1
|
Rosati D, Mastino P, Romeo M, de Soccio G, Pentangelo D, Petrella C, Barbato C, Minni A. Taste and Smell Alterations (TSAs) in Cancer Patients. Diseases 2024; 12:130. [PMID: 38920562 PMCID: PMC11203271 DOI: 10.3390/diseases12060130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
Recently, smell and taste disorders have seen renewed interest, as these symptoms are frequent complications of SARS-CoV-2 infection, since approximately 60% of patients affected by COVID-19 have shown olfactory and gustatory alterations. Otolaryngology pays attention to taste and smell abnormalities (TSAs), especially when associated with oncology. TSAs are common symptoms in people affected by cancer, yet they are ignored and underestimated. The clinical outcome of TSAs in cancer evidences the importance of identifying them with chemotherapy or radiotherapy in general, and they are associated with many types of cancer. We recognize the findings of the literature on TSAs in cancer, evaluating how it is important to consider and identify these disorders concerning reduced food enjoyment or inappropriate nutrient intake, and modulating the nutritional status, quality of life, and impact of therapy. This review aims to critically evaluate and recognize the assessment and clinical perspectives of taste and smell disorders in a cancer population.
Collapse
Affiliation(s)
- Davide Rosati
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Pierluigi Mastino
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Martina Romeo
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Giulia de Soccio
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Daniele Pentangelo
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy;
| | - Christian Barbato
- Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy;
| | - Antonio Minni
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
- Department of Sense Organs DOS, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| |
Collapse
|
2
|
Takahashi S, Matsumoto K, Ohba K, Nakano Y, Miyazawa Y, Kawaguchi T. The Incidence and Management of Cancer-Related Anorexia During Treatment with Vascular Endothelial Growth Factor Receptor-Tyrosine Kinase Inhibitors. Cancer Manag Res 2023; 15:1033-1046. [PMID: 37771675 PMCID: PMC10522463 DOI: 10.2147/cmar.s417238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
Cancer-related anorexia is a common complication and frequently occurs in cancer patients treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs). Anorexia contributes to malnutrition, body weight loss, and cachexia in affected patients. Furthermore, patients who experience anorexia have worse outcomes than those who maintain their appetite, highlighting the importance of managing anorexia and related symptoms. However, as the causes of anorexia are both diverse and interconnected, there have been challenges in evaluating and implementing effective interventions. In this review, we described the contributing factors to cancer-related anorexia and reviewed recent literature for the frequency of anorexia symptoms in patients treated with VEGFR-TKIs. Additionally, we evaluated the evidence for current interventions and the potential benefits of multimodal and multidisciplinary approaches to care. The frequency of anorexia symptoms in patients who received VEGFR-TKIs ranged from 14%-58% for all-grade anorexia and 0%-6% for grade 3 or 4 anorexia. While many of the interventions for cancer-related anorexia have minimal benefit or adverse events, recent advances in our understanding of cancer-related anorexia suggest that multimodal therapy with multidisciplinary care is a promising avenue of investigation. Several studies currently underway are anticipated to further assess the effectiveness of multimodal approaches.
