Nutritional Deterioration in Cancer: The Role of Disease and Diet

Ravasco, Paula; Grillo, I. Monteiro; Vidal, Pedro; Camilo, M.

doi:10.1016/s0936-6555(03)00155-9

Cited by 206 publications

(165 citation statements)

References 26 publications

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“…Patients are encouraged to eat "as many calories as they can" and when food gets harder to swallow, supplementing it with either oral or parenteral nutrition via a PEG [42]. However, decreased caloric intake is probably only partially responsible for sarcopenia and simply increasing calories may not address loss of muscle mass.…”

Section: Main Textmentioning

confidence: 99%

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

2016

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Background: Concurrent chemotherapy and radiation (CTRT) improves disease-free survival in locally advanced head and neck cancer but is associated with numerous acute and chronic toxicities resulting in substantial alterations in body mass and composition. We aim to summarize the current evidence on body composition changes experienced by patients undergoing CTRT, examine the impact of these changes on clinical outcomes and address potential interventions aimed at mitigating the loss. Main Body: Loss of 20 % of pre-CTRT weight predicts poorer treatment tolerance and 30-day mortality. While clinical practice focuses on body weight, emerging data indicates that CTRT causes profound adverse changes in lean body mass (sarcopenia). Higher prevalence of sarcopenia predicts poorer disease-free survival as well as overall survival, lower quality of life and functional performance. The magnitude of CTRT-induced sarcopenia is the equivalent to that observed in a decade of aging in a healthy adult. Alterations in body composition are only explained, in part, by decreased caloric intake; other significant predictors include body mass index, stage, and dysphagia. Lifestyle interventions aimed at preventing loss of whole-body and especially lean mass include nutritional counseling, nutritional supplements, dietary supplements and exercise training. Personalized nutritional counseling has been associated with improvement in quality of life, while the benefits of feeding tube placement are inconsistent. There are inconsistently reported benefits of resistance training in this population. Conclusion: Patients with head and neck cancer undergoing CTRT therapy experience dramatic shifts in body composition, including sarcopenia, which can negatively impact clinical outcomes. Efforts to understand the magnitude, clinical importance and mechanisms of sarcopenia are needed to inform a more personalized approach to mitigating the body composition changes associated with CTRT.

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Section: Main Textmentioning

confidence: 99%

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

2016

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“…INTERNATIONAL JOURNAL OF ONCOLOGY 28: [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]2006 Table III. Biochemical outcomes; data used in the meta-analysis.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Elia

Schueren

Garvey³

et al. 2006

Int J Oncol

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Abstract. The aim of this systematic review was to determine the efficacy and potential benefits of enteral nutritional support [oral nutritional supplements (ONS) or enteral tube feeding (ETF)], and eicosapentaenoic acid (EPA, free acid, ethyl esters or fish oil; provided as capsules or enriched ONS or ETF) in patients with cancer. Clinical studies were identified using electronic databases, and studies were selected according to predetermined criteria. For each treatment modality (chemo/radiotherapy, surgery, and palliative care), the comparisons of interest were nutritional support vs. routine care (no nutritional support), EPA supplement (capsule or enriched ONS or ETF) vs. routine care (no supplement or standard supplement), ETF vs. parenteral nutrition (PN). The reviewed outcomes were dietary intake, anthropometry, clinical (mortality, length of hospital stay, complications, and quality of life) and haematological/biochemical (white blood cell count, serum transferrin and albumin, CD3-positive lymphocytes, and inflammatory markers). Meta-analyses were performed where possible. In patients undergoing radiotherapy, meta-analysis showed that ONS significantly increase dietary intake (381 kcal/day, 95% CI 193 to 569 in 3 RCTs) compared to routine care. In patients undergoing surgery, meta-analyses showed that ETF results in a significantly shorter length of hospital stay (1.72 fewer days, 95% CI 0.90 to 2.54 in 8 RCTs), lower incidence of any complications (OR 0.62, 95% CI 0.50 to 0.77 in 4 RCTs) and infectious complications (OR 0.67, 95% CI 0.55 to 0.82 in 11 RCTs) and lower sepsis scores (2.21 points, 95% CI 1.49 to 2.92 in 2 RCTs), but no difference in mortality (OR 0.72, 95% CI 0.40 to 1.29 in 7 RCTs) compared to PN. There was also no difference in mortality between ONS or ETF vs. routine care in patients undergoing chemotherapy/radiotherapy (OR 1.00, 95% CI 0.62-1.61 in 4 RCTs) or surgery (OR 2.44, 95% CI 0.75 to 7.95 in 4 RCTs). Individual studies of EPA supplementation as capsules showed improvements in survival, complications and inflammatory markers in patients undergoing bone marrow transplant (BMT). In palliative care patients receiving EPA-enriched ONS or capsules, there were inconsistent positive effects on survival and quality of life. In those undergoing surgery, EPA-enriched ETF had no effect. Further research is required to elucidate the clinical efficacy of enteral nutrition support, including the potential benefits of EPA supplementation, in patients with cancer.

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“…Dietary intake and nutritional status is related to tumour burden (Ravasco et al, 2003b), but also to the site of the primary tumour. Patients with advanced or metastatic disease are more likely to have cachexia, characterized by progressive weight loss and asthenia, than patients with localized disease receiving adjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

Dietary intake and nutritional indicators are transiently compromised during radiotherapy for rectal cancer

et al. 2005

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Objective: Patients with rectal cancer receive curative radiotherapy towards the pelvis for 5 weeks. Little is known about the impact of radiotherapy on dietary intake and nutritional status. The objective was to examine whether curative radiotherapy for rectal cancer promoted altered intake of energy and nutrients, and change in nutritional indicators. Design: Prospective study. Setting: Department of Oncology in a tertiary care hospital. Subjects: A total of 31 consecutive patients receiving radiotherapy for rectal cancer (50 Gray). Interventions: A 7-day food intake registration, body weight, upper arm circumference, and analyses of blood samples were performed at the start and the end of radiotherapy, and at follow-up 4-6 weeks and 1 year after the end of radiotherapy. Results: At the end of 5 weeks of radiotherapy, the mean daily energy intake was reduced by 15% from 8.9 to 7.6 MJ as compared with baseline (P ¼ 0.002), and the intake of several nutrients was reduced (Po0.01). The percentages of energy derived from fat, protein, and carbohydrates did not change, nor did the nutrient density. A transient body weight reduction ofo1 kg was observed (P ¼ 0.009). Serum concentrations of vitamin A and 25-OH vitamin D did not change during radiotherapy. The daily intake of energy and nutrients, and body weight, had increased towards pretreatment values 4-6 weeks after radiotherapy. Conclusions: Radiotherapy for rectal cancer caused a transient reduction in energy intake and nutritional indicators. The nutritional quality of the diet was unchanged during radiotherapy.

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Nutritional Deterioration in Cancer: The Role of Disease and Diet

Cited by 206 publications

References 26 publications

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Dietary intake and nutritional indicators are transiently compromised during radiotherapy for rectal cancer

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