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Impact of Baseline Nutrition and Exercise Status on Toxicity and Outcomes in Phase I and II Oncology Clinical Trial Participants. Oncologist 2019; 25:161-169. [PMID: 31748339 DOI: 10.1634/theoncologist.2019-0289] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Malnutrition and physical inactivity are common in patients with advanced cancer and are associated with poor outcomes. There are increasing data that altered body composition is related to the pharmacokinetic properties of cancer therapies. These adverse conditions may impact outcomes in early-phase oncology clinical trials. MATERIALS AND METHODS We aimed to understand the relationships between baseline nutrition and exercise status with important trial endpoints including treatment-related toxicity and survival. Baseline assessments of nutrition and exercise status were conducted in patients prior to initiation of phase I and II oncology clinical trials. Patients were followed prospectively for the onset of adverse events. Tumor response and survival data were also obtained. Fisher's exact test and chi-square analysis were used to determine statistical significance. Kaplan-Meier curves were used to compare patient duration on study and survival. RESULTS One hundred patients were recruited, of whom 87 were initiating a phase I trial. Sixty percent were initiating trials studying immunotherapeutic agents. Critical malnutrition was found in 39% of patients, and 52% were sedentary. Patients who were malnourished had significantly increased rates of grade ≥ 3 toxicity (p = .001), hospitalizations (p = .001), and inferior disease control rate (p = .019). Six-month overall survival was significantly reduced in malnourished patients versus nonmalnourished patients (47% vs. 84%; p = .0003), as was median duration on study (48 days vs. 105 days; p = .047). Being sedentary at baseline was associated with decreased duration on study (57 days vs. 105 days; p = .019). CONCLUSION Malnutrition and sedentary lifestyle are highly prevalent in patients enrolling on early-phase oncology clinical trials and are associated with poor outcomes. The quality of data from these studies may be compromised as a result of these pre-existing conditions. IMPLICATIONS FOR PRACTICE Phase I and II trials are critical steps in the development of effective cancer therapeutics, yet only a small percentage of agents are ultimately approved for human cancer care. Despite increasing awareness of the interactions between malnutrition, sarcopenia, and treatment-related outcomes such as toxicity and response, these factors are not commonly incorporated into therapeutic decision making at the time of clinical trial consideration. Nutritional status and physical performance may be key biomarkers of mechanisms mediating treatment-related toxicity, dose modifications, risk of hospitalizations, and success of novel agents. This study advocates that a baseline nutritional assessment and early nutritional support may improve tolerability and response to experimental therapies.
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Carbone JW, Pasiakos SM. Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit. Nutrients 2019; 11:nu11051136. [PMID: 31121843 PMCID: PMC6566799 DOI: 10.3390/nu11051136] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022] Open
Abstract
Adequate consumption of dietary protein is critical for the maintenance of optimal health during normal growth and aging. The current Recommended Dietary Allowance (RDA) for protein is defined as the minimum amount required to prevent lean body mass loss, but is often misrepresented and misinterpreted as a recommended optimal intake. Over the past two decades, the potential muscle-related benefits achieved by consuming higher-protein diets have become increasingly clear. Despite greater awareness of how higher-protein diets might be advantageous for muscle mass, actual dietary patterns, particularly as they pertain to protein, have remained relatively unchanged in American adults. This lack of change may, in part, result from confusion over the purported detrimental effects of higher-protein diets. This manuscript will highlight common perceptions and benefits of dietary protein on muscle mass, address misperceptions related to higher-protein diets, and comment on the translation of academic advances to real-life application and health benefit. Given the vast research evidence supporting the positive effects of dietary protein intake on optimal health, we encourage critical evaluation of current protein intake recommendations and responsible representation and application of the RDA as a minimum protein requirement rather than one determined to optimally meet the needs of the population.
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Affiliation(s)
- John W Carbone
- School of Health Sciences, Eastern Michigan University, Ypsilanti, MI 48197, USA.
| | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, USA.
