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Taieb J, Abdallah R, Thibault R, Pessaux P, Artru P, Marchal T, Neuzillet C. Nutrition support in pancreatic cancer: An expert statement on practical implementation of French guidelines. Clin Res Hepatol Gastroenterol 2023; 47:102153. [PMID: 37364633 DOI: 10.1016/j.clinre.2023.102153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines, shortened in 2021, are widely used for providing the most suitable nutrition support to patients with cancer. However, there is a lack of specialized guidelines for different cancer types. In 2020, members of the French medical and surgical societies involved in digestive oncology, nutrition and supportive care developed the Thésaurus National de Cancérologie Digestive (TNCD) practice guidelines which are specific nutritional and physical activity guidelines for patients with digestive cancers. These guidelines were recently updated in 2022. This review discusses the French intergroup guidelines, specifically in the context of pancreatic cancer at different stages of the disease. Pancreatic cancer is highly prevalent in Europe, with an increasing worldwide incidence over the last three decades. In France alone, about 14,000 new cases of pancreatic cancer are reported annually. More than 60% of patients with pancreatic cancer reportedly experience malnutrition and other nutritional issues which are known to have a negative impact on quality of life, treatment tolerability, general morbidity, and mortality. Given that the recommendations of TNCD guidelines correlate to other guidelines like the International Study Group on Pancreatic Surgery (ISGPS; for the perioperative setting), ESPEN and Spanish Society of Medical Oncology (SEOM) guidelines, their use can be suitably applied in other European countries. This review discusses the recommendations issued by nutrition guidelines, the challenges with effective integration of nutrition support in oncologic treatment, and the proposed algorithms on patient care pathways for pancreatic cancer management in the clinical setting.
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Affiliation(s)
- Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Université Paris-Cité, SIRIC CARPEM comprehensive cancer center, Paris, France.
| | - Raëf Abdallah
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, University of Paris, Paris, France
| | - Ronan Thibault
- Nutrition unit, CHU Rennes, INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Patrick Pessaux
- Head of Department of Digestive Surgery, Nouvel Hôpital Civil, University Hospital Strasbourg, Faculty of Medicine Strasbourg, France
| | - Pascal Artru
- Department of Gastroenterology and Digestive Oncology Jean Mermoz Hospital, Lyon, France
| | - Timothée Marchal
- Department of Supportive and Palliative Care, Institut Curie, Paris, France
| | - Cindy Neuzillet
- Head of GI Oncology, Department of Medical Oncology, Curie Institute, Saint Cloud, Versailles Saint-Quentin University (UVSQ) - Paris Saclay University, France
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Choi YC, Chan PC, Cheung KWA, Huang JJ, Wong KLA, Doescher J, Lam TC. Impact of weight loss on treatment interruption and unplanned hospital admission in head and neck cancer patients undergoing curative (chemo)-radiotherapy in Hong Kong. Support Care Cancer 2023; 31:487. [PMID: 37486576 DOI: 10.1007/s00520-023-07952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Malnutrition is highly prevalent in head and neck cancer (HNC) patients, with weight loss being one of the major nutritional indicators. The objective of this study was to investigate the impact of weight loss on treatment interruptions and unplanned hospital admissions in HNC patients undergoing radiotherapy (RT) with or without chemotherapy. METHODS In this retrospective cohort study, consecutive HNC patients who started RT between January 2011 and December 2019 were included. Data from a total of 1086 subjects with 747 (68.8%) nasopharyngeal carcinomas (NPCs) and 31.2% (N=339) non-NPC patients were analysed. Body weight (BW) was measured before, during, and after RT treatment. Factors associated with ≥10% weight loss, treatment interruption, and unplanned admissions were analysed using multivariate logistic regression. RESULTS The prevalence of ≥10% weight loss was 26.8% (N=288), with 32.7% (N=243) in NPC and 13.5% (N=45) in non-NPC patients. The prevalence of RT delay in patients with ≥10% vs. <10% weight loss was 6.2% vs. 7.0% (p=0.668) in NPC patients and 42.2% vs. 50.5% (p=0.300) in non-NPC patients. The prevalence of unplanned admissions in patients with ≥10% vs. <10% weight loss was 51.9% vs. 25.3% (p<0.001) in NPC patients and 68.9% vs. 27.0% (p<0.001) in non-NPC patients. CONCLUSION In our study, ≥10% weight loss was found to be associated with a higher rate of unplanned admissions but not with RT delay or chemotherapy interruption. CLINICAL IMPLICATIONS With the knowledge of the impact of weight loss on hospital admissions and the characteristics of patients with weight loss, nutritional intervention can be effectively focused on the stratification of patients for intensive nutritional support to reduce weight loss.
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Affiliation(s)
- Ying-Chu Choi
- Department of Dietetics, Tuen Mun Hospital, Hong Kong, China.
| | - Po-Chung Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | | | - Jia-Jie Huang
- Quality and Services Department, Tuen Mun Hospital, Hong Kong, China
| | | | - Johannes Doescher
- Department of Otolaryngology, Augsburg University Hospital, Augsburg, Germany
| | - Tai-Chung Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
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Jang MK, Park C, Tussing-Humphreys L, Fernhall B, Phillips S, Doorenbos AZ. The Effectiveness of Sarcopenia Interventions for Cancer Patients Receiving Chemotherapy: A Systematic Review and Meta-analysis. Cancer Nurs 2023; 46:E81-E90. [PMID: 34054070 PMCID: PMC8627517 DOI: 10.1097/ncc.0000000000000957] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Among people with cancer undergoing chemotherapy, generalized loss of muscle mass, termed secondary sarcopenia , is associated with treatment toxicities and physical disability. OBJECTIVE This systematic review and meta-analysis aimed to provide an overview of current interventions for sarcopenia in cancer patients receiving chemotherapy and to assess potentially effective interventions. METHODS We searched PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and EMBASE for primary original research of exercise and nutrition interventions for sarcopenia published in English. The review used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Standardized mean difference and 95% confidence interval (CI) were calculated as effect measures by applying the random-effects model. RESULTS The 6 included studies showed a trend toward significantly increasing skeletal muscle mass after intervention (mean difference, 0.168; 95% CI, -0.015 to 0.352; P = .072), with no significant changes in lean body mass loss after intervention (mean difference, -0.014; 95% CI, -1.291 to 1.264; P = .983). Resistance exercise and combined exercise and nutrition intervention were more effective at preserving or increasing muscle mass. CONCLUSIONS Early implementation of a resistance exercise intervention or a combined exercise and nutrition intervention is a promising strategy for avoiding muscle mass loss during chemotherapy. Additional evidence-based assessments of interventions for secondary sarcopenia are needed to identify the most effective approach. IMPLICATIONS FOR PRACTICE In clinical practice, oncology nurses should frequently assess cancer patients' muscle mass and when warranted should implement the most feasible early sarcopenia intervention to minimize the adverse outcomes of this condition.
