Dietary strategies for chemotherapy-induced nausea and vomiting: A systematic review

The effect of diaphragmatic breathing on nausea, vomiting and functional status among breast cancer patients undergoing chemotherapy

PURPOSE

To examine the effect of diaphragmatic breathing (DB) on nausea, vomiting, and functional status among breast cancer patients undergoing chemotherapy in Indonesia.

METHODS

A quasi experimental study with non-equivalent pretest and posttest control group was conducted. A total of forty-eight breast cancer patients (24 DB and 24 control participants) undergoing chemotherapy participated in this study selected conveniently. DB intervention was performed to the intervention group after chemotherapy cycle twice a day for six days, meanwhile the control group received usual care. A set of questionnaires was used to collect data consisting of Patient Information Form, Rhodes Index Nausea, Vomiting and Retching (RINVR) and The Functional Living Index-Cancer (FLI-C). Data were analyzed and interpreted using Generalized Linear Model, Wilcoxon Test, Paired T Test and Mann-Whitney U test.

RESULTS

There were significant changes in RINVR mean scores for the intervention group that started on the third day after chemotherapy (p = 0.000); meanwhile, the significant changes in RINVR mean scores for the control group began on the fifth day (p = 0.000). The total score of FLI-C was significantly different between the intervention and control groups (p = 0.000).

CONCLUSION

DB could decrease nausea and vomiting, and increase functional status of breast cancer patients undergoing chemotherapy. It can be promoted as a useful low-cost self-management approach and an additional and complementary therapy to manage chemotherapy-related nausea and vomiting.

2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting

•Nausea and vomiting are considered amongst the most troublesome adverse events for patients receiving antineoplastics. •The guideline covers emetic risk classification, prevention and management of treatment-induced nausea and vomiting. •The Consensus Committee consisted of 34 multidisciplinary, health care professionals and three patient advocates. •Recommendations are based on evidence-based data (level of evidence) and the authors’ collective expert opinion (grade). •All recommendations are for the first course of antineoplastic therapy; modifications may be needed in subsequent courses.

A Systematic Review of Dietary Interventions for Cancer Survivors and Their Families or Caregivers

Family or caregiver engagement has the potential to support healthy dietary changes among cancer survivors. However, little is known about these family- or caregiver-involved dietary interventions and their effects. This systematic review aimed to identify the behavior change techniques (BCTs) used in dietary interventions for cancer survivors and their families or caregivers and to synthesize intervention effects on dietary and health outcomes. Following the PRISMA guidelines, we conducted systematic searches in three databases and identified 12 trials (16 peer-reviewed manuscripts) for inclusion in this review. Data were extracted from these manuscripts and the BCT taxonomy was used to identify the BCTs. A total of 38 BCTs were identified from 12 trials, 13 of which were used in at least half of the 12 trials. Ten studies reported significant intervention effects on health outcomes (e.g., adiposity) and six suggested significant improvements in dietary behaviors (e.g., fruit and vegetable intake). Overall, this review found that family- or caregiver-involved interventions for cancer survivors significantly improved dietary and health outcomes. Future research should identify BCTs particularly for dietary changes and develop effective dyadic strategies to facilitate diet-related interactions between survivors and their families or caregivers to enhance their engagement in healthy diets.

2023 MASCC/ESMO consensus antiemetic guidelines related to integrative and non-pharmacological therapies

PURPOSE

Review the literature to propose suggestions or recommendations for controlling nausea and vomiting through integrative and non-pharmacological treatments for the MASCC/ESMO 2023 update of its antiemetic guidelines.

METHODS

The authors identified available systematic reviews and/or meta-analyses for 12 integrative therapies, including acupressure, acupuncture, auricular therapy, electrical stimulation of point PC6, ginger use (i.e., Zingiber officinale), guided imagery, hypnosis, inhalation aromatherapy, music therapy, food-based interventions, progressive muscle relaxation, and reflexology. Reviews were assessed for quality through the AMSTAR2 tool. A consensus committee reviewed recommendations as per MASCC/ESMO established processes.

RESULTS

Thirty-nine systematic reviews and/or meta-analyses were used. There were major methodological flaws for many of the trials used as the bases for the reviews. No recommendation for ingested ginger could be made because of conflicting evidence. Recommendations were possible for acupuncture/electroacupuncture treatments, food-based interventions, and progressive muscle relaxation training alone or combined with guided imagery. No recommendations could be reached for a number of food-based approaches, inhalation aromatherapy, hypnosis in adults, music therapy, and reflexology.

CONCLUSION

While a limited number of suggestions are provided, there is a need for significantly higher quality trials in many of the therapeutic approaches assessed, before stronger recommendations and a wider range of approaches are made.