Collapse
Affiliation(s)
- Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koji Matsumoto
- Department of Medical Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Kojiro Ohba
- The Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasuhiro Nakano
- Department of Pharmacy, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasushi Miyazawa
- Department of Clinical Nutrition, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| |
Collapse
|
3
|
Benito I, Encío IJ, Milagro FI, Alfaro M, Martínez-Peñuela A, Barajas M, Marzo F. Microencapsulated Bifidobacterium bifidum and Lactobacillus gasseri in Combination with Quercetin Inhibit Colorectal Cancer Development in Apc Min/+ Mice. Int J Mol Sci 2021; 22:4906. [PMID: 34063173 PMCID: PMC8124226 DOI: 10.3390/ijms22094906] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022] Open
Abstract
Recent studies have suggested that flavonoids such as quercetin and probiotics such as Bifidobacterium bifidum (Bf) and Lactobacillus gasseri (Lg) could play a relevant role in inhibiting colon cancer cell growth. Our study investigated the role of dietary supplementation with microencapsulated probiotics (Bf and Lg) along with quercetin in the development of mouse colorectal cancer (CRC). Methods: Adenomatous polyposis coli/multiple intestinal neoplasia (ApcMin/+) mice were fed a standard diet or the same diet supplemented with microencapsulated probiotics (Bf and Lg strains, 107 CFU/100 g food) or both probiotics strains plus microencapsulated quercetin (15 mg/100 g food) for 73 days. Changes in body and organ weights, energy metabolism, intestinal microbiota, and colon tissue were determined. The expression of genes related to the Wnt pathway was also analyzed in colon samples. Results: Dietary supplementation with microencapsulated probiotics or microencapsulated probiotics plus quercetin reduced body weight loss and intestinal bleeding in ApcMin/+ mice. An improvement in energy expenditure was observed after 8 weeks but not after 10 weeks of treatment. A supplemented diet with microencapsulated Bf and Lg reduced the number of aberrant crypt foci (ACF) and adenomas by 45% and 60%, respectively, whereas the supplementation with Bf, Lg and quercetin decreased the number of ACF and adenomas by 57% and 80%, respectively. Microencapsulated Bf and Lg in combination with quercetin could exert inhibition of the canonical Wnt/β-catenin signaling pathway in the colon of ApcMin/+ mice Conclusions: The administration of microencapsulated Bf and Lg, individually or in combination with quercetin, inhibits the CRC development in ApcMin/+ mice.
Collapse
Affiliation(s)
- Iván Benito
- Laboratory of Animal Physiology and Nutrition, School of Agronomy, Public University of Navarre, Campus Arrosadia, 31006 Pamplona, Spain; (I.B.); (M.A.)
| | - Ignacio J. Encío
- Biochemistry Area, Department of Health Science, Public University of Navarre, 31008 Pamplona, Spain;
| | - Fermín I. Milagro
- Department of Nutrition, Food Sciences and Physiology, Center for Nutrition Research, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain;
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Alfaro
- Laboratory of Animal Physiology and Nutrition, School of Agronomy, Public University of Navarre, Campus Arrosadia, 31006 Pamplona, Spain; (I.B.); (M.A.)
| | | | - Miguel Barajas
- Biochemistry Area, Department of Health Science, Public University of Navarre, 31008 Pamplona, Spain;
| | - Florencio Marzo
- Laboratory of Animal Physiology and Nutrition, School of Agronomy, Public University of Navarre, Campus Arrosadia, 31006 Pamplona, Spain; (I.B.); (M.A.)
| |
Collapse
|
4
|
Ehret C, Jatoi A. Should Loss of Appetite Be Palliated in Patients with Advanced Cancer? Curr Treat Options Oncol 2021; 22:31. [PMID: 33641020 PMCID: PMC7914034 DOI: 10.1007/s11864-021-00829-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
Loss of appetite is common among patients with advanced cancer. However, it remains controversial how, when, and if to palliate this symptom. Here, we provide an update on recent as well as past literature to address the question of whether loss of appetite should be palliated in patients with advanced cancer. In our opinion—and as discussed here—we believe that this symptom should be palliated, although perhaps not always with pharmacologic interventions.
