Unmet needs in cancer patients: Creating recommendations to overcome geographical disparities in economic growth

Cancer is a major clinical, economic and societal challenge across different world regions. Effective anticancer therapies are now available, yet the impact of these treatments on the needs of patients with cancer remains questionable, since improved survival is not frequently associated with improved quality of life. In an effort to raise patients' needs at the core of anticancer therapies, the importance of nutritional support has become recognized by international scientific societies. It is recognized that the needs of patients with cancer are universal, yet the economic and societal status of any country influence the availability and implementation of nutritional care. The Middle East is a geographic area in which major differences in economic growth coexist. Consequently, it appears reasonable that international guidelines on nutritional care in oncology are reviewed to highlight those recommendations which could be universally adopted and those which may need a progressive implementation. To this end, a group of Middle East healthcare professionals working in cancer centers across the region gathered to develop a list of recommendations to be implemented in daily practice. This would translate in a likely better acceptance and delivery of nutritional care, aligning all Middle East cancer centers to the quality standards now available only in selected hospital across the region.

Effect of seaweed (Ecklonia cava extract) on blood glucose and insulin level on prediabetic patients: A double-blind randomized controlled trial

To investigate the effect of polyphenolic-rich seaweed extract (Ecklonia cava) on postprandial blood glucose (PPBG) and postprandial insulin level (PPIL) as well as investigating any associated side effects related to the study intervention in 20 prediabetic patients in Saudi Arabia. The double-blind, randomized-controlled trial was conducted from November 2020 to April 2021 in Riyadh, in 20 prediabetic patients with no other health complications. Subjects were given 600 mg of seaweed extract in a single dose for acute effect investigation. PPBG and PPIL were measured immediately at intervals of 30, 60, 90, and 120 min following 75 g of carbohydrate consumption, iAUC and peak concentration were calculated accordingly. Insignificant differences were shown for PPBG levels between study groups at intervals of 30 and 60 min (p > .05). However, PPBG results were significantly lower in the intervention group compared to placebo of 90 and 120 min after carbohydrate (75 g) consumption. The mean (SD) of PPBG in the seaweed group at 90 and 120 min was 108.1 (±8.9) and 101.3 (±8.7), respectively, compared to the placebo group at 90 and 120 min with a mean of 122.2 (±16.9) and 112.9 (±12.1), respectively (p value at 90 min = 0.032) and (p value at 120 min = 0.024). iAUC of PPBG shows no significant differences between the study groups (p > .05). There was no significant difference in PPIL between study groups at all study measurements (p > .05). Discomfort symptoms were similar between study groups (p > .05). This study indicated that a single dose of 600 mg of E. cava extract has a lowering effect on postprandial blood glucose with no associated side effects. Further research should investigate the glycemic modulating effects of marine algal extracts in the long-term investigation.

Randomized clinical trial of the impact of insulin therapy on liver function in patients undergoing major liver resection

BACKGROUND

Postoperative liver dysfunction is the major source of morbidity and mortality in patients undergoing partial hepatectomy. This study tested the benefits of a metabolic support protocol based on insulin infusion, for reducing liver dysfunction following hepatic resection.

METHODS

Consecutive consenting patients scheduled for liver resection were randomized to receive preoperative dextrose infusion followed by insulin therapy using the hyperinsulinaemic normoglycaemic clamp protocol (n = 29) or standard therapy (control group, n = 27). Patients in the insulin therapy group followed a strict dietary regimen for 24 h before surgery. Intravenous dextrose was started at 2 mg per kg per min the night before and continued until surgery. Hyperinsulinaemic therapy for a total of 24 h was initiated at 2 munits per kg per min at induction of anaesthesia, and continued at 1 munit per kg per min after surgery. Normoglycaemia was maintained (3.5-6.0 mmol/l). Control subjects received no additional dietary supplement and a conventional insulin sliding scale during fasting. All patients were tested serially to evaluate liver function using the Schindl score. Liver tissue samples were collected at two time points during surgery to measure glycogen levels.

RESULTS

Demographics were similar in the two groups. More liver dysfunction occurred in the control cohort (liver dysfunction score range 0-8 versus 0-4 with insulin therapy; P = 0.031). Median (interquartile range) liver glycogen content was 278 (153-312) and 431 (334-459) µmol/g respectively (P = 0.011). The number of complications rose with increasing severity of postoperative liver dysfunction (P = 0.032) CONCLUSION: The glucose-insulin protocol reduced postoperative liver dysfunction and improved liver glycogen content.

REGISTRATION NUMBER

NCT00774098 (http://www.clinicaltrials.gov).

Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) to characterize cachexia in newly diagnosed advanced cancer patients

9574

Background: Our objective was to evaluate whether the scored PGSGA questionnaire in advanced cancer patients (ACP) might relate better then weight loss (WL) alone to the nutritional, functional, biological and quality of life features of cachexia (C) and to some complications related to this syndrome. Methods: 214 newly diagnosed ACP with non-small cell lung and gastrointestinal primaries were categorized according to PG-SGA triage intervals of 0–1, 2–8 and ≥9 and also according to WL ≤5% or >5%. Baseline assessments included: hand-grip strenght, body composition by DXA, selective measures of symptom and quality of life (QoL), CBC and differential counts, albumin and CRP. Survival hospitalization rates and data on chemotherapy tolerability were recorded during patient follow-up. Beta coefficients (β), odds ratios (OR), and hazard ratios (HR) were estimated to compare patients with >5% WL to those with ≤5% WL and to compare patients with PGSGA of 0–1 to those with 2–8 and ≥9 scores. All analyses were controlled for gender, age, diagnosis (lung/GI), treatment (radio/chemo), survival (at 8 weeks), and medications. Results: PGSGA was better than the simple recording of WL in defining a population of patients that differed for WBC 109/L(>5% WL β: 0.25 vs. 2–8 PGSGA β: 0.57 and ≥9 PGSGA β: 1.72), CRP mg/L (4.12 vs. 2.16 and 17.49), albumin g/L(-0.63 vs -2.60 and -4.45); weakness 0–10 (1.57 vs.1.56 and 3.32), anorexia 0–10 (2.36 vs. 2.36 and 5.17); Brief Fatigue Inventory 0–90 (17.75 vs. 9.89 and 25.15); McGill QoL 10–0 (-0.95 vs. -0.64 and -2.29); grip strength lbs.(-4.04 vs. -8.82 and -8.06); body fat kg. ( -8.74 vs. -5.94 and -11.72). PGSGA was able to better identify patients with higher rates of both hospitalization (2.6 vs. 1.62 and 9.46) and dose reduction of chemotherapy (1.2 vs. 0.58 and 1.74). Finally, PGSGA was able to better characterize patient survival as compared to WL alone (>5% WL HR: 1.85; 2–8 PGSGA HR: 1.6 and ≥9 PGSGA HR 3.35). Conversely, WL alone was associated with higher probability of a sarcopenia diagnosis by DXA (>5% WL OR: 1.56)Conclusions: Our data support the use of the PGSGA versus the simple recording of WL for identifying C, monitoring its clinical course and predicting possible complications of this syndrome in ACP.

No significant financial relationships to disclose.