Effect of Fish Oil on Appetite and Other Symptoms in Patients with Advanced Cancer and Anorexia/Cachexia: A Double‐Blind, Placebo‐Controlled Study

Bruera, Éduardo; Strasser, Florian; Palmer, J. Lynn; Willey, Jie; Calder, Kathryn; Amyotte, G.; Baracos, Vickie E.

doi:10.1177/0115426503018006524

Cited by 56 publications

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“…9 Their study had critical differences in design compared with the current study. First, Bruera et al administered a daily dose of 3 g EPA plus DHA, compared with Ͼ 7 g per day (for a 70 kg patient) in the current study.…”

Section: Discussionmentioning

confidence: 89%

“…Bruera and colleagues reported on a doubleblind controlled study of 60 patients with cancer cachexia, 50% of whom received gelatin fish oil capsules. 9 Those authors found no effect on weight, appetite, or fatigue compared with placebo during the 2 weeks that patients took the capsules. In that study, it was determined that the ingestion of 3 g eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) for a brief period (14 days) had no effect on the cachectic symptoms or markers associated with terminal malignancy.…”

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confidence: 98%

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Phase II study of high‐dose fish oil capsules for patients with cancer‐related cachexia

Burns

Halabi²,

Clamon

et al. 2004

Cancer

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BACKGROUNDThe authors undertook a multiinstitutional Phase II cooperative group study to examine the potential of oral fish oil fatty acid supplements administered at high doses to slow weight loss and to improve quality of life in patients with malignancy‐related cachexia.METHODSPatients with advanced malignancy and weight loss ≥ 2% of body weight in the preceding month took concentrated, high‐dose omega‐3 fatty acid capsules (7.5 g eicosapentaenoic acid plus docosahexaenoic acid for a 70 kg individual) that were supplied by the National Institutes of Health.RESULTSForty‐three patients with moderate or severe malnutrition were enrolled. The median time receiving treatment was 1.2 months. For the 36 patients who took at least 1 capsule and did not have edema, there was a weight change ranging from −6.2 kg to +3.5 kg and an overall median weight loss of 0.8 kg. Twenty‐four patients had weight stabilization (a gain of ≤ 5% or a loss of < 5%), 6 patients gained > 5% of their body weight, and 6 patients lost ≥ 5% of their body weight. There was marked variability in the tolerability of the capsules, and many patients had gastrointestinal side effects. There was a correlation between time receiving treatment and weight gain for the 22 patients who were able to tolerate the capsules for at least 1 month. Quality‐of‐life scores were superior for patients who gained weight.CONCLUSIONSA majority of patients did not gain weight, and in that sense, the results of the study were unfavorable. However, a small but definite subset of patients had weight stabilization or weight gain. This suggests that omega‐3 fatty acids have potential utility at the study doses, which were more than twice the doses used in published Phase III studies. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 89%

mentioning

confidence: 98%

Phase II study of high‐dose fish oil capsules for patients with cancer‐related cachexia

Burns

Halabi²,

Clamon

et al. 2004

Cancer

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“…Dietary fish oil in advanced cancer VC Pratt et al EPA, it is perhaps not surprising that the main study (Bruera et al, 2002) did not detect a significant treatment effect on weight or body composition. However, in this smaller subgroup of patients, the magnitude of the change in plasma PL EPA, was significantly related to the amount of weight gained by the subjects receiving fish oil, providing evidence for a dose response relationship.…”

Section: Discussionmentioning

confidence: 94%

“…The patients with advanced cancer were a cohort of subjects participating in a larger study (Bruera et al, 2002). A random sub-sample of 14 subjects per treatment arm were assigned to receive more detailed measures of fatty acid status described here.…”

Section: Subjectsmentioning

confidence: 99%

Plasma and neutrophil fatty acid composition in advanced cancer patients and response to fish oil supplementation