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Freitas RDS, Campos MM. Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications. Nutrients 2019; 11:nu11050945. [PMID: 31035457 PMCID: PMC6566772 DOI: 10.3390/nu11050945] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/24/2022] Open
Abstract
Omega-3 polyunsaturated fatty acids (PUFAs) are considered immunonutrients and are commonly used in the nutritional therapy of cancer patients due to their ample biological effects. Omega-3 PUFAs play essential roles in cell signaling and in the cell structure and fluidity of membranes. They participate in the resolution of inflammation and have anti-inflammatory and antinociceptive effects. Additionally, they can act as agonists of G protein-coupled receptors, namely, GPR40/FFA1 and GPR120/FFA4. Cancer patients undergo complications, such as anorexia-cachexia syndrome, pain, depression, and paraneoplastic syndromes. Interestingly, the 2017 European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines for cancer patients only discuss the use of omega-3 PUFAs for cancer-cachexia treatment, leaving aside other cancer-related complications that could potentially be managed by omega-3 PUFA supplementation. This critical review aimed to discuss the effects and the possible underlying mechanisms of omega-3 PUFA supplementation in cancer-related complications. Data compilation in this critical review indicates that further investigation is still required to assess the factual benefits of omega-3 PUFA supplementation in cancer-associated illnesses. Nevertheless, preclinical evidence reveals that omega-3 PUFAs and their metabolites might modulate pivotal pathways underlying complications secondary to cancer, indicating that this is a promising field of knowledge to be explored.
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Affiliation(s)
- Raquel D S Freitas
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde, PUCRS, Porto Alegre 90619-900, RS, Brazil.
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, PUCRS, Porto Alegre 90619-900, RS, Brazil.
| | - Maria M Campos
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde, PUCRS, Porto Alegre 90619-900, RS, Brazil.
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, PUCRS, Porto Alegre 90619-900, RS, Brazil.
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde, PUCRS, Porto Alegre 90619-900, RS, Brazil.
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Sathianathen NJ, Kwaan M, Lawrentschuk N, Weight CJ, Kim SP, Murphy DG, Moon DA, Konety BR. Adverse impact of malnutrition markers on major abdominopelvic cancer surgery. ANZ J Surg 2019; 89:509-514. [PMID: 30959573 DOI: 10.1111/ans.15129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malnutrition has been associated with adverse postoperative outcomes in a range of procedures but none have evaluated the interaction between clinical indicators of malnutrition. We aimed to comparatively evaluate how combinations of nutritional parameters impact postoperative outcomes amongst patients undergoing major cancer operations. METHODS Major abdominopelvic cancer surgery cases (colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, nephrectomy, pancreatectomy, pneumonectomy and prostatectomy) were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2007-2016. Malnutrition was defined by the presence of the following parameters: body mass index <18.5 kg/m2 ; preoperative serum albumin <3.0 g/dL or more than 10% weight loss in the last 6 months. Malnourished cases were matched with cases with satisfactory nutritional status using propensity scores. The primary outcome was the incidence of Clavien III-IV complications. RESULTS Of the 30 207 cases included, 8.5% had at least one marker of malnutrition. The incidence of Clavien III-IV complications across all cases was 5.8%. In the matched cohort, malnourished cases had a higher rate of complications than those with adequate nutritional status (11.3% versus 9.6%, P = 0.018). A correlation was observed between the number of malnutrition markers possessed and the incidence of Clavien III-V complications. Cases with all three makers had the highest likelihood of experiencing a complication (odds ratio 5.47, 95% confidence interval 1.85-16.17). CONCLUSION Poor nutritional status confers an increased risk of major postoperative complications and being discharged to a facility in non-upper gastrointestinal cancer patients. There was a correlation between the number of malnutrition parameters and the risk of complications.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Surgery, The University of Melbourne and Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Victoria, Australia.,Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary Kwaan
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nathan Lawrentschuk
- Department of Surgery, The University of Melbourne and Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Simon P Kim
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Daniel A Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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Kostecka M. The Potential Influence of Dietary Counseling on Nutritional Status and Dietary Supplement Consumption in Breast Cancer Patients: A Pilot Study. Nutr Cancer 2019; 71:749-755. [PMID: 30632832 DOI: 10.1080/01635581.2018.1531138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cancer, in particular breast cancer, is one of the leading causes of death among women. Good nutritional status contributes to the efficacy of treatment and recovery, and nutritional interventions can minimize the adverse effects of cancer therapy. AIM The aim of this study was to describe the potential role of dietary counseling in breast cancer patients. The impact of nutritional advice on the nutritional status of patients, the use of dietary supplements, and the knowledge of phytoestrogens were assessed. MATERIALS AND METHODS The study was conducted between April and July 2016 in the Lublin Oncology Center on a group of 173 female patients undergoing breast cancer treatment. The patients filled out a questionnaire containing 34 open-ended and closed-ended questions. The collected data were processed in Excel and Statistica 5.0 programs, and the results were regarded as significant at P < 0.05. RESULTS The mean age of the evaluated patients was 66.8 ± 11.3 years. The duration of disease was significantly correlated with the patients' nutritional status expressed by the body mass index (P = 0.0368). The main sources of knowledge about nutrition in cancer care were nurses (29.71%), physicians (12.31%), and nutritionists (13.78%). Patients who received nutritional advice had significantly greater knowledge about phytoestrogens (P = 0.0001), and they were of the opinion that a diet rich in phytoestrogens was safe (P = 0.001). More than 85% of the polled subjects used dietary supplements during treatment, and 2/3 of them did so without professional advice. In this study, 73.07% of the respondents regularly monitored their body weight. Patients who did not receive dietary advice less frequently informed their physician about weight changes. CONCLUSIONS The nutritional status of patients was correlated with access to nutrition and dietary advice during illness. The risk of malnutrition was minimized when patients received and understood educational materials. The patients who did not receive dietary advice more frequently overdosed on dietary supplements. Phytoestrogens were more widely used by patients who regularly attended a dietitian.
