The effect of an elemental diet on oral mucositis of esophageal cancer patients treated with DCF chemotherapy: a multi-center prospective feasibility study (EPOC study)

Abstract

PurposeOral mucositis (OM) is one of the most uncomfortable adverse events experienced by cancer patients undergoing chemotherapy. Previous reports have revealed that the oral administration of an elemental diet (ED) may prevent OM. However, the incidence of OM has not been accurately determined by specialized diagnostic methods and the effects of an ED on OM remain unclear. We investigated the dose that could feasibly be administered and its effects with regard to the suppression of OM in esophageal cancer patients undergoing chemotherapy.MethodsWe performed a prospective multi-center feasibility study of the administration of an ED (160 g/day) with 2 cycles of docetaxel/cisplatin/5-FU (DCF) chemotherapy. We assessed compliance to the ED for 49 days and the incidence of OM according to the amount of the ED that was orally administered. The incidence of OM was graded by a dental specialist who was experienced in dental oncology using a central OM review system.ResultsFourteen of 20 patients (70%) were able to complete the orally administered ED (160 g/day) during the course of chemotherapy. Three patients (15%) could not take the ED orally for 9, 14, and 21 days, respectively, while 1 patient (5%) took the ED orally at an average dose of 80 g/day for 35 days. The remaining 2 patients (10%) could not take the 80 g/day dose for 11 and 12 days, respectively. The incidence of grade ≥ 2 OM in the ED completion group (15.4%, 2 of 13 patients) was significantly lower than that in the non-completion group (66.7%, 4 of 6 patients) (p = 0.046).ConclusionsAn ED might be a one of the test treatment to reduce the incidence of OM in esophageal cancer patients treated with DCF and should be evaluated in further randomized study.Clinical trialThe date of submission: Dec 08th, 2017.Electronic supplementary materialThe online version of this article (10.1007/s10388-018-0620-1) contains supplementary material, which is available to authorized users.

Oligomeric Enteral Nutrition in Undernutrition, due to Oncology Treatment-Related Diarrhea. Systematic Review and Proposal of An Algorithm of Action

“…Further details about the literature search process are provided in Figure 1. Relevant studies were identified [52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68], and their results are summarized in Table 2 and Table 3.…”

“…Regarding chemotherapy-induced intestinal mucositis [60,61,62,63,64,65,66,67,68] (Table 3), all the studies we have found used the same oligomeric formula of enteral nutrition (Elental ® ). In total there are 345 patients, of whom 203 were treated with this oligomeric enteral nutrition, and the rest are controls without enteral nutrition.…”

“…In summary, the main objective of the studies is the effect of this type of oral nutritional supplement on oral mucositis in patients with chemotherapy. In all of the studies [60,61,62,63,64,65,66,67,68] oral mucositis improves, while the rest of the outcomes show different results. Only one study observes improvement in controls on body weight [68], while two others do not find differences [64,67], although in another they find improvement in lean body mass [60].…”

“…Only one study observes improvement in controls on body weight [68], while two others do not find differences [64,67], although in another they find improvement in lean body mass [60]. With regards to the response of diarrhea to this supplementation, the majority of studies do not find differences compared to the control group [62,65,66,68]. Despite these poor results, some authors note that hospitalization time decreases [62], and there are fewer cases in which chemotherapy should be stopped due to its side effects [64,67].…”

“…The Tanaka group have studied and measured the intestinal mucosal integrity on the basis of plasma diamine oxidase activity. In a recent study they found that the integrity of the intestinal mucosa tends to be maintained in the enteral oligomeric nutrition group [66]. Previous studies have shown that amino acids themselves can protect the mucosa and have anti-inflammatory effects [74].…”