Pratt

Watanabe

Bruera³

et al. 2002

Br J Cancer

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Metabolic demand and altered supply of essential nutrients is poorly characterised in patients with advanced cancer. A possible imbalance or deficiency of essential fatty acids is suggested by reported beneficial effects of fish oil supplementation. To assess fatty acid status (composition of plasma and neutrophil phospholipids) in advanced cancer patients before and after 14 days of supplementation (12±1 g day −1 ) with fish (eicosapentaenoic acid, and docosahexaenoic acid) or placebo (olive) oil. Blood was drawn from cancer patients experiencing weight loss of >5% body weight ( n =23). Fatty acid composition of plasma phospholipids and the major phospholipid classes of isolated neutrophils were determined using gas liquid chromatography. At baseline, patients with advanced cancer exhibited low levels (<30% of normal values) of plasma phospholipids and constituent fatty acids and elevated 20 : 4 n -6 content in neutrophil phospholipids. High n -6/ n -3 fatty acid ratios in neutrophil and plasma phospholipids were inversely related to body mass index. Fish oil supplementation raised eicosapentaenoic acid and docosahexaenoic acid content in plasma but not neutrophil phospholipids. 20 : 4 n -6 content was reduced in neutrophil PI following supplementation with fish oil. Change in body weight during the supplementation period related directly to increases in eicosapentaenoic acid in plasma. Advanced cancer patients have alterations in lipid metabolism potentially due to nutritional status and/or chemotherapy. Potential obstacles in fatty acid utilisation must be addressed in future trials aiming to improve outcomes using nutritional intervention with fish oils. British Journal of Cancer (2002) 87 , 1370–1378. doi: 10.1038/sj.bjc.6600659 www.bjcancer.com © 2002 Cancer Research UK

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“…The vast majority of the clinical trials in which fish oil derived n-3 PUFAs were tested report an increase (Wigmore et al, 1996(Wigmore et al, , 2000Barber et al, 1999Barber et al, , 2001Jatoi et al, 2004) or maintenance (Burns et al, 1999(Burns et al, , 2004Fearon et al, 2003) of body weight (BW), whereas in two other clinical trials no effect on the loss of BW was found (Gogos et al, 1998;Bruera et al, 2003). In the latter, however, the supplementation period was only 2 weeks (Bruera et al, 2003) and/or only a small number of patients was included (Gogos et al, 1998). In a clinical trial in pancreatic cancer patients, in which a fish oil-enriched product was tested against an isocaloric/isonitrogenous placebo, no differences between groups were found on either LBM or physical activity.…”

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confidence: 99%

Dietary supplementation with a specific combination of high protein, leucine, and fish oil improves muscle function and daily activity in tumour-bearing cachectic mice

et al. 2009

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Cancer cachexia is characterised by metabolic alterations leading to loss of adipose tissue and lean body mass and directly compromises physical performance and the quality of life of cancer patients. In a murine cancer cachectic model, the effects of dietary supplementation with a specific combination of high protein, leucine and fish oil on weight loss, muscle function and physical activity were investigated. Male CD2F1 mice, 6 -7 weeks old, were divided into body weight-matched groups: (1) control, (2) tumourbearing, and (3) tumour-bearing receiving experimental diets. Tumours were induced by s.c. inoculation with murine colon adenocarcinoma (C26) cells. Food intake, body mass, tumour size and 24 h-activity were monitored. Then, 20 days after tumour/ vehicle inoculation, the animals were killed and muscle function was tested ex vivo. Tumour-bearing mice showed reduced carcass, muscle and fat mass compared with controls. EDL muscle performance and total daily activity were impaired in the tumour-bearing mice. Addition of single nutrients resulted in no or modest effects. However, supplementation of the diet with the all-in combination of high protein, leucine and fish oil significantly reduced loss of carcass, muscle and fat mass (loss in mass 45, 52 and 65% of TB-con, respectively (Po0.02)) and improved muscle performance (loss of max force reduced to 55 -64% of TB-con (Po0.05)). Moreover, total daily activity normalised after intervention with the specific nutritional combination (50% of the reduction in activity of TB-con (Po0.05)). In conclusion, a nutritional combination of high protein, leucine and fish oil reduced cachectic symptoms and improved functional performance in cancer cachectic mice. Comparison of the nutritional combination with its individual modules revealed additive effects of the single components provided.

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Effect of Fish Oil on Appetite and Other Symptoms in Patients with Advanced Cancer and Anorexia/Cachexia: A Double‐Blind, Placebo‐Controlled Study

Cited by 56 publications

References 0 publications

Phase II study of high‐dose fish oil capsules for patients with cancer‐related cachexia

Phase II study of high‐dose fish oil capsules for patients with cancer‐related cachexia

Plasma and neutrophil fatty acid composition in advanced cancer patients and response to fish oil supplementation

Dietary supplementation with a specific combination of high protein, leucine, and fish oil improves muscle function and daily activity in tumour-bearing cachectic mice

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