Early and Intensive Dietary Counseling in Lung Cancer Patients Receiving (Chemo)Radiotherapy—A Pilot Randomized Controlled Trial

Abstract

Malnutrition is prevalent in patients undergoing (chemo)radiotherapy (RT) for lung cancer. This pilot study tested the feasibility and acceptability of delivering an intensive nutrition intervention for lung cancer patients receiving RT. Twenty-four patients with lung cancer were randomized to receive the intervention which employed a care pathway to guide intensive dietary counseling from pretreatment until 6-wk posttreatment or usual care. Nutritional, fatigue, and functional outcomes were assessed using valid and reliable questionnaires before randomization, at the start and end of RT and 1- and 3-mo post-RT. Consent rate was 57% with an overall attrition of 37%. Subject compliance with the completion of study questionnaires was 100%. A clinically important mean difference indicated greater overall satisfaction with nutritional care in the intervention group (5.00, interquartile range [IQR] 4.50-5.00; 4.00, IQR 4.00-4.00). Clinically important differences favoring the intervention were observed for weight (3.0 kg; 95% confidence interval [CI] -0.8, 6.8), fat-free mass (0.6 kg; 95% CI -2.1, 3.3), physical well-being (2.1; 95% CI -2.3, 6.5), and functional well-being (5.1; 95% CI 1.6, 8.6), but all 95% CIs were wide and most included zero. Recruitment feasibility and acceptability of the intervention were demonstrated, which suggest larger trials using an intensive nutrition intervention would be achievable.

Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer

“…However, their early nutrition intervention was essentially equivalent to our control group. A similar style of study has recently been undertaken in patients with lung cancer (Kiss et al , 2016). Our current study design initiates supplementary prophylactic tube feeding prior to commencement of treatment and so could be described as an even more intensive early intervention.…”

Nutrition therapy for the management of cancer-related fatigue and quality of life: a systematic review and meta-analysis

“…Abstracts of the full-text records were assessed for eligibility; forty-eight articles were subsequently included for full-text revision, with one article additionally included through reference lists screening of the included articles. A total of sixteen articles met the inclusion criteria and were included in the review (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54) , with one intervention described in two separate studies (43,44) .…”

Optimising nutrition support in patients with head and neck cancer

“…Nutrition support has been widely investigated for the role of preoperative nutrition support (Bertrand, Piquet, Bordier, Monnier, & Roulet, 2002;Flynn & Leightty, 1987;Weimann et al, 2006) particularly in regards to the role of immunonutrition (Stableforth, Thomas, & Lewis, 2009), but there have been limited studies investigating the timing of nutrition support prior to oncological or radiotherapy treatment. Positive outcomes have recently been reported following pretreatment nutrition intervention in lung cancer patients undergoing CRT (Kiss et al, 2016).…”

“…Poor patient adherence to the intervention was potentially due to a lack of understanding of increased nutritional needs. A trial of earlier dietary counselling may be beneficial to develop patient engagement and self-management, as this has been successful in a pilot study in lung cancer (Kiss et al, 2016).…”

“…In regards to the first component of fidelity (study design), the intervention was based on theory from the literature review regarding the behaviours associated with feeding tubes (Merrick & Farrell, 2012;Salas et al, 2009) and the role of pre-treatment nutrition interventions in other cancer patients (Kiss et al, 2016). The study ensured minimising contamination between treatment arms by designating different dietitians to each arm of the trial.…”