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Affiliation(s)
- Małgorzata Kostecka
- a University of Life Sciences in Lublin , Faculty of Food Science and Biotechnology , Lublin , Poland
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Pereira MME, Queiroz MDSC, de Albuquerque NMC, Rodrigues J, Wiegert EVM, Calixto-Lima L, de Oliveira LC. The Prognostic Role of Phase Angle in Advanced Cancer Patients: A Systematic Review. Nutr Clin Pract 2018; 33:813-824. [PMID: 29786894 DOI: 10.1002/ncp.10100] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Phase angle (PA) is a ratio between the reactance and resistance obtained by bioelectric impedance analysis and has been interpreted as a cell membrane integrity indicator and a predictor of total body cell mass. A low PA may suggest deterioration of the cell membrane, which in advanced cancer patients may result in a reduced overall survival (OS). This systematic review sought to investigate the current evidence regarding whether there is an association between PA and OS in patients with advanced cancer (ie, metastatic disease). The search was conducted on electronic databases in August 2017. A total of 34 articles were identified in the initial literature search. Nine studies reporting on 1496 patients were deemed eligible according to our inclusion criteria. PA data were analyzed as continuous variables or according to different cutoffs, under a frequency of 50 Khz. Low PA was associated with worse nutrition status evaluated by body mass index, serum albumin level, transferrin, and fat-free mass. The median OS of the included papers varied from 25.5-330 days, and all studies analyzed showed a significant association between PA and OS, in that patients with low PA had worse OS. Future studies are necessary to justify the use of PA in therapeutic decisions for this population and to evaluate whether nutrition status can influence the association between PA and survival.
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Affiliation(s)
| | | | | | - Juliana Rodrigues
- Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil
| | | | - Larissa Calixto-Lima
- Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil
| | - Livia Costa de Oliveira
- Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil
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Influence of Nutritional Status on the Absorption of Polyphyllin I, an Anticancer Candidate from Paris polyphylla in Rats. Eur J Drug Metab Pharmacokinet 2018; 43:587-597. [DOI: 10.1007/s13318-018-0473-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, Plastino F, Gori S, Magarotto R, Carteni G, Chiurazzi B, Pavese I, Marchetti L, Zagonel V, Bergo E, Tonini G, Imperatori M, Iacono C, Maiorana L, Pinto C, Rubino D, Cavanna L, Di Cicilia R, Gamucci T, Quadrini S, Palazzo S, Minardi S, Merlano M, Colucci G, Marchetti P. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget 2017; 8:79884-79896. [PMID: 29108370 PMCID: PMC5668103 DOI: 10.18632/oncotarget.20168] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In cancer patients, malnutrition is associated with treatment toxicity, complications, reduced physical functioning, and decreased survival. The Prevalence of Malnutrition in Oncology (PreMiO) study identified malnutrition or its risk among cancer patients making their first medical oncology visit. Innovatively, oncologists, not nutritionists, evaluated the nutritional status of the patients in this study. METHODS PreMiO was a prospective, observational study conducted at 22 medical oncology centers across Italy. For inclusion, adult patients (>18 years) had a solid tumor diagnosis, were treatment-naive, and had a life expectancy >3 months. Malnutrition was identified by the Mini Nutritional Assessment (MNA), appetite status with a visual analog scale (VAS), and appetite loss with a modified version of Anorexia-Cachexia Subscale (AC/S-12) of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT). FINDINGS Of patients enrolled (N=1,952), 51% had nutritional impairment; 9% were overtly malnourished, and 43% were at risk for malnutrition. Severity of malnutrition was positively correlated with the stage of cancer. Over 40% of patients were experiencing anorexia, as reported in the VAS and FAACT questionnaire. During the prior six months, 64% of patients lost weight (1-10 kg). INTERPRETATION Malnutrition, anorexia, and weight loss are common in cancer patients, even at their first visit to a medical oncology center.
