Defining the role of dietary intake in determining weight change in patients with cancer cachexia

Nasrah, R.; Kanbalian, Mary; Borch, Christina Van Der; Swinton, Nelda; Wing, Simon S.; Jagoe, R. Thomas

doi:10.1016/j.clnu.2016.12.012

Cited by 39 publications

(43 citation statements)

References 35 publications

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“…Despite the impact on patient quality of life and treatment outcomes, weight loss is seldom monitored or managed over the course of cancer treatment . Although anorexia can contribute to weight loss in cancer patients, nutritional intervention alone is often inadequate to fully reverse declining body condition . Oncologists and nutritionists treating cachectic cancer patients seek to improve treatment options, and multimodal interventions that include stimulating anabolic pathways may provide a palliative intervention …”

Section: Introductionmentioning

confidence: 99%

A randomized trial of adjunct testosterone for cancer‐related muscle loss in men and women

Wright

Dillon

Durham

et al. 2018

J cachexia sarcopenia muscle

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BackgroundCancer cachexia negatively impacts cancer‐related treatment options, quality of life, morbidity, and mortality, yet no established therapies exist. We investigated the anabolic properties of testosterone to limit the loss of body mass in late stage cancer patients undergoing standard of care cancer treatment.MethodsA randomized, double‐blind, placebo‐controlled phase II clinical trial was undertaken to assess the potential therapeutic role of adjunct testosterone to limit loss of body mass in patients with squamous cell carcinoma of the cervix or head and neck undergoing standard of care treatment including chemotherapy and chemoradiation. Patients were randomly assigned in blocks to receive weekly injections of either 100 mg testosterone enanthate or placebo for 7 weeks. The primary outcome was per cent change in lean body mass, and secondary outcomes included assessment of quality of life, tests of physical performance, muscle strength, daily activity levels, resting energy expenditure, nutritional intake, and overall survival.ResultsA total of 28 patients were enrolled, 22 patients were studied to completion, and 21 patients were included in the final analysis (12 placebo, nine testosterone). Adjunct testosterone increased lean body mass by 3.2% (95% confidence interval [CI], 0–7%) whereas those receiving placebo lost 3.3% (95% CI, −7% to 1%, P = 0.015). Although testosterone patients maintained more favourable body condition, sustained daily activity levels, and showed meaningful improvements in quality of life and physical performance, overall survival was similar in both treatment groups.ConclusionsIn patients with advanced cancer undergoing the early phase of standard of care therapy, adjunct testosterone improved lean body mass and was also associated with increased quality of life, and physical activity compared with placebo.

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Section: Introductionmentioning

confidence: 99%

A randomized trial of adjunct testosterone for cancer‐related muscle loss in men and women

Wright

Dillon

Durham

et al. 2018

J cachexia sarcopenia muscle

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“…When patients were grouped into prognostic categories for patients with cancer based on both weight and prior weight loss,5 the majority of patients (65%) were in the two worst prognostic categories (grades 3 and 4) (table 2). As described previously,27 only a minority (15%) were consuming recommended levels of dietary energy and protein and a significant minority (21.7%) had markedly insufficient diets. The majority of patients (77%) were doing no exercise when they attended the first clinic visit, and over one-third of patients reported severe levels37 of at least one of the following symptoms: fatigue, weakness, anorexia (table 2).…”

Section: Resultsmentioning

confidence: 54%

“…On average, the management of patients with cancer cachexia in the CNR-JGH clinic leads to stabilisation of weight27; and the results of the current study show that those patients who gain weight or have improvements in physical function have the greatest improvements in QoL (figure 3). Furthermore, though there were differences in QoL at visit 1 between different clinical subgroups, these subgroups did not predict subsequent change in QoL in those who continued to be followed by the CNR-JGH clinical team (figure 2).…”

Section: Discussionmentioning

confidence: 58%

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A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life

Parmar

Vanderbyl

Kanbalian

et al. 2017

BMJ Support Palliat Care

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Improving management of all facets of the cancer cachexia syndrome, including poor QoL, remains a priority. The multimodal approach to management of cancer cachexia offered by the CNR-JGH results in clinically important improvements in QoL. All patients who are able to receive this type of intervention have similar potential to improve their QoL, but the greatest benefits are seen in those who gain weight and improve their 6MWT.

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“…Weight loss is more severe and more frequent in those with advanced disease, but it is a strong poor prognostic sign at all stages of disease and is associated with reduced treatment tolerance and increased morbidity and mortality . Low dietary energy intake is clearly correlated with weight loss, and recent data from our group have shown that over 80% of patients referred to our clinic for cancer cachexia were not consuming recommended levels of protein and energy . Using a multidisciplinary approach, including dietitian‐led nutritional counselling, mean dietary intake was increased, and overall weight stabilized in patients attending the clinic.…”

Section: Introductionmentioning

confidence: 89%

Defining barriers to implementation of nutritional advice in patients with cachexia

Nasrah

Borch

Kanbalian

et al. 2019

J cachexia sarcopenia muscle

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Background Cancer cachexia is a multidimensional wasting syndrome and a reduced dietary intake is both common and strongly correlated with degree of weight loss. Many patients with cachexia do not achieve recommended dietary intake even after nutritional counselling. Prior reports suggest this is likely due to barrier symptoms, but other potential contributory factors have not been studied in detail. Methods Dietitian‐assigned barriers to successful nutritional intervention were recorded at each visit in all patients attending a multidisciplinary clinic for management of cancer cachexia. The barriers were grouped into 15 categories and classified as either symptom‐related or not symptom‐related. In addition, symptom scores, dietary intake, and weight change were recorded. Results Data on 94 new patients showed that 89% of patients had at least one major barrier. Four of the five most common barriers and 65% of all barriers identified were not symptom‐related. Over sequential visits the specific barrier(s) in any one patient changed approximately 50% of the time. However, the presence of barriers did not render patients refractory to nutritional intervention and with intervention from the CNR‐JGH team, mean dietary intake increased significantly. Conclusions In advanced cancer patients with cachexia, non‐symptom‐related barriers to nutritional intervention are more common than symptom‐related. Barriers are dynamic, and repeated careful evaluation over time is required to achieve optimal impact with nutritional intervention in cancer cachexia. Members of the multidisciplinary team need appropriate expertise to address the barriers identified and achieve optimal results with nutritional intervention.

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Defining the role of dietary intake in determining weight change in patients with cancer cachexia

Cited by 39 publications

References 35 publications

A randomized trial of adjunct testosterone for cancer‐related muscle loss in men and women

A randomized trial of adjunct testosterone for cancer‐related muscle loss in men and women

A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life

Defining barriers to implementation of nutritional advice in patients with cachexia

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