Collapse
Affiliation(s)
| | - Aminah Jatoi
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
5
|
A high-protein diet, not isolated BCAA, is associated with skeletal muscle mass index in patients with gastrointestinal cancer. Nutrition 2020; 72:110698. [DOI: 10.1016/j.nut.2019.110698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/03/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023]
|
6
|
Gevorkov AR, Boyko AV, Volkova EE, Shashkov SV. Prevalence, clinical significance and possible correction of taste and smell abnormalities in patients with oncological diseases. HEAD AND NECK TUMORS (HNT) 2019. [DOI: 10.17650/2222-1468-2019-9-2-53-65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- A. R. Gevorkov
- P.A. Hertzen Moscow Oncology Research Institute — branch of the National Medical Research Radiology Center of the Ministry of Health of Russia
| | - A. V. Boyko
- P.A. Hertzen Moscow Oncology Research Institute — branch of the National Medical Research Radiology Center of the Ministry of Health of Russia
| | | | - S. V. Shashkov
- P.A. Hertzen Moscow Oncology Research Institute — branch of the National Medical Research Radiology Center of the Ministry of Health of Russia
| |
Collapse
|
7
|
Can Inflammatory and Nutritional Serum Markers Predict Chemotherapy Outcomes and Survival in Advanced Stage Nonsmall Cell Lung Cancer Patients? BIOMED RESEARCH INTERNATIONAL 2019; 2019:1648072. [PMID: 30941358 PMCID: PMC6421052 DOI: 10.1155/2019/1648072] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 12/11/2022]
Abstract
Purpose. To determine the values of prognostic nutritional and inflammatory markers in chemotherapy outcomes and survival in the patients with advanced nonsmall cell lung cancer (NSCLC) and also in the secondary malnutrition and cachexia. Methods. Twenty-five patients with diagnosis of aNSCLC were registered for the prospective study. Malnutrition was determined by the Subjective Global Assessment (SGA) and performance status by criteria of the Eastern Cooperative Oncology Group (ECOG). Before treatment, serum levels of albumin, prealbumin, vitamin D, zinc (Zn), C-reactive protein (CRP), IL-6, IL-1 β, TNF-α, lipoprotein lipase (LPL), and the Glasgow Prognostic Score (GPS) were recorded. Patients were followed prospectively for treatment outcomes and survival. Results. Due to the deaths of 18 patients during the 4-month follow-up period, no adequate measurements of inflammatory and nutritional markers could be performed. However, seven patients completed the treatment period and evaluations of these markers could be performed during the three periods. Eighty-four percent of patients were male with a mean age of 63.3 ± 8.7 years. Evaluation of the malnutrition by SGA showed that 5 (20%) patients were well nourished (A), 12(48%) were moderately malnourished (B), and 8(32%) were severely malnourished (C). Low levels of serum albumin (<3.5g/dl), prealbumin (<20 mg/ml), 25-hydroxycholecalciferol (<30 ng/ml), and Zn (<70mg/ml) were detected in 15(60%), 17(68%), 24 (96%), and 22 (88%) patients, respectively. Elevated levels of CRP (≥10 mg/L), IL6 (≥18pg/ml), TNF-α (≥24pg/ml), IL-1β (≥10pg/ml), and LPL (<12pg/ml) were found in 24 (96%), 11(44%), 9(36), 13(52%), and 11(44%) patients, respectively. Moderate and severe malnutrition, acute phase response, and reduced survival were determined in patients with NCSLC. In 7 patients that completed the treatment period, there was an association between elevated serum levels of IL-6, IL-1β, TNF-α, CRP, and LPL and also the reduced serum levels of albumin, prealbumin, Zn, vitamin D, and GPS, respectively. Similarly, Friedman analysis indicated that prealbumin significantly increased (p=0.007) in the follow-up period. But the serum levels of CRP (mean 37.3±22.3; Wilcoxon test P=0.368) in the seven patients were lower than those of the 18 patients that expired (mean 75.82±56.2). Conclusion. Malnutrition and cachexia negatively influence oncological outcomes in patients with NSCLC. These nutritional/inflammatory markers may be useful for selection of high risk and reduced survival in patients with aNSCLC undergoing adjuvant chemotherapy.