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Affiliation(s)
- Min Kyeong Jang
- Author Affiliations: Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago (Drs Jang, Park, and Doorenbos); University of Illinois Cancer Center, Chicago (Drs Jang and Doorenbos); and Department of Medicine and Cancer Center and (Dr Tussing-Humphreys) Integrative Physiology Laboratory (Dr Fernhall) and Department of Physical Therapy (Dr Phillips), College of Applied Health Sciences, University of Illinois at Chicago
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Cotogni P, Bozzetti F, Goldwasser F, Jimenez-Fonseca P, Roelsgaard Obling S, Valle JW. Supplemental parenteral nutrition in cancer care: why, who, when. Ther Adv Med Oncol 2022; 14:17588359221113691. [PMID: 36188487 PMCID: PMC9520136 DOI: 10.1177/17588359221113691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Malnutrition is an often-overlooked challenge for patients with cancer. It is associated with muscle mass reduction, poor compliance and response to cancer treatments, decreased quality of life, and reduced survival time. The nutritional assessment and intervention should be a vital part of any comprehensive cancer treatment plan. However, data on artificial nutrition supplied based on caloric needs during cancer care are scarce. In this review, we discuss the recommendations of the European and American societies for clinical nutrition on the use of nutritional interventions in malnourished patients with cancer in the context of current clinical practice. In particular, when enteral nutrition (oral or tube feeding) is not feasible or fails to meet the complete nutritional needs, supplemental parenteral nutrition (SPN) can bridge the gap. We report the available evidence on SPN in cancer patients and identify the perceived barriers to the wider application of this intervention. Finally, we suggest a ‘permissive’ role of SPN in cancer care but highlight the need for rigorous clinical studies to further evaluate the use of SPN in different populations of cancer patients.
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Affiliation(s)
- Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, Corso Bramante 88-90, Turin 10126, Italy
| | | | - François Goldwasser
- Medical Oncology Department, URP 4466, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Asturias Central University Hospital, ISPA, Oviedo, Spain
| | - Sine Roelsgaard Obling
- Department of Medical Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Juan W Valle
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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Li LQ, Fu QG, Zhao WD, Wang YD, Meng WW, Su TS. Chemoradiotherapy Versus Chemotherapy Alone for Advanced Esophageal Squamous Cell Carcinoma: The Role of Definitive Radiotherapy for Primary Tumor in the Metastatic Setting. Front Oncol 2022; 12:824206. [PMID: 35433478 PMCID: PMC9005791 DOI: 10.3389/fonc.2022.824206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The role of definitive radiotherapy in advanced esophageal squamous cell carcinoma (ESCC), especially in the metastatic setting, remains unclear. Therefore, we aimed to investigate the efficacy of chemoradiotherapy (CRT) versus chemotherapy (CT) alone in these selected patients. Methods We retrospectively evaluated 194 newly diagnosed advanced ESCC who underwent definitive CRT or CT alone, including 97 patients with locally advanced and 97 patients with distant metastatic disease. Cumulative overall survival (OS) and progression-free survival (PFS) were evaluated with a log-rank test. Propensity score matching was used to simulate random allocation. In addition, we performed subgroup analysis in the locally advanced and metastatic disease. Results After matching, 63 well-paired patients were selected. The adjusted median OS (12.5 vs. 7.6 months, p = 0.002) and PFS (9.0 vs. 4.8 months, p = 0.0025) in the CRT group were superior to that in the CT-alone group. Further subgroup analysis revealed that CRT conferred survival benefits to both locally advanced and metastatic cohorts. For patients with distant metastasis, median OS (12.9 vs. 9.3 months, p = 0.029) and PFS (9.9 vs. 4.0 months, p =0.0032) in the CRT group were superior to that in the CT-alone group. In a multivariate Cox regression analysis of the entire cohort, additional definitive radiotherapy was independently associated with better OS (p = 0.041) and PFS (p = 0.007). Conclusions In both locally advanced and metastatic ESCC, additional definitive-dose radiotherapy was associated with improved clinical outcomes. Therefore, more consideration should be given to its application in the metastatic setting.
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Affiliation(s)
- Li-Qing Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Qing-Guo Fu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Wei-Dong Zhao
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yu-Dan Wang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Wan-Wan Meng
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Ting-Shi Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
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Youn BY, Lee SY, Cho W, Bae KR, Ko SG, Cheon C. Global Trends of Nutrition in Cancer Research: A Bibliometric and Visualized Analysis Study over the Past 10 Years. Int J Environ Res Public Health 2022; 19:ijerph19074165. [PMID: 35409847 PMCID: PMC8998574 DOI: 10.3390/ijerph19074165] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023]
Abstract
The increasing application of nutrition in cancer management has attracted a great deal of research interest in recent decades. Nutritional therapies, interventions, and assessments were known to have positive effects on reducing side effects from cancer therapy. In order to identify the global research output for nutrition in cancer research, a bibliometric analysis during the past 10 years was conducted to evaluate the current status of trends, gaps, and research directions as no bibliometric studies have been conducted regarding nutrition and cancer. After the data collection, a total of 1521 articles were chosen for this bibliometric study. The visualization analysis was performed with VOSviewer. The number of publications has grown continuously since a substantial spark was identified in 2019. The majority of the authors’ affiliations were in European countries. Four cancer types were recognized among the top 10 author keywords; they were breast cancer, head and neck cancer, colorectal cancer, and gastric cancer. The Nutrients journal was the most popular among the authors as the journal published 195 articles related to the topic. In conclusion, providing evidence-based nutritional solutions for various types of cancer is essential to nutrition and cancer research. Since it is presumed to have a growing number of cancer patients worldwide with the aging population, it is vital to continuously generate research finding effective nutrition therapies for cancer patients.
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Affiliation(s)
- Bo-Young Youn
- Department of Preventive Medicine, Kyung Hee University, Seoul 02447, Korea; (B.-Y.Y.); (S.-G.K.)
| | - Seo-Yeon Lee
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Wonje Cho
- Department of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Kwang-Rok Bae
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Seong-Gyu Ko
- Department of Preventive Medicine, Kyung Hee University, Seoul 02447, Korea; (B.-Y.Y.); (S.-G.K.)
| | - Chunhoo Cheon
- Department of Preventive Medicine, Kyung Hee University, Seoul 02447, Korea; (B.-Y.Y.); (S.-G.K.)
