Introduction of an Omega-3 Enriched Oral Supplementation for Cancer Patients Close to the First Chemotherapy: May It Be a Factor for Poor Compliance?

Abstract

The present study aims to evaluate compliance of cancer patients to EPA-enriched supplementation at the beginning of chemotherapy, and its effects on inflammation. Gastrointestinal and lung cancer patients were randomly assigned to receive nutritional supplement enriched with 2.2 g EPA or standard isocaloric one. Supplements were introduced 72 h before the first chemotherapy and continued for 4 wk. Serum C-reactive protein was measured and its variation was analyzed according to tumor location and treatment group. Compliance was assessed by phone contact and counting of supplement bottles returned after treatment. Sixty-nine patients were assessed, mean aged 65.5 yr old, most of them (59%) men. Gastrointestinal cancer was more prevalent and lung cancer had the highest C-reactive protein values (P = 0.009). Twenty-four patients interrupted treatment (trend for more interruption in EPA group), mainly because of gastrointestinal intolerance. No difference was found in C-reactive protein variation between EPA and control groups after treatment. Lung tumors showed higher inflammation than gastrointestinal ones. A short intervention with EPA was insufficient to reduce inflammation, which may be caused by the frequent abandoning of treatment. The beginning of chemotherapy may not be the optimal time point to initiate EPA supplementation because uncomfortable effects of both treatments may lead to poor adherence.

Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials

“…% BW loss was 11.8 (4.3-18) (Ctr) and 12.9 (3.8-32.8) (Int) 100 High-protein, n -3 PUFA- enriched ONS Isocaloric isonitrogeneous ONS 8.5 weeks Trabal [ 28 ] 1 13 68.2±15.6 Ctr and 61.5±15.8 Int CRC stage IV FOLFOX or capecitabin Two patients at risk of malnutrition, exclusion of severely malnourished patients (according to SGA scores). % BW loss was 3.1±3.3 (Ctr) and 8.1±6.9 (Int) 15 High-protein, n -3 PUFA- enriched ONS+DC DC 12 weeks Van der Meij [ 27 , 33 ] 5 42 57.2±8.1 Ctr and 58.4±12 Int NSCLC stage III Cisplatin+ docetaxel or cisplatin +bevacizumab with concurrent thoracic radiotherapy % BW loss in past mo: 1.5±4.7 (Ctr) and 0.3±2.4 (Int) 20% patients were considered malnourished based on BMI <18.5 and/or BW loss >5% in previous mo and/or BW loss >10% in previous 6 mo 20 High-protein, n -3 PUFA- enriched ONS Isocaloric ONS 5 weeks Sanchez-Lara [ 34 ] 3 92 61±12.4 Ctr and 58.8±14 Int NSCLC stage III–IV Paclitaxel+cisplatin/ carboplatin % BW loss was 7.1±9 (Ctr) and 8.8±8 (Int) Malnutrition based on SGA: none ( N =48), moderate ( N =21), severe ( N =23) 48 High-protein, n -3 PUFA- enriched ONS Isocaloric diets 6–8 weeks Pastore [ 38 ] 3 69 63.5±11.8 GI–lung Not reported ...…”

“…In one trial, both groups had similar target goals and received nutritional counseling, however only the intervention group received ONS [ 37 ]. Five other studies investigated the effect of ONS enriched with protein and n -3 PUFA, providing 590–600 kcal, 32–33 g protein and 2–2.2 g of eicosapentaenoic acid (EPA) per day, usually compared with an isocaloric control [ 27 , 28 , 31 , 33 , 34 , 38 ]. In these studies, there was some heterogeneity in control groups; in one RCT patients received DC only [ 28 ], and another RCT included an isocaloric, isonitrogeneous control [ 31 ].…”

“…Compliance was suboptimal in the study by Van der Meij et al [ 27 ], where patients in the intervention arm took only half of the prescribed dose. In Pastore et al [ 38 ] compliance was poor, 36% of patients in the intervention group and 14% patients in the control group stopped taking the ONS. Three of these RCT reported achieved dietary intake [ 27 , 31 , 34 ].…”

“…Effects of high-protein, n -3 PUFA-enriched ONS on circulating levels of CRP were reported in four RCT [ 27 , 31 , 34 , 38 ]. Serum CRP levels significantly decreased compared with baseline in a study in lung cancer patients ( P < 0.05) [ 31 ] and a further study in NSCLC patients ( P = 0.02), while no change was observed in the control groups in either study [ 34 ].…”

Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia?

“…Therefore, the results of the studies may be affected by an insufficient EPA dose ingestion. Perhaps a better adherence could be obtained if EPA was given after adaptation to chemotherapy, when patients are able to recognize its side effects, thus avoiding a biased association with EPA (19).…”