Collapse
|
8
|
Spotten L, Corish C, Lorton C, Ui Dhuibhir P, O’Donoghue N, O’Connor B, Walsh T. Subjective and objective taste and smell changes in cancer. Ann Oncol 2017; 28:969-984. [DOI: 10.1093/annonc/mdx018] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
9
|
Cancer Appetite and Symptom Questionnaire (CASQ) for Brazilian Patients: Cross-Cultural Adaptation and Validation Study. PLoS One 2016; 11:e0156288. [PMID: 27275947 PMCID: PMC4898714 DOI: 10.1371/journal.pone.0156288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Appetite and symptoms, conditions generally reported by the patients with cancer, are somewhat challenging for professionals to measure directly in clinical routine (latent conditions). Therefore, specific instruments are required for this purpose. This study aimed to perform a cultural adaptation of the Cancer Appetite and Symptom Questionnaire (CASQ), into Portuguese and evaluate its psychometric properties on a sample of Brazilian cancer patients. METHODS This is a validation study with Brazilian cancer patients. The face, content, and construct (factorial and convergent) validities of the Cancer Appetite and Symptom Questionnaire, the study tool, were estimated. Further, a confirmatory factor analysis (CFA) was conducted. The ratio of chi-square and degrees of freedom (χ2/df), comparative fit index (CFI), goodness of fit index (GFI) and root mean square error of approximation (RMSEA) were used for fit model assessment. In addition, the reliability of the instrument was estimated using the composite reliability (CR) and Cronbach's alpha coefficient (α), and the invariance of the model in independent samples was estimated by a multigroup analysis (Δχ2). RESULTS Participants included 1,140 cancer patients with a mean age of 53.95 (SD = 13.25) years; 61.3% were women. After the CFA of the original CASQ structure, 2 items with inadequate factor weights were removed. Four correlations between errors were included to provide adequate fit to the sample (χ2/df = 8.532, CFI = .94, GFI = .95, and RMSEA = .08). The model exhibited a low convergent validity (AVE = .32). The reliability was adequate (CR = .82 α = .82). The refined model showed strong invariance in two independent samples (Δχ2: λ: p = .855; i: p = .824; Res: p = .390). A weak stability was obtained between patients undergoing chemotherapy and radiotherapy (Δχ2: λ: p = .155; i: p < .001; Res: p < .001), and between patients undergoing chemotherapy combined with radiotherapy and palliative care (Δχ2: λ: p = .058; i: p < .001; Res: p < .001). CONCLUSION The Portuguese version of the CASQ had good face and construct validity and reliability. However, the CASQ still presented invariance in independent samples of Brazilian patients with cancer. However, the tool has low convergent validity and weak invariance in samples with different treatments.
Collapse
|
10
|
Alterations in inflammatory biomarkers and energy intake in cancer cachexia: a prospective study in patients with inoperable pancreatic cancer. Med Oncol 2016; 33:54. [PMID: 27119533 DOI: 10.1007/s12032-016-0768-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/19/2016] [Indexed: 12/18/2022]
Abstract
Chronic systemic inflammatory response is proposed as an underlying mechanism for development of cancer cachexia. We conducted a prospective study to examine changes in inflammatory biomarkers during the disease course and the relationship between inflammatory biomarkers and cachexia in patients with inoperable pancreatic cancer. Twenty patients, median (range) age 67.5 (35-79) years, 5 females, were followed for median 5.5 (1-12) months. Cachexia was diagnosed according to the 2011 consensus-based classification system (weight loss >5 % past six months, BMI < 20 kg/m(2) and weight loss >2 %, or sarcopenia) and the modified Glasgow Prognostic score (mGPS) that combines CRP and albumin levels. Inflammatory biomarkers were measured by enzyme immunoassays. The patients had increased levels of most inflammatory biomarkers, albeit not all statistically significant, both at study entry and close to death, indicating ongoing inflammation. According to the consensus-based classification system, eleven (55 %) patients were classified as cachectic upon inclusion. They did not differ from non-cachectic patients with regard to inflammatory biomarkers or energy intake. According to the mGPS, seven (35 %) were defined as cachectic and had a higher IL-6 (p < 0.001) than the non-cachectic patients. They also had a slightly, but insignificantly longer survival than non-cachectic patients (p = 0.08). The mGPS should be considered as an additional framework for identification of cancer cachexia.
