Impact of improved nutritional status on survival in ovarian cancer

Perioperative nutrition interventions for women with ovarian cancer

BACKGROUND

Women with ovarian cancer have been shown to be at significant risk of malnutrition with incidence rates described as being between 28% to 67%. Nutrition interventions may improve clinical outcomes positively, nutritional status or quality of life measures in this patient group.

OBJECTIVES

This review was conducted to assess the effects of nutrition interventions during the perioperative period for women with ovarian cancer.

SEARCH METHODS

Electronic searches were conducted of the Cochrane Gynaecological Cancer Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 7), Medline (1946 to July week 4 2012), Embase (1980 to 2012 week 31), DARE (to 7th August 2012) AMED (1985 to April 2012), BNI (1992 to April 2012), CINAHL (to April 2012). We also searched trials databases, conference proceedings and related citation lists. Reference listings were handsearched. No restrictions were applied on language or date.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in which women 18 years and over with any stage of ovarian cancer, including recurrent cancer, were in the perioperative phase of treatment and received any type of nutrition intervention.

DATA COLLECTION AND ANALYSIS

Titles and abstracts were screened by two review authors with study selection discussed by a team. Pairs of review authors worked independently on data collection and compared findings.

MAIN RESULTS

A total of 4092 titles were screened and 14 full text reports reviewed; a single small study met the inclusion criteria. In the included RCT, 40 women (35 with ovarian cancer) had extensive elective surgery including bowel resection for treatment of gynaecological malignancy. Randomisation was made to either early oral feeding (oral fluids in the first 24 hours, solid foods on the following day) or to a 'traditional' feeding regimen where oral fluids and foods were delayed until there was evidence of bowel function. Most women in the early feeding group (14/18) were able to resume eating solid food one day after surgery. This resulted in a significantly shorter hospital stay with no increase in postoperative complications or change in quality of life measures in comparison with the women on the 'traditional' feeding regimen. The incidence of nausea and vomiting during the postoperative stay was similar in both groups and was noted in slightly more than half of the women. Overall survival was evaluated until 30 days following discharge from hospital; in this period, there was one death of a woman who had been in the 'traditional oral feeding' group, cause of death was not noted. We assessed risk of bias and found no high risk of bias was identified in the methodology and reporting of the included study, although there was an increased risk of bias due to the small size of the study in which not all of the women had ovarian cancer.

AUTHORS' CONCLUSIONS

Although women with ovarian cancer have been shown to be at risk of malnutrition, there is a lack of evidence derived from RCTs evaluating the identification, assessment and treatment of malnutrition during the perioperative phase of treatment. There is evidence from one small study that some women with ovarian cancer undergoing surgery with associated bowel resection may safely commence oral fluids within 24 hours of surgery and solid foods on the following day. Further research is required, including a RCT, to generate guidance concerning the treatment of malnutrition in this patient group.

Quality of life and nutritional status among cancer patients on chemotherapy

OBJECTIVES

Malnutrition is prevalent among cancer patients, and maybe correlated with altered quality of life. The objective of this study is to determine wether quality of life among cancer patients on chemotherapy at the National Kidney and Transplant Institute- Cancer Unit differs from patients with normal nutrition based on the Subjective Global Assessment scale.

METHODS

A cross sectional study was conducted among cancer patients admitted for chemotherapy at the National Kidney and Transplant Institute-Cancer Unit from January to May 2011. Demographic profile, performance status by Eastern Cooperative Oncology Group performance scale, nutritional status assessment by Subjective Global Assessment, and quality of life assessment by the European Organization for Research and Treatment of Cancer QoL-30 core module were obtained. Descriptive statistics and ANOVA were performed for analysis of quality of life parameters and nutritional status.

RESULTS

A total of 97 subjects were included in this study, 66 subjects (68.04%) were females and 31 (31.96%) were males. Mean age was 54.55 ± 11.14 years, while mean performance status by the Eastern Cooperative Oncology Group classification was 0.88 ± 0.83 with a range of 0-3. According to the Subjective Global Assessment, there were 58 patients with SGA A, classified to have adequate nutrition, and 39 patients (40.21%) were considered malnourished. Among these 39 patients, 32 were classified SGA-B (moderately malnourished) and 7 were classified SGA C (severely malnourished) mean global quality of life was 68.73 ± 19.05. Results from ANOVA test revealed that patients were statistically different across the Subjective Global Assessment groups according to global quality of life (p<0.001), physical (p<0.001), role (p<0.001), emotional (p<0.001), and cognitive functioning (p<0.001); fatigue (p<0.001), nausea and vomiting (p<0.001), pain (p<0.001), insomnia (p<0.001), and appetite loss (p<0.001).

