (NRS 2002≥2). Patients were screened but refused participation in an RCT testing supplemental HPN. To assess sarcopenia, data on skeletal muscle mass (SMM) from the cross-sectional area of L3 were assessed using computerized tomography scan (CT scan). SMM evaluation was included if a CT scan was available within 60 days from the inclusion date. Differences in survival were tested according to sarcopenia and modified Glasgow Prognostic Score (mGPS). Survival was compared between the patients who refused to participate in the RCT and patients who actually did participate. Results Eligible for inclusion were 187 patients, and 165 had a CT scan available for analysis. Most prevalent diagnosis was pancreatic cancer (52%), median age was 70.5 (41.2-89.4), median BMI 22.3 (14.4-36.8) and 99% were receiving chemotherapy. Sarcopenia was present in 78% of the overall cohort, more women (88%) than men (70%) were sarcopenic at inclusion. There was a positive correlation between BMI and SMM, but SMM accounted for only 8% of the variance in BMI. Conclusions Prevalence of sarcopenia was high in this cohort of patient with incurable gastrointestinal cancer; SMM did positively correlate to BMI, but only accounted for minor variations. mGPS was in the multivariate cox regression model predictive of survival and sarcopenia did not add to this elevated risk.

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“…Cancer‐related cachexia is not reversible by conventional oral nutritional support . Parenteral nutrition and supplementation with branched chain amino acids and fish oil have shown promising results in preserving muscle mass loss in patients at risk for developing cachexia . Interventions to increase amino acid ingestions to promote protein synthesis in patients diagnosed with cachexia have shown conflicting results .…”

Section: Exercise and Nutritional Interventionsmentioning

confidence: 99%

Cancer‐ and Chemotherapy‐Induced Musculoskeletal Degradation

et al. 2019

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Mobility in advanced cancer patients is a major health care concern and is often lost in advanced metastatic cancers. Erosion of mobility is a major component in determining quality of life but also starts a process of loss of muscle and bone mass that further devastates patients. In addition, treatment options become limited in these advanced cancer patients. Loss of bone and muscle occurs concomitantly. Advanced cancers that are metastatic to bone often lead to bone loss (osteolytic lesions) but may also lead to abnormal deposition of new bone (osteoblastic lesions). However, in both cases there is a disruption to normal bone remodeling and radiologic evidence of bone loss. Many antitumor therapies can also lead to loss of bone in cancer survivors. Bone loss releases cytokines (TGFβ) stored in the mineralized matrix that can act on skeletal muscle and lead to weakness. Likewise, loss of skeletal muscle mass leads to reduced bone mass and quality via mechanical and endocrine signals. Collectively these interactions are termed bone‐muscle cross‐talk, which has garnered much attention recently as a prime target for musculoskeletal health. Pharmacological approaches as well as nutrition and exercise can improve muscle and bone but have fallen short in the context of advanced cancers and cachexia. This review highlights our current knowledge of these interventions and discusses the difficulties in treating severe musculoskeletal deficits with the emphasis on improving not only bone mass and muscle size but also functional outcomes. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial

Abstract: (NCT02066363) www.clinicaltrials.gov.

Cited by 58 publications

References 45 publications

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

Assessment of muscle mass with computerised tomography in patients with incurable gastrointestinal cancer. A prospective single centre study

Cancer‐ and Chemotherapy‐Induced Musculoskeletal Degradation

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