Collapse
|
11
|
|
12
|
Cohen J, Wakefield CE, Tapsell LC, Walton K, Fleming CAK, Cohn RJ. Exploring the views of parents regarding dietary habits of their young cancer-surviving children. Support Care Cancer 2014; 23:463-71. [DOI: 10.1007/s00520-014-2394-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
|
13
|
Chao TH, Fu PK, Chang CH, Chang SN, Chiahung Mao F, Lin CH. Prescription patterns of Chinese herbal products for post-surgery colon cancer patients in Taiwan. JOURNAL OF ETHNOPHARMACOLOGY 2014; 155:702-708. [PMID: 24945402 DOI: 10.1016/j.jep.2014.06.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
ETHNO-PHARMACOLOGICAL RELEVANCE Traditional Chinese medicine (TCM) is commonly provided to cancer patients, however, the patterns of prescriptions for this type of medicine in Taiwan are unclear. This study aimed to evaluate the use of traditional Chinese medicine products in colon cancer patients post-surgery in Taiwan and to research patterns of TCM. MATERIAL AND METHODS This was a cross-sectional study of newly diagnosed colon cancer patients who received surgery between 2004 and 2008 identified from the National Health Insurance Research Database of Taiwan. The prescription patterns and reasons for the use of TCM for colon cancer were analyzed. RESULTS The results showed that "symptoms, signs and ill-defined conditions" (23.3%) and diseases of the digestive system (16.9%) were the most common reasons for using Chinese herbal medicine. Xiang-sha-liu-jun-zi-tang (7.1%), Bu-zhong-yi-qi-tang (4.3%), Jia-wei-xiao-yao-san (4.1%), Shen-Ling-Bai-Zhu-San (3.7%), Ban-Xia-Xie-Xin-Tang (3.4%), Gui-pi-tang (2.4%), Ping-Wei-San (2.4%), Gan-Lu-Yin (2.0%), Bao-He-Wan (1.9%), and Zhen-Ren-Huo-Ming-Yin (1.8%) were the most commonly prescribed single Chinese herbal formulae (CHF) for colon cancer patients post-surgery. Hedyotis diffusa Willd (Bai Hua She She Cao) (5.1%) and Scutellaria barbata (Ban Zhi Lian )(4.8%) were the most commonly prescribed single Chinese herbs. CONCLUSIONS This study identified patterns of TCM use in colon cancer patients post-surgery in Taiwan. The herbal ingredients were most commonly used for stimulate ghrelin secretion to increase food intake and had potential anti-tumor effect. However, further research is required to evaluate any beneficial effects which could identify leads for the development of new treatment strategies using TCM.
Collapse
Affiliation(s)
- Te-Hsin Chao
- Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan, ROC; Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Pin-Kuei Fu
- Division of Critical Care & Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan, ROC; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan, ROC
| | - Chiung-Hung Chang
- School of Chinese Medicine, China Medical University, Taichung 404, Taiwan, ROC; Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan, ROC
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, #160, Section 3, Chung-Kang Rd., Taichung, Taichung 407, Taiwan, ROC
| | - Frank Chiahung Mao
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, #160, Section 3, Chung-Kang Rd., Taichung, Taichung 407, Taiwan, ROC.
| |
Collapse
|
14
|
Symptoms in advanced pancreatic cancer are of importance for energy intake. Support Care Cancer 2012; 21:219-27. [DOI: 10.1007/s00520-012-1514-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 05/21/2012] [Indexed: 01/27/2023]
|
15
|
Davis M, Lasheen W, Walsh D, Mahmoud F, Bicanovsky L, Lagman R. A Phase II dose titration study of thalidomide for cancer-associated anorexia. J Pain Symptom Manage 2012; 43:78-86. [PMID: 21640548 PMCID: PMC4496946 DOI: 10.1016/j.jpainsymman.2011.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 03/04/2011] [Accepted: 03/05/2011] [Indexed: 11/26/2022]
Abstract