Association between Dietary Patterns and the Risk of Hyperemesis Gravidarum

(1) Background: Although studies have suggested that dietary interventions may have potential benefits over conventional medical treatments, research on the association between dietary patterns and hyperemesis gravidarum (HG) in pregnant women is scarce. (2) Methods: To explore the relationship between dietary patterns and the risk of HG, a cross-sectional study was conducted in Xi'an, China from April 2021 to September 2022. Dietary intake was assessed by a semi-quantitative food-frequency questionnaire, and then factor analysis was used to derive dietary patterns. HG was defined as persistent and severe nausea and vomiting with weight loss ≥ 5%, pregnancy-unique quantification of emesis (PUQE) score ≥ 13, or hospitalization due to vomiting. Logistic regression models were used to estimate ORs and 95% CIs for HG according to dietary pattern scores. Stratified analyses and tests for interaction were performed by potential confounders. (3) Results: Of the 3122 pregnant women enrolled, 2515 individuals (mean age: 31.2 ± 3.4 years) were included in the final analysis. In total, 226 (8.9%) pregnant women were identified as having HG. Five dietary patterns were identified. After adjusting for covariates, the highest quartile of the "fish, shrimp and meat" and "egg, milk and water drinking" patterns was associated with a 37% and 58% lower risk of HG compared with the lowest quartile, respectively (p-trend < 0.05). Conversely, the highest quartile of the "beverage" pattern was associated with a 64% higher risk of HG compared with the lowest quartile (p-trend = 0.02). Furthermore, significant interactions were observed between the "egg, milk and water drinking" pattern and parity, employment status and nutritional supplement use (p-interaction < 0.05). (4) Conclusions: A diet rich in eggs, milk, seafood and unprocessed poultry and animal meat may be a protective factor against HG, while a diet high in beverages may be detrimental to HG. These associations may vary by parity, employment status and nutritional supplement use.

Effects of food-based interventions in the management of chemoradiotherapy-induced nausea and vomiting: a systematic review

BACKGROUND

Cancer treatment-related nausea and vomiting continue to be common and distressing symptoms for patients, despite improvements in antiemetics. Dietary modifications could potentially improve this symptom experience. Clinicians frequently provide dietary advice to patients, although the evidence base of such suggestions or recommendations is not clear.

PURPOSE

This systematic review aimed to examine the current literature on food interventions associated with improvements in cancer treatment-related nausea and vomiting.

METHODS

Eight electronic databases were searched with a specific search term strategy covering trials without time or language limitations. Eligible studies focused on a food substance, defined as any nutritious substance that people eat or drink to maintain life and well-being. Trials in children and adults during chemotherapy or radiotherapy were included. Cochrane risk of bias tool was used to assess trial quality and GRADE was used to assess the certainty in the effect of each outcome.

RESULTS

Seventeen trials were included, 3 focusing on children and 14 on adults. Two trials included patients receiving radiation. Ten out of 17 trials (59%) had a high risk of bias. Strongest evidence with highest certainty was found for dietary counseling to meet macronutrient requirements in reducing incidence of radiotherapy-related nausea and vomiting in adults (n=2 studies; n=124 participants; GRADE level: moderate). There was also moderate certainty in the beneficial effect of protein supplementation on nausea and vomiting incidence in adults during radiotherapy (n=2 studies; n=124 participants; GRADE level: moderate). A significant positive effect on CINV incidence and/or severity in adults was also found for dietary counseling to meet macronutrient requirements during chemotherapy, a peppermint drink, scaly wood mushroom, chamomile, protein with ginger, and a colorless odorless diet (GRADE level: low to very low).

CONCLUSIONS

The review identified food-based approaches that could improve the nausea and vomiting experience in patients with cancer and provide guidance to clinicians. However, confidence in these findings was low and studies were heterogeneous and mostly of low quality, requiring further investigation before stronger recommendations can be made. Future research is needed to confirm efficacy and safety.

TRIAL REGISTRATION

PROSPERO CRD42022341154.

Effects of Continuous Nutrition Care on Nutritional Status and Dietary Habits of Patients With Colorectal Cancer Receiving Adjuvant Chemotherapy After Surgery

Patients with colorectal cancer may experience symptoms such as diarrhea, nausea, and anorexia, during surgery and chemotherapy, which can increase the risk of malnutrition. In addition, dietary habits play a key role in the onset of colorectal cancer; therefore, it is necessary to improve dietary habits to prevent recurrence during treatment after diagnosis. In this study, a clinical nutritionist conducted 4 interviews for patients diagnosed with colorectal cancer and scheduled for colectomy: before surgery, after surgery, 1st chemotherapy, and 2nd chemotherapy, and provided nutrition care for each treatment course to determine its effects on nutrition status and disease prognosis. Significant weight loss but no decrease in muscle mass was observed during treatment. Body fat mass, although not statistically significant, showed a decreasing tendency. The percentage of people who responded 'yes' to the below items increased after compared to before receiving nutrition education: 'I eat meat or eggs more than 5 times a week,' 'I eat seafood at least three times a week,' 'I eat vegetables at every meal,' 'I eat fruits every day,' and 'I eat milk or dairy products every day.' These results indicate that the patients changed their dietary habit from a monotonous eating pattern to a pattern of consuming various food groups after receiving nutrition education. These results suggest that continuous nutrition care by clinical dietitians, according to the patient's treatment process, can help improve the patient's nutritional status and establish healthy eating habits.