CONCLUSION

GLOBAL QUALITY OF LIFE AND ITS PARAMETERS: physical state, role, emotional state, cognitive functioning, cancer fatigue, nausea and vomiting, pain, insomnia, and loss of appetite were statistically different across all Subjective Global Assessment groups. Moreover, there was no difference between financial difficulties, social functioning, constipation and diarrhea among the Subjective Global Assessment groups.

Adverse events associated with complementary and alternative medicine use in ovarian cancer patients

INTRODUCTION

Many women with ovarian cancer are choosing to include complementary and alternative medicine (CAM) substances in conjunction with their conventional treatment for ovarian cancer. Many oncologists express concern that the adjunct use of CAM substances may be detrimental to the achievement of therapeutic levels of chemotherapy leading to increases in drug toxicity, under-treatment of disease or other adverse events. In an effort to ascertain the extent of the potential problem with simultaneous use of CAM with conventional treatment we undertook comprehensive systematic review of published case reports describing CAM-related adverse events among ovarian cancer patients.

STUDY DESIGN

This article describes a systematic literature review.

METHODS

The Natural Medicines Comprehensive Database (NMCD). PubMed, EMBASE® and the Cochrane Central Register of Controlled Trials (CCTR) were systematically reviewed for research articles pertaining to case reports describing adverse events in patients, and clinical trials which examined the effects of herbs and supplements used during cancer treatment.

RESULTS

Only one case report and one clinical trial were identified which met our inclusion criteria and were relevant to the current investigation.

CONCLUSION

Although there are concerns about the potential for adverse events related to concurrent use of CAM substances during conventional treatment we found few case reports and clinical trials in the literature which support this.

Disease specific substrates in cancer cachexia - Reality and anticipation

In recent years, the concept of nutrition in patients with tumour diseases has been changing very significantly. The article discusses the pathogenesis of tumour cachexia and sarcopenia, which have been intensively studied, particularly in the last ten years. The possibilities and modern approaches in nutritional support in oncology are reviewed with a special emphasis on the group of elderly patients. Also, a detailed list of the most frequently used pharmaconutrients in oncology is presented. The recommendations for nutritional care of elderly oncological patients are given and discussed.

Prognostic impact of weight loss in 1-year survivors after transthoracic esophagectomy for cancer

Malnutrition is common 1 year after esophageal cancer surgery. However, the prognostic impact of this malnutrition on long-term outcome has been poorly reported. This study aims at determining the potential effect on disease-free survival (DFS) of weight loss observed at 1 year in disease-free survivors after curative esophageal resection. From a prospective single-institution database, 304 patients having undergone a transthoracic esophagectomy with two-field lymphadenectomy and gastric reconstruction between 1996 to 2008 were identified. Patients who died during the postoperative course (n= 24), patients who died within the first postoperative year (n= 12), patients who presented with an early recurrence within the first postoperative year (n= 20), and those who were lost to follow-up (n= 22) were excluded from the study, as well as those for whom the follow-up was shorter than 1 year (n= 21). The remaining 205 patients constituted a homogeneous group of 1-year disease-free survivors after full postoperative work-up and formed the material of the present study. Body weight (BW) values were collected before any treatment at the onset of symptoms (initial BW) and 1 year after esophagectomy. A 1-year weight loss (1-YWL) exceeding 10% of the initial BW defined an important malnutrition. Impact of the 1-YWL ≥ or <10% of the initial BW on DFS was investigated. Logistic regression was performed to identify factors affecting DFS. The mean initial BW was 69.1 ± 12 kg, corresponding to a mean body mass index (BMI) of 23.8 ± 3 kg/m(2) . Preoperatively, 32 (15%) patients were in the underweight category (BMI < 20 kg/m2), 110 (54%) were in normal (BMI = 20-24 kg/m2), and 63 (31%) were in the overweight category (BMI ≥ 25 kg/m2). Mean 1-year BW was 63.5 ± 12 kg. 1-YWL was <10% of the initial BW in 92 patients (45%) and ≥ 10% in 113 patients (55%). Accordingly, 5-year DFS rates were 66% (median: 80 months) and 48% (median: 51 months), respectively (P= 0.005). On multivariate analysis, only three independent variables affected the DFS significantly: clinical N stage (cN) status (P= 0.007; odds ratio: 1.99, 1.2-3.3), incomplete resection (P= 0.008, OR: 3.6, 1.3-9.3), and 1-YWL ≥ 10% (P= 0.004, OR: 2.1: 1.2-3.4). 1-YWL of or exceeding 10% of the initial BW in 1-year disease-free survivors has a negative prognostic impact on DFS after esophagectomy for cancer. This information offers another view on the objectives of the perioperative nutritional care of these patients. Special vigilance program on the nutritional status in post-esophagectomy patients should be the rule.