- Correspondence: ; Tel.: +82-2-961-2382
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Ak E, Demirel B, Atasoy BM, Yumuk PF. Translation, validity, and reliability of NUTRISCORE: the nutrition risk assessment screening test for Turkish cancer patients. Nutr Clin Pract 2021; 37:705-714. [PMID: 34861067 DOI: 10.1002/ncp.10804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The aim was to determine the validity and the reliability of the Turkish version of the screening test named NUTRISCORE in cancer patients. METHODS The language validity of the Turkish form of the study scale was provided by the translationback-translation method. NUTRISCORE and nutritional risk screening (NRS)-2002, malnutrition screening tool (MST), and European Diagnostic Criteria (EDC) were administered to 240 volunteers in oncology clinics, and receiver operating characteristic curves (ROC) were calculated for the validity and reliability analysis. Cohen's kappa coefficient was used to determine the fit between the screening tests. RESULTS Thirteen experts were consulted for scale content validity, and the content validity index was found to be 0.94. The scale was administered to 67 patients with 4-week intervals for test-retest reliability, and a positive, high-level and statistically significant relationship was found between the two measurements (r = 0.971, P < 0.01). Compared with the reference test NRS-2002, the specificity values of NUTRISCORE, MST, and EDC screening tests were found to be 100%, 83%, and 91%, whereas the sensitivity values of same screening tests were calculated as 85%, 91% and 81%, respectively. According to Cohen's kappa statistics, the kappa agreement between NRS-2002 and NUTRISCORE was 0.88, the kappa agreement between NRS-2002 and MST was 0.34, and it was found to be 0.73 for NRS-2002 and EDC. CONCLUSION The nutrition screening test named NUTRISCORE showed adequate validity and reliability in Turkish and can detect malnutrition risk of cancer patients treated in oncology clinics as a screening tool.
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Affiliation(s)
- Elif Ak
- Department of Nutrition and Dietetics, Istanbul Bilgi University Faculty of Health Sciences, Istanbul, Turkey
| | - Birsen Demirel
- Department of Nutrition and Dietetics, Istanbul Bilgi University Faculty of Health Sciences, Istanbul, Turkey
| | - Beste M Atasoy
- Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Istanbul, Turkey
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Sonmez O, Tezcanli E, Bas D, Kazanci HB, Altinok A, Demir A, Uluc BO. Identifying Knowledge and Practices regarding Cancer Patient Malnutrition: A Survey Study among Oncologists. Nutr Cancer 2021; 74:2392-2399. [PMID: 34856863 DOI: 10.1080/01635581.2021.2008987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Malnutrition is one of the most common complications of cancer and its treatments with a prevalence of up to 80% among cancer patients. Thus, standardized and target-oriented attitudes of oncologists toward nutritional management are particularly important. This study aims to report the questionnaire-based evaluation of different views toward medical nutrition among medical and radiation oncologists with the purpose to underline the problems and requirements of cancer nutrition. A national web-based survey composed of 26 multiple choice questions about participant demographics, level of knowledge about cancer nutrition, and approaches to malnutrition were completed by 247 oncologists. The survey was answered by a total of 247 (34%) radiation and medical oncologists. The majority of the oncologists (77%) were working at the University Hospitals and Education & Research Hospitals. Most of them were specialists with 5-10 years of experience. Nutritional status was routinely assessed in oncology units of 84% of (206) oncologists. However, only 50% reported nutritional evaluation follow-ups without waiting for a patient's declaration and 5 (2%) oncologists reported the absence of nutritional evaluation in their unit. Additionally, more than 79% of participants reported that their knowledge was not enough about enteral and parenteral nutrition while 8% were skeptical about the benefits of medical nutrition. Although the role of nutrition as an essential part of cancer care is widely recognized, the availability of limited high-quality evidence, problems of accessibility, lack of routine nutritional evaluation, and varying indicators for malnutrition are some of the problems preventing standardized nutritional management. Therefore, there are a variety of approaches and barriers to the implementation of guidelines. Further studies are needed to identify areas of improvement, as well as strategies to implement nutritional therapy in cancer care.
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Affiliation(s)
- Ozlem Sonmez
- Department of Medical Oncology, Acibadem University, Istanbul, Turkey
| | - Evrim Tezcanli
- Radiation Oncology Department, Acibadem Altunizade Hospital, Radiation Oncology Clinic, Istanbul, Turkey
| | - Dilsat Bas
- Clinical Nutrition Unit, Acibadem Altunizade Hospital, Istanbul, Turkey
| | | | - Ayse Altinok
- Medical Oncology Department, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Atakan Demir
- Medical Oncology Department, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Basak Oyan Uluc
- Department of Medical Oncology, Acibadem University, Istanbul, Turkey
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Poisson J, Martinez-Tapia C, Heitz D, Geiss R, Albrand G, Falandry C, Gisselbrecht M, Couderc AL, Boulahssass R, Liuu E, Boudou-Rouquette P, Chah Wakilian A, Gaxatte C, Pamoukdjian F, de Decker L, Antoine V, Cattenoz C, Solem-Laviec H, Guillem O, Medjenah H, Natella PA, Canouï-Poitrine F, Laurent M, Paillaud E. Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer). J Cachexia Sarcopenia Muscle 2021; 12:1477-1488. [PMID: 34519440 PMCID: PMC8718093 DOI: 10.1002/jcsm.12776] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality. METHODS A French nationwide cross-sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality. RESULTS Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79-87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49-55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up-and-go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05-2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications. CONCLUSIONS More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.
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Affiliation(s)
- Johanne Poisson
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France
| | - Claudia Martinez-Tapia
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
| | - Damien Heitz
- Oncology and Hematology Unit, Strasbourg University Hospital Center - Hautepierre Hospital, Strasbourg, France
| | - Romain Geiss
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Gilles Albrand
- Geriatric Oncology Unit, Antoine Charial hospital, Hospices Civils de Lyon, Lyon, France
| | - Claire Falandry
- Geriatrics Unit, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mathilde Gisselbrecht
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Anne-Laure Couderc
- AP-HM, Division of Internal Medicine, Geriatric Medicine and Therapeutic, Sainte Marguerite Hospital, Marseille, France
| | | | - Evelyne Liuu
- Geriatric Department, CHU La Milétrie, Poitiers, France
| | | | - Anne Chah Wakilian
- Geriatric Department, Broca Hospital, Paris Centre Hospitals, Paris Descartes University, Paris, France
| | - Cedric Gaxatte
- Geriatric Oncology Unit, Lille University Hospital, Lille, France
| | - Fréderic Pamoukdjian
- AP-HP, Geriatric Oncology Unit, Avicenne Hospital and Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Laure de Decker
- Clinical Gerontology Department, Nantes University Hospital Center, Nantes, France
| | - Valery Antoine
- Department of Geriatric Medicine, Nimes University Hospital, Nimes, France
| | | | - Heidi Solem-Laviec
- Geriatric Oncology Unit, Oncology Supportive Care Department, François Baclesse Regional Cancer Center, Caen, France
| | - Olivier Guillem
- Geriatric Medicine Unit, Inter-communal Hospital Center from Southern Alps, Gap, France
| | - Hayat Medjenah
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Pierre André Natella
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Florence Canouï-Poitrine
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France.,Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Marie Laurent
- Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France
| | - Elena Paillaud
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France.,INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
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Białek M, Białek A, Ruszczyńska A, Bulska E, Zaworski K, Czauderna M. Evaluation of the influence of diet supplementation with conjugated linoleic acid isomers on elemental composition in the cardio-oncological nutritional programming rat' model. J Trace Elem Med Biol 2021; 68:126816. [PMID: 34329902 DOI: 10.1016/j.jtemb.2021.126816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/17/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The 'developmental origin of health and disease' (DOHaD) hypothesis assumes that due to the action of some stimuli during fetal life the long-term physiological changes occurs and may affects the risk of various diseases. The main aim of this study was to assess impact of supplementation of maternal' and early postnatal diet with conjugated linoleic acids (CLA) isomers on selected elements content in hearts of their female offspring with chemically induced breast cancer. METHODS Elemental composition was determined by quadrupole mass spectrometer with inductively coupled plasma ionization (ICP-MS). RESULTS The effect of maternal' diet on the elements content was more pronounced than the progeny diet modifications. Significant correlations among determined elements, especially macroelements, and lipidomic parameters, in the experimental factors dependent manner were observed. It can be concluded that supplementation of maternal and progeny diets with CLA isomers may significantly influence the contents of both macro- and microelements in cardiac tissue of newborns. CONCLUSION Our results also indicate, that dynamic and intricate balance among various elements in body may be affected by the lipid dietary supplements also in the pathological state. Utility of cardio-oncological approach in developmental programming study was confirmed.