CONTEXT Sixty-five percent of people with advanced cancer suffers from loss of appetite. Several inflammatory cytokines appear to cause appetite loss in animal models. Thalidomide is an immunomodulatory drug that has been associated with improved appetite in those with HIV infections and cancer. OBJECTIVES We completed a two-stage Phase II dose titration study of thalidomide, the primary purpose of which was to assess appetite response to thalidomide in cancer-associated anorexia. METHODS Individuals older than 18 years of age with active cancer, loss of appetite by numerical rating scale (NRS), life expectancy of at least four weeks, and Eastern Cooperative Oncology Group performance status of 0-3 were entered into the study. Pretreatment screening included medical history, neurologic examination, and symptoms by NRS and categorical scale (CAT). Patients received 50mg of thalidomide by mouth at bedtime for two weeks. Individuals who did not respond were dose escalated to 100mg at night for two weeks. Assessment of appetite, early satiety, fatigue, insomnia, night sweats, pain, and quality of life (QOL) occurred at two-week intervals. Toxicity also was assessed. The primary outcome was appetite response defined as a two-point reduction in the NRS or a one-point improvement in the CAT. RESULTS Thirty-five patients entered the study; 33 completed 14 days of therapy and were analyzed for efficacy and toxicity. Sixty-four percent who completed at least two weeks of thalidomide had improved appetite. The CAT scores for appetite, insomnia, and QOL improved significantly. The 95% confidence intervals did not overlap. Five participants dropped out because of toxicity: two before two weeks and three later. CONCLUSION Thalidomide reduced multiple symptoms commonly associated with cancer-related anorexia and improved QOL. Our findings confirmed and validated a previously published single-arm trial. A recent randomized trial demonstrated greater benefits when thalidomide is used combined with other agents to treat cancer-associated anorexia and cachexia. Thalidomide helped cancer-associated anorexia in most patients. It also improved insomnia and QOL in advanced cancer.
Collapse
Affiliation(s)
- Mellar Davis
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | | | | | | | | | | |
Collapse
|
16
|
Del Fabbro E, Hui D, Dalal S, Dev R, Nooruddin ZI, Noorhuddin Z, Bruera E. Clinical outcomes and contributors to weight loss in a cancer cachexia clinic. J Palliat Med 2011; 14:1004-8. [PMID: 21793729 DOI: 10.1089/jpm.2011.0098] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cancer cachexia is considered intractable, with few therapeutic options. Secondary nutrition impact symptoms (S-NIS) such as nausea may further contribute to weight loss by decreasing nutrient intake. In addition, treatable metabolic abnormalities such as hypogonadism, vitamin B12 deficiency, hypothyroidism, and hypoadrenalism could exacerbate anorexia and muscle wasting in patients with cancer cachexia. We determined the frequency and type of contributors to appetite and weight loss, and the effect of the cachexia clinic on clinical outcomes. METHODS Review of 151 consecutive patients referred to a cachexia clinic. All received dietary counseling and exercise recommendations. Assessments included weight, body mass index (BMI), S-NIS, resting energy expenditure by indirect calorimetry, serum thyroid stimulating hormone (TSH), cortisol, total testosterone, and vitamin B12. RESULTS Median weight loss in the 100 days before referral was 9% (4%-13%); median BMI at presentation was 20.8. Median number of S-NIS was 3 (2-4), most commonly treated by metoclopramide, laxatives, and antidepressants. Forty-one percent (24/59) of patients were hypermetabolic and 73% (52/71) of males hypogonadic, whereas hypoadrenalism (0/101, 0%), hypothyroidism (4/113, 4%), and low vitamin B12 (3/107, 3%) were uncommon. Poor appetite and weight loss before referral (r = 0.18, p = 0.036) were associated with increased S-NIS (r = 0.22, p = 0.008). Appetite improved (p < 0.001) and 31/92 (34%) of patients returning for a second visit gained weight. CONCLUSIONS Patients had a high frequency of multiple S-NIS, hypogonadism, and hypermetabolism. A combination of simple pharmacological and nonpharmacological interventions improved appetite significantly, and increased weight in one third of patients who were able to return for follow-up. Cachexia clinics are feasible and effective for many patients with advanced cancer.