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Affiliation(s)
| | - Simone Lucia
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vito Lorusso
- Department of Medical Oncology, National Cancer Research Centre Giovanni Paolo II, Bari, Italy
| | - Valeria Saracino
- Department of Medical Oncology, National Cancer Research Centre Giovanni Paolo II, Bari, Italy
| | - Carlo Barone
- Department of Medical Oncology, Catholic University of Sacred Heart, Largo A. Gemelli, Rome, Italy
| | - Francesca Plastino
- Department of Medical Oncology, Catholic University of Sacred Heart, Largo A. Gemelli, Rome, Italy
| | - Stefania Gori
- Medical Oncology Unit, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Roberto Magarotto
- Medical Oncology Unit, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | | | | | - Ida Pavese
- Oncology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Luca Marchetti
- Oncology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Vittorina Zagonel
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Eleonora Bergo
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marco Imperatori
- Department of Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Carmelo Iacono
- Department of Medical Oncology, Azienda Ospedaliera Civile - Maria Paternò Arezzo, Ragusa, Italy
| | - Luigi Maiorana
- Department of Medical Oncology, Azienda Ospedaliera Civile - Maria Paternò Arezzo, Ragusa, Italy
| | - Carmine Pinto
- Medical Oncology, Clinical Cancer Centre, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Daniela Rubino
- Medical Oncology, Clinical Cancer Centre, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Luigi Cavanna
- Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Roberto Di Cicilia
- Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, S.S. Trinita Hospital, Sora, Italy
| | | | - Salvatore Palazzo
- Division of Medical Oncology, Mariano Santo Hospital, Azienda Ospedaliera, Cosenza, Italy
| | - Stefano Minardi
- Division of Medical Oncology, Mariano Santo Hospital, Azienda Ospedaliera, Cosenza, Italy
| | - Marco Merlano
- Medical Oncology, Oncology Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | - Giuseppe Colucci
- Medical Oncology Department, National Cancer Research Centre Giovanni Paolo II, Bari, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology Sapienza, St. Andrea Hospital, Rome, Italy
- IDI-IRCCS, Rome, Italy
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Lin JX, Chen XW, Chen ZH, Huang XY, Yang JJ, Xing YF, Yin LH, Li X, Wu XY. A multidisciplinary team approach for nutritional interventions conducted by specialist nurses in patients with advanced colorectal cancer undergoing chemotherapy: A clinical trial. Medicine (Baltimore) 2017; 96:e7373. [PMID: 28658162 PMCID: PMC5500084 DOI: 10.1097/md.0000000000007373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND & AIMS Nutritional interventions for malnutrition in cancer patients can be helpful. However, concise intervention recommendations remain controversial. Thus, the aim of this study was to report on a nutrition intervention conducted by a multidisciplinary team of specialist nurses and to explore the effect of nutritional intervention on cancer patients. METHODS This prospective clinical trial study enrolled 110 colorectal cancer patients undergoing chemotherapy. The patients were evaluated upon admission using the 2002 Nutritional Risk Screening system (NRS-2002). The patients were randomly divided into intervention and control groups including 55 patients each. Patients in the control group were administered a normal diet, while those in the intervention group received individual recipes developed by a team of professional nurses, clinical doctors, dietitian, family caregivers, and the patients themselves. Patient weight and serum albumin and prealbumin levels were compared between the 2 groups at different time points. RESULTS There was a significant difference in patient weight and serum albumin and prealbumin levels before and after nutrition intervention in the intervention group (P < .05). In the control group, weight did not change during ordinary diet guidance. Serum albumin level was slightly improved after 12 cycles of chemotherapy, similar to the prealbumin results. There were statistically significant differences in serum albumin and prealbumin levels between the intervention and control groups after nutrition intervention (P < .05). However, there was no statistically significant difference in weight between the groups after nutrition intervention (P > .05). CONCLUSION A multidisciplinary team approach for nutrition intervention conducted by specialist nurses improved prealbumin levels in colorectal cancer patients undergoing chemotherapy, with no weight change.
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Affiliation(s)
- Jin-Xiang Lin
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University
| | - Xiang-Wei Chen
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University
| | - Zhan-Hong Chen
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University
| | - Xiu-Yan Huang
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University
| | - Jin-Jie Yang
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University
| | - Yan-Fang Xing
- Department of Nephrology, the Third Affiliated Hospital of Guangzhou Medical University
| | - Liang-Hong Yin
- Department of Nephrology, First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Xing Li
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University
| | - Xiang-Yuan Wu
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University
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