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Affiliation(s)
- Małgorzata Białek
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110 Jabłonna, Poland.
| | - Agnieszka Białek
- Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of Polish Academy of Sciences, Postępu 36A Jastrzębiec, 05-552 Magdalenka, Poland
| | - Anna Ruszczyńska
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Ewa Bulska
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Kamil Zaworski
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110 Jabłonna, Poland
| | - Marian Czauderna
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110 Jabłonna, Poland
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11
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Arain A. The lost art of preventive oncology. Ecancermedicalscience 2021; 15:ed113. [PMID: 34567267 PMCID: PMC8426006 DOI: 10.3332/ecancer.2021.ed113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Indexed: 11/06/2022] Open
Abstract
As the second most common cause of mortality worldwide, cancer is now prevalent in our society. The overall number of cases continue to rise each year and given the advancements in treatment strategies we now have a large population of cancer survivors. In the busy oncology clinic, patients often bring up the question of what caused their cancer. Oftentimes the answer is not very clear. This article is highlighting the role of oncology clinic in improving the awareness of overall health in patients and their families. The oncologist can play a crucial role in reducing the risk of malignancies in the family members of their patients. There is a need to have a quick discussion on the role of diet, exercise, vaccination against HPV, avoidance of smoking, alcohol, and other toxins such as pesticides in the oncology clinic.
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Affiliation(s)
- Abeer Arain
- Houston Methodist Hospital, 6565 Fannin street, Houston, TX 77030
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12
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Carrato A, Cerezo L, Feliu J, Macarulla T, Martín-Pérez E, Vera R, Álvarez J, Botella-Carretero JI. Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus. Clin Transl Oncol 2021. [PMID: 34363594 DOI: 10.1007/s12094-021-02674-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022]
Abstract
Purpose Malnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients. Methods A Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients. Results The panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment. Conclusions There is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.
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13
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Webb N, Fricke J, Hancock E, Trueman D, Ghosh S, Winstone J, Miners A, Shepelev J, Valle JW. The clinical and cost-effectiveness of supplemental parenteral nutrition in oncology. ESMO Open 2021; 5:e000709. [PMID: 32576610 PMCID: PMC7312316 DOI: 10.1136/esmoopen-2020-000709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 01/09/2023] Open
Abstract
Background Clinical guidelines recommend that parenteral nutrition (PN) is added to enteral nutrition (EN; supplemental parenteral nutrition (SPN)) in order to meet energy and protein needs in patients with cancer when EN alone is insufficient. However, although cancer-related malnutrition is common, there is poor awareness of the value of nutritional care, resulting in SPN being chronically underused. Methods We performed a targeted literature review and exploratory cost-utility analysis to gather evidence on the clinical effectiveness of SPN, and to estimate the potential cost-effectiveness of SPN versus EN alone in an example cancer setting. Results The literature review identified studies linking SPN with malnutrition markers, and studies linking malnutrition markers with clinical outcomes. SPN was linked to improvements in body mass index (BMI), fat-free mass, phase angle (PhA) and prealbumin. Of these markers, BMI and PhA were strong predictors of survival. By combining published data, we generated indirect estimates of the overall survival HR associated with SPN; these ranged from 0.80 to 0.99 (mode 0.87). In patients with Stage IV inoperable pancreatic cancer, the incremental cost-effectiveness ratio versus EN alone was estimated to be £41 350 or £91 501 depending on whether nursing and home delivery costs for EN and SPN were combined or provided separately. Conclusion Despite a lack of direct evidence, the results of the literature review demonstrate that SPN may provide important clinical and quality of life benefits to patients with cancer. The potential for any improvement in outcomes in the modelled patient population is very limited, so cost-effectiveness may be greater in patients with less severe disease and other types of cancer.
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Affiliation(s)
- Neil Webb
- Source Health Economics, Oxford, UK.
| | | | | | | | | | | | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Julian Shepelev
- Health Economics and Outcomes Research, Clinical Nutrition, Baxter Healthcare Ltd, Compton, UK
| | - Juan W Valle
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
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14
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Huong LT, Phuong DT, Anh DK, Toi PL, Anh NLT, Huy TL, Linh NT. Nutritional Intervention Improves Nutrition Outcomes in Stomach and Colon Cancer Patients Receiving Chemotherapy: Finding from a Quasi-Experiment in Vietnam. Healthcare (Basel) 2021; 9:healthcare9070843. [PMID: 34356221 PMCID: PMC8304715 DOI: 10.3390/healthcare9070843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Evidence on the effects of nutritional interventions on gastrointestinal cancer patients receiving chemotherapy is not well documented. This study aims to assess the effects of nutritional intervention in patients diagnosed with stomach and colon cancer receiving chemotherapy in Vietnam. Methods: A quasi-experiment with intervention and control groups for pre- and post-intervention was carried out in cancer patients receiving chemotherapy in a university hospital in Vietnam. Patients in the intervention group were provided nutritional counseling, personalized specific dietary advice, and received oral nutrition supplements (ONSs) while patients in the control group only received nutrition counseling. Results: The weight in the intervention and control group after 2 months increased significantly by 1.4 ± 2.6 kg and 0.4 ± 2.3 kg, respectively. Muscle mass increased by 1.2 ± 4.1 cm in the intervention group, while those in the control group decreased by 0.55 ± 2.77 cm. There was no statistical significance between two groups after intervention in terms of Mid–Upper Arm Circumference (MUAC) and percentage of fat. The percentage of malnutrition based on the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Body Mass Index (BMI) declined after the intervention in both groups. According to the average treatment effect on the treated (ATT) using the propensity score matching and DiD method, participants receiving the intervention were more likely to have a higher score of weight (Coef = 0.84; 95%CI = 0.47; 2.16) and muscle mass (Coef = 1.08; 95%CI = 0.09; 2.06) between pre- and post-intervention. By contrast, the PG-SGA scores on treated participants were more likely to decrease after the intervention (Coef = −1.28; 95%CI = −4.39; −0.84). After matching, being female, living in rural areas, or having stomach cancer were still positively related to being moderately/severely malnourished by the PG-SGA, and these findings were statistically significant (p < 0.05). Conclusion: The nutritional interventions had a positive effect on weight gain, muscle mass, and reduced malnutrition. Further studies with a longer follow-up duration are needed to confirm the effects of the intervention.