Collapse
Affiliation(s)
- Egidio Del Fabbro
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW To discuss the psychosocial support of people affected by cancer anorexia, drawing on recent publications. RECENT FINDINGS Recent studies describe the problem of distress in response to cancer anorexia. There are propositions of appropriate support and calls for the development of psychosocial interventions to relieve cachexia-related distress. Preliminary work is now testing these ideas. SUMMARY Psychosocial support for cancer anorexia is a new and promising field of study. The prevention or alleviation of the anorexia of cachexia would relieve much eating-related suffering experienced by patients and their families. However, whilst the scientific community works to achieve this goal there is another task to be addressed: to help people with cancer anorexia to adapt and live with the symptom. Despite accounts over many years of the distress caused by poor appetite, little attention has been paid to the potential for psychosocial support to aid self-management of the symptom. Emergent thinking is that psychosocial support for cancer anorexia can have benefit for both patients and their family members.
Collapse
|
18
|
Mahmoud FA, Aktas A, Walsh D, Hullihen B. A Pilot Study of Taste Changes Among Hospice Inpatients With Advanced Cancer. Am J Hosp Palliat Care 2011; 28:487-92. [DOI: 10.1177/1049909111402187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Identification of taste abnormalities can help understand difficulties in nutrition. We evaluated 15 hospice inpatients with advanced cancer for subjective taste changes. The majority had both subjective and objective taste changes. Most thought all food was tasteless followed by loss of sweet sensation and meat aversion. About half of the participants exhibited anorexia and weight loss with decreased energy intake. Both detection and recognition thresholds for these basic tastes were abnormal for the majority of participants. Reduced sensitivity for sweet and salt taste and altered perception for sour predominated in formal taste testing.
Collapse
Affiliation(s)
- Fade A. Mahmoud
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
| | - Aynur Aktas
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
| | - Declan Walsh
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
- St. Christopher’s Hospice, London, UK
| | - Barbara Hullihen
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
| |
Collapse
|
19
|
Abstract
To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m(2)) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages--precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management.
Collapse
|
20
|
Bossola M, Luciani G, Rosa F, Tazza L. Appetite and gastrointestinal symptoms in chronic hemodialysis patients. J Ren Nutr 2011; 21:448-54. [PMID: 21239186 DOI: 10.1053/j.jrn.2010.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/06/2010] [Accepted: 09/08/2010] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The aim of the present cross-sectional study was to assess the association between self-reported appetite and gastrointestinal symptoms in chronic hemodialysis patients. DESIGN A cross-sectional study was carried out. SETTING The study was carried out at an outpatient hemodialysis service center. PATIENTS A total of 110 patients were included in this study. INTERVENTION The first question of the Hemodialysis Study Appetite questionnaire was used to assess the appetite of the HD patients. The multiple-choice answers for the first question "During the past week, how would you rate your appetite?" were as follows: (1) very good, (2) good, (3) fair, (4) poor, or (5) very poor. At the same time, each patient was invited to answer the following questions: Did you have any of the following symptoms (hiccups, feeling full after a few bites of food, nausea, vomiting, indigestion, abdominal pain, bloating, and constipation) in the last 2 weeks? Are there particular foods that you used to like but now do not? Did you have changes in smell in the last 2 weeks? Did you have taste changes in the last 2 weeks? MAIN OUTCOME MEASURE Possible associations between appetite and gastrointestinal symptoms were assessed in this study. RESULTS In 52 (47.2%) HD patients, the appetite was very good or good (group A), in 28 (25.4%) fair (group B), and in 30 (27.3) poor or very poor (group C). The most frequent symptoms were bloating and constipation. The frequency of food aversion and early satiety were 23.6% and 18.2%, respectively. The frequency of changes in smell and taste were 3.6% and 7.2%, respectively. The frequency of early satiety, food aversion, changes in smell and taste was significantly higher in group C as compared with group A. Similarly, the frequency of early satiety, food aversion, and changes in taste were higher in group B than in group A. The other frequencies did not differ significantly among group A, B, and C. CONCLUSION Food aversion, early satiety, changes in taste and smell were significantly more frequent in HD patients with poor or very poor appetite as compared with those with good or very good appetite.
Collapse
Affiliation(s)
- Maurizio Bossola
- Hemodialysis Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy.
| | | | | | | |
Collapse
|
21
|
Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Recent Literature. J Palliat Med 2010. [DOI: 10.1089/jpm.2010.9843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
23
|
|