The Efficacy of Oral Nutritional Intervention in Malnourished Cancer Patients: a Systemic Review

Abstract

Cancer is currently a leading cause of deaths worldwide and the number of new cases is growing rapidly in both, developed and developing countries. Nutritional management during and after cancer treatment affects treatment efficacy and patient quality of life (QOL). This review systemically examined the effect of oral nutritional interventions on nutritional and clinical outcomes in cancer patients. We especially focused on outcomes such as nutritional status indices, immune-associated biochemical markers, and QOL assessments to provide insights on the applicability of different outcomes. A total of 28 papers were selected for systematic review. The nutritional composition of oral nutritional supplements (ONS), outcome measures, and efficacy of the oral nutritional interventions were summarized and discussed. Most ONS contain 1 or more functional components in addition to basic nutrients. Each study used various outcome measures and significant efficacy was observed for a limited number of measures. Nutritional status indices, QOL measures, and the duration of hospital stay improved in about 40% of the studies. One or more markers of immune function and inflammatory responses were improved by ONS in 65% of the selected studies. These results suggest that appropriate use of ONS may be an ideal way to improve treatment efficacy; however, additional intervention trials are required to confirm these findings.

Effectiveness of a Screening Tool for Early Identification of Malnutrition in Patients with Head and Neck Cancer

“…Thus, enhancing preoperative nutritional statues by early identification of nutritional status using the MUST have demonstrated good outcomes which is evidenced in our study. This is supported by several studies [1,9,13,30,33], where positive outcomes prediction associated with the use of MUST were demonstrated in terms of length of hospitalization stay, mortality, hospitalization cost and improved quality of life. In addition, it was observed that participants who were non-smokers and underwent primary surgical closure were related to decreased length of hospitalization stay.…”

“…Postoperative complications are often challenging to manage due to preexisting poor nutritional state [9], which is a contributing factor in the spiral effects of postoperative complications and mortality particularly in patients with head and neck cancer [1,5,32]. Increased postoperative infection rates ranging from 20 to 40%, were observed in both surgical and non-surgical-related infections and were significantly correlated with patients who were malnourished at diagnosis [9,10,13,17,26,33]. Therefore, preoperative assessment of nutritional status using a validated screening tool that has high specificity and sensitivity is vital in the initial screening of patients so that accurate assessment of their nutritional status can be established.…”

“…Therefore, preoperative assessment of nutritional status using a validated screening tool that has high specificity and sensitivity is vital in the initial screening of patients so that accurate assessment of their nutritional status can be established. Early nutritional interventions to correct malnutrition can positively influence postoperative outcomes such as reduced postoperative complications and length of hospitalization [9,10,13,26,33].…”

“…It is used for identifying malnourished and at risk of malnutrition status with specific recommendations based on the score. There is also a correlation between MUST and its ability to predict postoperative outcomes for both surgical and non-surgical complications [1,2,23,28,30,31] in terms of length of hospitalization stay, mortality, hospitalization cost and improved quality of life [1,9,13,30,33]. MUST is an effective measurement of nutritional status with high indexes for sensitivity, specificity and concordance agreement in comparison with the standard Patient-Generated Subjective Global Assessment (PG-SGA) for oncology patients [1, 3-5, 30, 31].…”

La place des lipides dans les compléments nutritionnels oraux (CNO)

“…Plus spécifiquement la méta-analyse de Milne et al (2009) incluant 62 études et plus de 10 000 personnes âgées à risque de dénutrition, a montré qu'une prise de CNO HP/HC augmente de façon significative le poids de 2,2 % (Milne et al, 2009). Ces résultats positifs sont également observés chez des personnes âgées atteintes de démence (Allen et al, 2013) et une majorité d'individus atteints de cachexie cancéreuse (selon le type de cancer et de traitement) (Kim et Sung, 2016 ;Laviano et al, 2016). Une autre revue de la littérature (Cawood et al, 2012) montre que la prise en charge de la dénutrition par des CNO hyperprotidiques permet d'augmenter significativement le poids et la force musculaire de préhension, et de réduire significativement les complications (À30 %) et les réadmissions à l'hôpital (À40 %).…”