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Affiliation(s)
- Le Thi Huong
- Nutrition and Dietetics Department, Hanoi Medical University Hospital, Hanoi 10000, Vietnam; (L.T.H.); (N.T.L.)
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
| | - Duong Thi Phuong
- Nutrition and Dietetics Department, Hanoi Medical University Hospital, Hanoi 10000, Vietnam; (L.T.H.); (N.T.L.)
- Correspondence:
| | - Dang Kim Anh
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
| | - Phung Lam Toi
- Health Strategy and Policy Institute, Ministry of Health, Hanoi 10000, Vietnam;
| | - Nguyen Le Tuan Anh
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
| | - Trinh Le Huy
- Oncology Department, Hanoi Medical University, Hanoi 10000, Vietnam;
| | - Nguyen Thuy Linh
- Nutrition and Dietetics Department, Hanoi Medical University Hospital, Hanoi 10000, Vietnam; (L.T.H.); (N.T.L.)
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
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15
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Caccialanza R, De Lorenzo F, Lobascio F, Gnagnarella P, Iannelli E, Traclò F, Delrio P, Tancredi R, Pedrazzoli P. Nutritional care in cancer patients: Initiatives and perspectives of the Italian Intersociety Working Group for Nutritional Support in Cancer Patients. Nutrition 2021; 91-92:111358. [PMID: 34303958 DOI: 10.1016/j.nut.2021.111358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/07/2021] [Accepted: 05/18/2021] [Indexed: 01/07/2023]
Abstract
Malnutrition is a frequent comorbidity in people with cancer, associated with poor tolerance of anticancer treatments, prognosis, and quality of life. Despite the abundance of scientific literature supporting this evidence and the availability of international guidelines for managing nutritional care in people with cancer, attitudes about this issue still vary considerably among oncologists, to the point that many patients who are malnourished do not receive adequate nutritional support. In view of this, the Italian Association of Medical Oncology, the Italian Society of Artificial Nutrition and Metabolism, and the Italian Federation of Volunteer-based Cancer Organizations implemented in 2016 a collaborative working group and initiated a structured project called Integrating Nutritional Therapy in Oncology, with the aim of increasing oncologists' awareness of nutritional issues and consequently improving the nutritional care of cancer patients in Italy. In 2019, the Italian Society of Oncological Surgery and the Technical Scientific Association of Food, Nutrition and Dietetics joined the working group. In this article, we present the updated initiatives and the perspectives of this intersociety project.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | | | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCSS, Milan, Italy
| | | | - Francesca Traclò
- Italian Federation of Volunteer-based Cancer Organizations, Rome, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Richard Tancredi
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine, University of Pavia, Pavia, Italy
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Abstract
Through food intake, humans obtain a variety of nutrients that are essential for growth, cellular function, tissue development, energy, and immune defense. A special interaction between nutrients and gut-associated lymphoid tissue occurs in the intestinal tract. Enterocytes of the intestinal barrier act as sensors for antigens from nutrients and the intestinal microbiota, which they deliver to the underlying immune system of the lamina propria, triggering an immune response. Studies investigating the mechanism of influence of nutrition on immunological outcomes have highlighted an important role of macronutrients (proteins, carbohydrates, fatty acids) and micronutrients (vitamins, minerals, phytochemicals, antioxidants, probiotics) in modulating immune homeostasis. Nutrients exert their role in innate immunity and inflammation by regulating the expression of TLRs, pro- and anti-inflammatory cytokines, thus interfering with immune cell crosstalk and signaling. Chemical substrates derived from nutrient metabolism may act as cofactors or blockers of enzymatic activity, influencing molecular pathways and chemical reactions associated with microbial killing, inflammation, and oxidative stress. Immune cell function appears to be influenced by certain nutrients that form parts of the cell membrane structure and are involved in energy production and prevention of cytotoxicity. Nutrients also contribute to the initiation and regulation of adaptive immune responses by modulating B and T lymphocyte differentiation, proliferation and activation, and antibody production. The purpose of this review is to present the available data from the field of nutritional immunology to elucidate the complex and dynamic relationship between nutrients and the immune system, the delineation of which will lead to optimized nutritional regimens for disease prevention and patient care.
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Affiliation(s)
- Evanthia Tourkochristou
- Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Christos Triantos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
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17
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Sánchez-Sánchez E, Ruano-Álvarez MA, Díaz-Jiménez J, Díaz AJ, Ordonez FJ. Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review. Nutrients 2021; 13:1562. [PMID: 34066386 DOI: 10.3390/nu13051562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022] Open
Abstract
Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The aim of this review is to know the current status in the management of EN by NG tube in patients under palliative care, and its effect in their wellbeing and quality of life. The following databases were used: PubMed, Web of Science (WOS), Scopus, Scielo, Embase and Medline. After inclusion and exclusion criteria were applied, as well as different qualities screening, a total of three entries were used, published between 2015 and 2020. In total, 403 articles were identified initially, from which three were selected for this review. The use of NGT caused fewer diarrhea episodes and more restrictions than the group that did not use NG tubes. Furthermore, the use of tubes increased attendances to the emergency department, although there was no contrast between NGT and PEG devices. No statistical difference was found between use of tubes (NGT and PEG) or no use, with respect to the treatment of symptoms, level of comfort, and satisfaction at the end of life. Nevertheless, it improved hospital survival compared with other procedures, and differences were found in hospital stays in relation to the use of other probes or devices. Finally, there are not enough quality studies to provide evidence on improving the health status and quality of life of the use of EN through NGT in patients receiving palliative care. For this reason, decision making in this field must be carried out individually, weighing the benefits and damages that they can cause in the quality of life of the patients.