Weight loss of 5% or more predicts loss of fat-free mass during palliative chemotherapy in patients with advanced cancer: a pilot study

The cutoff value of critical weight loss is still subject of discussion. In this pilot study, we investigated whether ≥ 5% weight loss in the past year predicts changes in nutritional status in patients with advanced cancer during treatment with palliative chemotherapy. In 20 patients with advanced cancer undergoing palliative (combination) chemotherapy, body weight, fat free mass (FFM), and cachexia were measured prior to the start and at 9 wk of treatment. History of weight loss was used to test differences in development of nutritional parameters during chemotherapy with use of independent sample t-tests. At baseline, 10 of 20 patients had lost ≥ 5% body weight during the past year and 5 patients were cachectic. The change in FFM in the first 9 wk of chemotherapy was significantly worse in patients with ≥ 5% weight loss compared to patients with <5% weight loss [mean difference: 3.5 kg (P = 0.001)]. Data also suggest that ≥ 5% weight loss predicts shorter survival (P = 0.03). We found that patients with ≥ 5% weight loss prior to chemotherapy have a deterioration in nutritional status during chemotherapy and may have a shorter survival. These results have to be confirmed in a larger study including a robust survival analysis.

A description of the nutritional status and quality of life of Australian gynaecological cancer patients over time

PURPOSE OF THE RESEARCH

To describe the quality of life, nutritional status and physical activity of women with gynaecological cancer over three time points.

METHODS AND SAMPLE

Women referred to a major gynaecological cancer service in Sydney for initial treatment were invited to complete validated questionnaires at baseline, three and six months after diagnosis. Quality of life was assessed using the 36-item Short Form Health Survey (SF36) and the Symptom Distress Scale. Nutritional status was assessed using the Patient Generated-Subjective Global Assessment and physical activity was assessed using the International Physical Activity Questionnaire short form. Effect sizes corrected for correlation were calculated using Cohen's d and Friedman's test was used to compare scores. Complete case analysis was used.

KEY RESULTS

Forty women were recruited and twenty-three (58%) completed assessment measures for all three time points. No important clinical or demographic differences existed between women who completed all measures and those who did not. Over the duration of the study, the number of well-nourished women increased from 16 to 21, while the number of malnourished women decreased from 7 to 2. Improvements in SF36 scores were seen in all aspects except general health, which declined (p>0.05). Statistically significant (p<0.05) improvements were seen for role physical, vitality, social functioning and role emotional. The median number of minutes of physical activity per week was highest at diagnosis and declined after that.

CONCLUSIONS

This study indicates the importance of assessing nutritional status at diagnosis for women with gynaecological cancer.

Beyond anorexia -cachexia. Nutrition and modulation of cancer patients' metabolism: supplementary, complementary or alternative anti-neoplastic therapy?

Anorexia and muscle wasting are frequently observed in cancer patients and influence their clinical outcome. The better understanding of the mechanisms underlying behavioral changes and altered metabolism yielded to the development of specialized nutritional support, which enhances utilization of provided calories and proteins by counteracting some of the metabolic derangements occurring during tumor growth. Inflammation appears to be a key factor determining the cancer-associated biochemical abnormalities eventually leading to anorexia and cachexia. Interestingly, inflammation is also involved in carcinogenesis, cancer progression and metastasis by impairing immune surveillance, among other mechanisms. Therefore, nutritional interventions aiming at modulating inflammation to restore nutritional status may also result in improved response to pharmacological anti-cancer therapies. Recent clinical data show that supplementation with nutrients targeting inflammation and immune system increases response rate and survival in cancer patients. This suggests that nutrition therapy should be considered as an important adjuvant strategy in the multidimensional approach to cancer patients.

Nutritional screening and early treatment of malnutrition in cancer patients

BACKGROUND: Malnutrition is a frequent complication in patients with cancer and can negatively affect the outcome of treatments. On the other hand, side effects of anticancer therapies can also lead to inadequate nutrient intake and subsequent malnutrition. The nutritional screening aims to identify patients at risk of malnutrition for prompt treatment and/or careful follow-up. METHODS AND RESULTS: This manuscript highlights the need of an interdisciplinary approach (oncologist, nutritionist, dietitian, psychologist, etc.) to empower patients who are experiencing loss of physiological and biological function, fatigue, malnutrition, psychological distress, etc., as a result of cancer disease or its treatment, and maintain an acceptable quality of life. CONCLUSIONS: It is necessary to make all healthcare professionals aware of the opportunity to identify cancer patients at risk of malnutrition early in order to plan the best possible intervention and follow-up during cancer treatment and progression.