Updated evidence‐based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy

Abstract

Aims:The aim of this paper was to update the evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy and broaden the scope to include chemotherapy. Methods: The following databases were searched using a range of keywords: Cochrane Database, CENTRAL, MEDLINE (via Ebscohost), EMBASE, CINAHL (Ebscohost), Web of Science, Health Source: Nursing/Academic Edition and PubMed. Relevant papers (n = 47) were reviewed by at least two members of the steering committee and assigned a level of evidence and a quality rating. Results: There were no new published randomised controlled trials (RCTs) of nutrition intervention in radiation therapy. Most statements in the previous radiation therapy guidelines have strong evidence supporting nutrition intervention. There were 12 studies in chemotherapy including five RCTs. While these studies provided strong evidence that simple nutrition intervention improves nutritional outcomes such as dietary intake and weight, they did not find an improvement in quality of life or survival. Several RCTs found no benefits of nutrition support in patients undergoing chemotherapy. None of the RCTs in chemotherapy used medical nutrition therapy (MNT) as the intervention, but rather simple dietary advice and/or supplements. Conclusions:The evidence to support nutrition intervention in patients receiving radiation therapy remains strong. However, the benefits of nutrition intervention in chemotherapy are less clear. Further studies are required to evaluate the impact of MNT as opposed to simple dietary advice in chemotherapy patients. This update contributes to a move towards comprehensive evidence-based guidelines for the nutritional management of patients with cancer.

Nutrition Intervention Improves Nutritional Status and Quality of Life Outcomes in Patients Undergoing Radiotherapy

“…Firstly, in order for patients with cancer who are at nutritional risk to be appropriately identified and referred to the dietician, nutrition screening should be routinely used in oncology settings (Isenring 2008 (Skipper et al, 2012). Some nutrition screening tools are more detailed than others and designed for different settings and users.…”

“…The use of enteral nutrition and parenteral nutrition support should be individualized with recognition of overall treatment goals (control or palliation) and the associated risks of medical complications and/or ethical dilemmas (Rock et al, 2012). For patients with endstage disease, focus should be on patient comfort and quality of life (Isenring et al, 2008). Patients with minimal dietary intake may require tube feeding (depending on prognosis and in consultation with patient and medical team) (Isenring et al, 2008).…”

Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients

“…It is well documented that the prevalence of malnutrition in the oncology population is high, yet malnutrition remains underdiagnosed and under-treated [1]. The diagnosis of a patient's nutritional status usually consists of a detailed investigation that takes into account medical and nutritional history, as well as an anthropometric assessment [2].…”

“…The diagnosis of a patient's nutritional status usually consists of a detailed investigation that takes into account medical and nutritional history, as well as an anthropometric assessment [2]. Evidence-based practice guidelines recommend the use of the Scored PatientGenerated Subjective Global Assessment (PG-SGA) for nutrition assessment within the oncology patient population [1]. However, comprehensive nutrition assessment is not practical for routine use for all oncology patients in large tertiary hospitals due to time and human resource limitations [3].…”

Nutrition and Exercise Interventions for Patients with Lung Cancer Appear Beneficial, but More Studies Are Required

“…Intensive individualized nutrition counselling has previously been demonstrated to be effective in achieving improvements in patient and clinical outcomes in both head-and-neck and gastrointestinal cancers 5,6 . This area warrants further exploration in patients with lung cancer.…”