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18
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Reiter M, Gerken M, Lindberg-Scharf P, Fuerst A, Liebig-Hörl G, Ortmann O, Eberl I, Bartholomeyczik S. Health services research in colorectal cancer: a quasi-experimental interventional pilot study on in- and outpatient oncology. J Cancer Res Clin Oncol 2020; 147:1789-1802. [PMID: 33373026 PMCID: PMC8076149 DOI: 10.1007/s00432-020-03454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022]
Abstract
Introduction Due to frequent treatment side effects and weight loss, colorectal cancer patients require oncologic care and nutritional counseling both during and after hospitalization. The current study evaluated differences in discharge and side effects management and nutritional behavior between colorectal cancer patients of a control group without systematic counseling and of an intervention group with access to structured in- and outpatient oncology nurse and nutritional counseling. Methods The presented explorative, quantitative, single-center, interventional pilot study is a health services research project with a quasi-experimental design. Using a self-designed standardized questionnaire, data were collected from the control group (n = 75) before and from the intervention group (n = 114) after the introduction of in- and outpatient oncology nurse and structured systematic nutritional counseling. The in- and outpatient counseling services were developed and evaluated in the form of a structured nurse-led counseling concept. Results Intervention group patients profited significantly from inpatient oncology nurse counseling in seven different areas of discharge management. No differences were observed concerning patient-reported general and gastrointestinal side effects except for xerostomia and dysphagia, but of the patients participating in both in- and outpatient oncology nurse counseling, 90.0% were better able to cope with general side effects of treatment. Patients with in- and outpatient structured systematic nutritional counseling more frequently received nutritional information (p = 0.001), were better at gauging food intolerances (p = 0.023), and followed the dietician's advice in cases of gastrointestinal side effects significantly more often (p = 0.003) than control patients. Counselor-reported outcomes concerning gastrointestinal side effects showed improvement in most of the patients taking part in systematic in- and outpatient nutritional counseling, except for weight loss in 4 patients. Conclusion In- and outpatient counseling in discharge and side effects management and nutrition improve the outcomes of colorectal cancer patients. Outpatient counseling should be further developed and evaluated in future studies.
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Affiliation(s)
- Margarete Reiter
- Diplom-Kauffrau, Faculty of Health, School of Nursing Science, PhD Student at the Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany. .,Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany.
| | - Michael Gerken
- Tumor Center Regensburg-Institute of Quality Management and Health Services Research of the University of Regensburg, Coordination, Epidemiology, Am Biopark 9, 93053, Regensburg, Germany
| | - Patricia Lindberg-Scharf
- Tumor Center Regensburg-Institute of Quality Management and Health Services Research of the University of Regensburg, Section Quality of Life, Am Biopark 9, 93053, Regensburg, Germany
| | - Alois Fuerst
- Director of the Department of General and Visceral Surgery, Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Gudrun Liebig-Hörl
- Medical Coordinator of Colon Cancer Center, Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Olaf Ortmann
- Director of the Department of Gynecology and Obstetrics, University Medical Center Regensburg, Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Ingeborg Eberl
- Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072, Eichstätt, Germany
| | - Sabine Bartholomeyczik
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
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Sanz-Paris A, Martinez-Trufero J, Lambea-Sorrosal J, Milà-Villarroel R, Calvo-Gracia F. Impact of an Oral Nutritional Protocol with Oligomeric Enteral Nutrition on the Quality of Life of Patients with Oncology Treatment-Related Diarrhea. Nutrients 2020; 13:E84. [PMID: 33383949 PMCID: PMC7824279 DOI: 10.3390/nu13010084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Nutritional status can influence the quality of life (QoL) of cancer patients. (2) Methods: This subanalysis evaluated the impact of an oral oligomeric enteral nutrition (OEN) protocol on the QoL of patients with oncology treatment-related diarrhea (OTRD) in a multicenter, observational, prospective study (DIAPOENO study). QoL was assessed with the Nottingham Health Profile (NHP) at baseline and after eight weeks of OEN treatment. (3) In the overall population, all the NHP categories significantly improved after eight weeks of OEN treatment: energy levels (p < 0.001), pain (p < 0.001), emotional reactions (p < 0.001), sleep (p < 0.001), social isolation (p = 0.023), and physical abilities (p = 0.001). QoL improvement was higher in patients with improved or maintained nutritional status and in those with improved consistency of stools with the OEN protocol. However, QoL did not significantly improve in patients with worse nutritional status and with worse or maintained stool consistency with the OEN protocol. QoL improved regardless of disease severity. Multivariate logistic regression analysis showed that weight change was significantly associated with improved QoL (OR 2.90-5.3), except for social isolation, in models unadjusted and adjusted to age, sex, oncology treatment, and stool consistency. (4) Conclusion: In this subanalysis, the OEN protocol was associated with improved QoL.
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Affiliation(s)
- Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
| | | | | | - Raimon Milà-Villarroel
- Group Research on Wellbeing (GRoW), Blanquerna School of Health Sciences-Universitat Ramon Llull, 08025 Barcelona, Spain;
| | - Fernando Calvo-Gracia
- Department of Endocrinology and Nutrition, University Clinic Hospital, 50009 Zaragoza, Spain;
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Nakahara S, Takasaki M, Abe S, Kakitani C, Nishioka S, Wakabayashi H, Maeda K. Aggressive nutrition therapy in malnutrition and sarcopenia. Nutrition 2020; 84:111109. [PMID: 33453622 DOI: 10.1016/j.nut.2020.111109] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022]
Abstract
Aggressive nutrition therapy is essential to improve nutrition and function in patients with malnutrition and sarcopenia. Malnutrition and sarcopenia negatively affect functional recovery and activities of daily living. Nutrition improvement is associated with better functional recovery. Target energy intake in aggressive nutrition therapy is defined as total energy expenditure (TEE) plus the amount of energy accumulated. The amount of energy accumulation per 1 kg of body weight is generally 7500 kcal. If the goal is to gain 1 kg of weight over 30 d, TEE + 250 kcal is the target daily energy intake. Aggressive nutrition therapy is implemented using a rehabilitation nutrition care process, which consists of five steps: assessment and diagnostic reasoning, diagnosis, goal setting, intervention, and monitoring. Aggressive nutrition therapy sets clear goals using the Specific, Measurable, Achievable, Relevant, and Time-bound principles. The application and effect of aggressive nutrition therapy differs depending on the etiology and condition of malnutrition. Precachexia, short bowel syndrome, and older people with mild to moderate dementia are indications for aggressive nutrition therapy. Nevertheless, aggressive nutrition therapy is usually contraindicated in cases of refractory cachexia, acute disease or injury with severe inflammation, and bedridden patients with severe dementia and reduced activity. Aggressive nutrition therapy should be combined with aggressive exercise and rehabilitation. Enhanced nutritional therapy combined with rehabilitation in patients with cerebrovascular disease, hip fracture, or acute disease is recommended in the 2018 clinical practice guidelines for rehabilitation nutrition. Further evidence for aggressive nutrition therapy is however required.
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Affiliation(s)
- Saori Nakahara
- Department of Nutrition, Suzuka General Hospital, Suzuka City, Mie Prefecture, Japan
| | - Miyuki Takasaki
- Division of Nutrition Support, Tsurumakionsen Hospital, Hadano City, Kanagawa Prefecture, Japan
| | - Sayaka Abe
- Department of Nutrition, Sapporonishimaruyama Hospital, Sapporo City, Hokkaido, Japan
| | - Chisa Kakitani
- Nutrition Management Department, Yoshida Hospital, Kobe City, Hyogo Prefecture, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki City, Nagasaki Prefecture, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan.
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu City, Aichi Prefecture, Japan
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Song YH, Kwon HN, Hong JI, Park J, Kim JY, Kim HJ. A Case Study on the Customized Nutrition Intervention for a Patient with Primary Gastrointestinal Non-Hodgkin Lymphoma Underlying Chronic Kidney Disease. Clin Nutr Res 2020; 9:332-342. [PMID: 33204672 PMCID: PMC7644365 DOI: 10.7762/cnr.2020.9.4.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/19/2022] Open
Abstract
Non-Hodgkin lymphoma comprises 2.1% of the total number of cancers in South Korea. Among those, diffuse large B cell lymphoma (DLBCL) comprises the largest percentage. Nutrition interventions have been highlighted because nutritional status in non-Hodgkin's lymphoma patients has a significant impact on treatment and prognosis, but relevant studies are inadequate. Therefore, the aim of this study was to share the case of a nutrition intervention for a patient with primary gastrointestinal non-Hodgkin lymphoma underlying chronic kidney disease who was comorbid with tumor lysis syndrome, which was a complication of a specific chemotherapy. The subject is a 76-year-old patient who was diagnosed with DLBCL. He had abdominal pain, constipation, and anorexia. After chemotherapy, he experienced the tumor lysis syndrome. The patient's condition was continuously monitored, and various nutrition interventions, such as nutrition counseling and education, provision of therapeutic diet, oral nutritional supplement, change of meal plans, and parenteral nutrition support were attempted. As a result of the nutrition intervention, oral intake was increased from 27% of the energy requirement to 70% and from 23% of the protein requirement to 77%. Despite the various nutrition interventions during the hospitalization, there were no improvements in weight and nutrition-related biochemical parameters or malnutrition. However, it was meaningful in that the patient was managed to prevent worsening and the planned third chemotherapy could be performed. These results can be used as the basis for establishing guidelines for nutritional interventions customized to patients under the same conditions.
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Affiliation(s)
- Young-Hwa Song
- Department of Nutrition, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul 07345, Korea
| | - Han-Na Kwon
- Department of Nutrition, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul 07345, Korea
| | - Jeong-Im Hong
- Department of Nutrition, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul 07345, Korea
| | - Juyeon Park
- Department of Nutrition, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul 07345, Korea
| | - Ji-Yeon Kim
- Department of Nutrition, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul 07345, Korea
| | - Hye-Jin Kim
- Department of Nutrition, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul 07345, Korea
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Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (CRT) followed by an esophagectomy is the standard treatment for locally advanced esophageal cancer, but remains a great challenge for elderly patients. Therefore, we aim to evaluate the efficacy of definitive CRT in elderly patients with esophageal cancer. METHODS From December 2007 to October 2017, 40 esophageal cancer patients aged ≥70 years receiving definitive CRT were retrospectively analyzed. All patients received cisplatin-based chemotherapy. Ten patients received standard doses of cisplatin 20 mg/m and fluorouracil (5-FU) 800 mg/m for 4 days, during the first and fifth weeks of radiotherapy. Eighteen patients received modified doses of cisplatin 16 to 18 mg/m and 5-FU 600 to 800 mg/m. Twelve patients received lower doses of cisplatin 10 to 12 mg/m and 5-FU 400 to 600 mg/m. The endpoints were overall survival (OS), tumor response rate, and treatment compliance. RESULTS The 3-year OS rate was 28.8% The 3-year OS rates for patients receiving standard, modified, and lower doses were 12.5%, 53.8%, and 0.0%, respectively (p = 0.05). There were 87.5% of patients completing the scheduled radiotherapy dose, along with two cycles of concurrent chemotherapy. The response rate (clinical complete response and partial response rate) was 70.0%. Multivariate analysis revealed that no statistical difference was found in the OS among three groups of chemotherapy dosage. The treatment response was the only independent prognostic factor to OS (p < 0.001). CONCLUSION Definitive CRT with dose modification is a feasible, safe, and reasonable treatment for elderly esophageal cancer patients. Achieving a better compliance to CRT via an optimal dose modification of chemotherapy may provide better clinical outcomes and would be the treatment goal for elderly esophageal cancer patients.
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Affiliation(s)
- Hao-Wei Lu
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chien-Chih Chen
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- PhD Program in Translational Medicine, National Chung-Hsing University, Taichung, Taiwan, ROC
| | - Hsin-Hua Chen
- PhD Program in Translational Medicine, National Chung-Hsing University, Taichung, Taiwan, ROC
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan, ROC
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan. ROC
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC
| | - Hui-Ling Yeh
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Address correspondence. Dr. Hui-Ling Yeh, Department of Radiation Oncology, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Taichung 407, Taiwan, ROC. E-mail address: (H.-L. Yeh)
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Caccialanza R, Lobascio F, Aprile G, De Lorenzo F, Pedrazzoli P. Reply to: The challenge for nutritional care in a cancer center: The need for integration between clinical nutritionist, oncologist and palliative care physician. Curr Probl Cancer 2020; 44:100648. [PMID: 32921437 DOI: 10.1016/j.currproblcancer.2020.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | | | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
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24
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Cotogni P, Caccialanza R, Pedrazzoli P, Bozzetti F, De Francesco A. Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients. Healthcare (Basel) 2020; 8:healthcare8020183. [PMID: 32585965 PMCID: PMC7348909 DOI: 10.3390/healthcare8020183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022] Open
Abstract
Current guidelines recommend home parenteral nutrition (HPN) for cancer patients with chronic deficiencies of dietary intake or absorption when enteral nutrition is not adequate or feasible in suitable patients. HPN has been shown to slow down progressive weight loss and improve nutritional status, but limited information is available on the monitoring practice of cancer patients on HPN. Clinical management of these patients based only on nutritional status is incomplete. Moreover, some commonly used clinical parameters to monitor patients (weight loss, body weight, body mass index, and oral food intake) do not accurately reflect patient’s body composition, while bioelectrical impedance analysis (BIA) is a validated tool to properly assess nutritional status on a regular basis. Therefore, patient’s monitoring should rely on other affordable indicators such as Karnofsky Performance Status (KPS) and modified Glasgow Prognostic Score (mGPS) to also assess patient’s functional status and prognosis. Finally, catheter-related complications and quality of life represent crucial issues to be monitored over time. The purpose of this narrative review is to describe the role and relevance of monitoring cancer patients on HPN, regardless of whether they are receiving anticancer treatments. These practical tips may be clinically useful to better guide healthcare providers in the nutritional care of these patients.
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Affiliation(s)
- Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-338-7018496
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine and Medical Therapy, Università degli Studi di Pavia, 27100 Pavia, Italy;
| | | | - Antonella De Francesco
- Clinical Nutrition, Department of Internal Medicine, Molinette Hospital, 10126 Turin, Italy;
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25
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Cotogni P, Monge T, Passera R, Brossa L, De Francesco A. Clinical characteristics and predictive factors of survival of 761 cancer patients on home parenteral nutrition: A prospective, cohort study. Cancer Med 2020; 9:4686-4698. [PMID: 32412178 PMCID: PMC7333857 DOI: 10.1002/cam4.3064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/14/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Robust data reporting the survival of cancer patients on home parenteral nutrition (HPN) are lacking. The aim of this prospective, cohort study was to investigate clinical characteristics, predictive factors, and overall survival (OS) of adult-malnourished cancer patients eligible for HPN according to the European guideline recommendations. METHODS During the study period, 1658 cancer patients were consecutively evaluated in a tertiary university hospital. Of these, 761 who received HPN were grouped into four cohorts according to the provision of supplemental PN (SPN) or total (TPN) and whether they received chemotherapy (CT+ or CT- ): SPN/CT+ (n = 376), TPN/CT+ (n = 99), SPN/CT- (n = 191), and TPN/CT- (n = 95). Patient demographics, nutritional status, cancer-related characteristics, and prognostic scores assessed at HPN start. The primary outcome was OS. RESULTS Median OS was 8.9, 4.3, 5.7, and 2.2 months for the SPN/CT+ , TPN/CT+ , SPN/CT- , and TPN/CT- cohorts, respectively. In multivariable analysis, predictors showing significant association with decreased survival were patient cohorts, modified Glasgow Prognostic Score (1 and 2 scores), weight loss (>15%) in the 3 months before HPN start, and TNM IV stage while protective factors of survival were Karnofsky Performance Status (>50), albumin level (>3.5 g/dL), oral protein intake, BMI (>20.5), and weight at HPN start. CONCLUSION For the first time, in four different cohorts of cancer patients on HPN, clinical characteristics and survival were compared. This large study showed that survival is significantly correlated with patient characteristics at HPN start and that the presence of favorable factors may determine even a fourfold increase in survival. These data are expected to assist physicians in the appropriate prescription of HPN.
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Affiliation(s)
- Paolo Cotogni
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy
| | - Taira Monge
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy.,Clinical Nutrition, Department of Internal Medicine, Molinette Hospital, Turin, Italy
| | - Roberto Passera
- Nuclear Medicine Division, Department of Radiology, Molinette Hospital, Turin, Italy
| | - Laura Brossa
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy.,Clinical Nutrition, Department of Internal Medicine, Molinette Hospital, Turin, Italy
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26
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Caccialanza R, Lobascio F, Brugnatelli S, Pedrazzoli P. Nutritional support in pancreatic cancer. Cancer 2020; 126:1810-1811. [PMID: 31943146 DOI: 10.1002/cncr.32713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Brugnatelli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Internal Medicine Department, University of Pavia, Pavia, Italy
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27
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Vilas-Boas V, Gijbels E, Jonckheer J, De Waele E, Vinken M. Cholestatic liver injury induced by food additives, dietary supplements and parenteral nutrition. Environ Int 2020; 136:105422. [PMID: 31884416 DOI: 10.1016/j.envint.2019.105422] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/05/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
Cholestasis refers to the accumulation of toxic levels of bile acids in the liver due to defective bile secretion. This pathological situation can be triggered by drugs, but also by ingredients contained in food, food supplements and parenteral nutrition. This paper provides an overview of the current knowledge on cholestatic injury associated with such ingredients, with particular emphasis on the underlying mechanisms of toxicity.
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Affiliation(s)
- Vânia Vilas-Boas
- Department of In Vitro Toxicology and Dermato-Cosmetology, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Eva Gijbels
- Department of In Vitro Toxicology and Dermato-Cosmetology, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Joop Jonckheer
- Department of Intensive Care, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Elisabeth De Waele
- Department of Intensive Care, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Mathieu Vinken
- Department of In Vitro Toxicology and Dermato-Cosmetology, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
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28
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Kiss N, Bauer J, Boltong A, Brown T, Isenring L, Loeliger J, Steer B, Findlay M. Awareness, perceptions and practices regarding cancer-related malnutrition and sarcopenia: a survey of cancer clinicians. Support Care Cancer 2020; 28:5263-5270. [PMID: 32103357 DOI: 10.1007/s00520-020-05371-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cancer-related malnutrition and sarcopenia have severe negative consequences including reduced survival and reduced ability to complete treatment. This study aimed to determine the awareness, perceptions and practices of Australian oncology clinicians regarding malnutrition and sarcopenia in people with cancer. METHODS A national cross-sectional survey of Australian cancer clinicians was undertaken between November 2018 and January 2019. The 30-item online purpose-designed survey was circulated through professional organizations and health services. RESULTS The 111 participants represented dietetic (38%), nursing (34%), medical (14%) and other allied health (14%) clinicians. Overall, 86% and 88% clinicians were aware of accepted definitions of malnutrition and sarcopenia, respectively. Perception of responsibility for identification of these conditions varied across participants, although 93% agreed this was a component of their role. However, 21% and 43% of clinicians had limited or no confidence in their ability to identify malnutrition and sarcopenia, respectively. Common barriers to the identification and management of malnutrition were access to the tools or skills required and a lack of services to manage malnourished patients. Common barriers to identification of sarcopenia were lack of confidence and lack of services to manage sarcopenic patients. Enablers for identification and management of malnutrition and sarcopenia were variable; however, training and protocols for management ranked highly. CONCLUSION While awareness of the importance of cancer-related malnutrition and sarcopenia are high, participants identified substantial barriers to delivering optimal nutrition care. Guidance at a national level is recommended to strengthen the approach to management of cancer-related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia. .,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Anna Boltong
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Liz Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Jenelle Loeliger
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
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29
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Pezzilli R, Caccialanza R, Capurso G, Brunetti O, Milella M, Falconi M. Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer. Cancers (Basel). 2020;12. [PMID: 31979186 DOI: 10.3390/cancers12020275] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
Pancreatic cancer is an aggressive malignancy and the seventh leading cause of global cancer deaths in industrialised countries. More than 80% of patients suffer from significant weight loss at diagnosis and over time tend to develop severe cachexia. A major cause of weight loss is malnutrition. Patients may experience pancreatic exocrine insufficiency (PEI) before diagnosis, during nonsurgical treatment, and/or following surgery. PEI is difficult to diagnose because testing is cumbersome. Consequently, PEI is often detected clinically, especially in non-specialised centres, and treated empirically. In this position paper, we review the current literature on nutritional support and pancreatic enzyme replacement therapy (PERT) in patients with operable and non-operable pancreatic cancer. To increase awareness on the importance of PERT in pancreatic patients, we provide recommendations based on literature evidence, and when data were lacking, based on our own clinical experience.
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30
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Pedrazzoli P, Pinto C, Rosti G, Caccialanza R. Nutritional support in cancer patients: reply to Scarpi et al. Support Care Cancer 2019; 28:1549-1550. [PMID: 31853700 DOI: 10.1007/s00520-019-05223-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. .,Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
| | - Carmine Pinto
- Medical Oncology, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Rosti
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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