Dietary intake variability in the cycle of cytotoxic chemotherapy

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Background: Several factors can affect overall survival of head and neck cancer (HNC) patients, including characteristics of the cancer disease and response to treatments. However, patients' nutritional status and the effectiveness of medical nutrition therapy (MNT) can also impact overall survival. The primary goal of our research was to collect real-life data on the use of MNT in HNC patients and to specifically investigate the correlation between survival and the duration of uninterrupted (persistent) nutrition. Method: The data of this retrospective, analytical, cohort study was collected from electronic healthcare records from the Hungarian National Health Insurance Fund Management. Overall, 38,675 HNC patients' data of the period between 2012 and 2021 was used. We applied multi-step exclusions to identify patient groups accurately and to avoid biasing factors. Statistical analysis was done by the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: Throughout the investigated period 16,871 (64%) patients received MNT therapy out of 26,253 newly diagnosed patients (≥18 years). In terms of the persistence of MNT, we divided the patients into three groups (1-3; 4-6; ≥7-month duration of MNT). When comparing these groups, we found that patients receiving long-term (≥7 months) MNT had a significantly longer overall survival (p < 0.0001) than those who received MNT for a shorter duration, both in locally advanced and recurrent/metastatic cases. Conclusion: The main outcome of the study is that there is a positive correlation between the persistence of MNT and the overall survival in HNC patients when nutritional intervention lasts several months. It highlights the responsibility of the specialists during the patient journey to use MNT early and to continue its use for as long as it is beneficial to the patients.

The Association between Dietary Patterns and Chemotherapy Side Effects in Patients with Breast Cancer (BrCa)

This study aimed to determine the relationship between food pattern and dietary intake before and during chemotherapy with the severity of gastrointestinal side effects, cancer-related fatigue, and chemotherapy-induced pain. This study was performed on 204 patients with breast cancer who were undergoing chemotherapy. Dietary pattern was collected by food frequency questionnaire and dietary intake during chemotherapy using a 24-hour food recall questionnaire. The severity of chemotherapy side effects including nausea, vomiting, constipation, diarrhea, CRF, and pain was also assessed by valid questionnaires. The relationship between dietary pattern and mean score of chemotherapy side effects was calculated using linear regression analysis. Three dietary patterns were extracted from the participants. After adjusting the effect of all possible confounders, no significant relationship was found between the dietary pattern one year before the start of treatment and the mean of chemotherapy side effects severity. Although the mean of daily energy intake with the severity of nausea and vomiting (r = -0.258, P-value <0.01), constipation, fatigue, and pain have a significant inverse relationship. Nutrition education and following a healthy diet are needed to reduce the severity of chemotherapy side effects during this period.

Ingestão Alimentar de Mulheres com Tumores Ginecológicos em Tratamento Oncológico: Revisão Integrativa da Literatura

Introdução: Pacientes com câncer apresentam uma tendência a perda ponderal e a desnutrição energético-proteica. Isso ocorre em razão das modificações que o organismo sofre pelo desenvolvimento da doença e pelos efeitos adversos do tratamento oncológico que contribuem para a redução da ingestão alimentar. Objetivo: Identificar evidencias disponíveis na literatura cientifica sobre a ingestão alimentar de mulheres com tumores ginecológicos em tratamento oncológico. Método: Revisão integrativa da literatura cujas buscas foram realizadas nas bases de dados Embase, MEDLINE e LILACS por meio da associação de termos descritores e palavras livres. Foram incluídos nas análises estudos observacionais que avaliaram a ingestão alimentar de mulheres adultas com tumores ginecológicos durante o tratamento oncológico, redigidos em português, inglês e espanhol. Resultados: Esta revisão analisou seis estudos que investigaram a mudança na ingestão alimentar dessa população. Identificou-se uma redução da ingestão em até 31% de energia, 39,9% de proteínas, 33,7% de lipídeos, 28,7% de carboidratos e uma inadequação da ingestão de determinados micronutrientes. Conclusão: Mulheres com tumores ginecológicos durante o tratamento oncológico apresentam redução significativa da ingestão de energia, proteínas, lipídeos, carboidratos e micronutrientes. Considerando que a perda de peso e a desnutrição em pacientes com câncer está associada a desfechos clínicos negativos, a avaliação e a análise da ingestão alimentar desses indivíduos são fundamentais para possibilitar uma intervenção nutricional precoce, boa resposta ao tratamento e consequente melhoria da qualidade de vida.

The effect of chemotherapy on dietary intake and nutritional status in patients with colorectal neoplasms and the importance of nutritional counseling

PURPOSE

This study aimed at assessing the effect of chemotherapy on dietary intake and nutritional status of patients with colorectal cancer undergoing chemotherapy.

METHODS

Observational, cross-sectional study conducted with 35 patients of both sexes, aged 50 years or older. Dietary intake was assessed four times: before (T₀), twice during (T₁ and T₂), and after (T_F) chemotherapy. Data on energy, macronutrients, and micronutrients were used for assessing dietary intake. Nutritional status was assessed on the first day and at the end of the chemotherapy cycle. The data were treated statistically using a 5% significance level.

RESULTS

The intake of energy, carbohydrates, lipids, selenium, and iron was lower after chemotherapy infusion (p < 0.05). Energy consumption decreased when comparing T₀ (1419.8 ± 527.1 kcal) with T₁ (1181.9 ± 423.2 kcal). Regarding macronutrients, carbohydrates and lipids showed a drop (p < 0.05), but there were no differences in protein intake, and it was observed that the consumption of food sources such as dairy was prioritized. In the analysis of vitamins and minerals, vitamins dropped but without a significant difference. There were significant differences between T₁ and T_F for iron (9.7 mg ± 4.5 mg and 12.0 ± 4.0 mg) and selenium (77.4 ± 29.7 µg and 93.6 ± 37.8 µg). There was no change in body composition and nutritional status between chemotherapy cycles.

CONCLUSION

The treatment reduced patients' food consumption after the chemotherapy session and impacted dietary intake, which demonstrates the importance of nutritional counseling and intervention, especially on energy consumption.

Lessons learned from a randomized controlled trial on a home delivered meal service in advanced cancer patients undergoing chemotherapy: a pilot study

BACKGROUND

Performing a randomized controlled trial (RCT) in the field of nutrition is challenging and success highly depends on understanding the factors that influence recruitment and dropout of participants. Our aim was to assess the feasibility of a RCT that evaluated a home delivered meal service in advanced cancer patients while receiving chemotherapy.

METHODS

This pilot RCT aimed to enroll 20 participants who were randomized into the home delivered meal service group or usual care group. Study procedures took place before chemotherapy (T0), 3 weeks after T0 (T1), 6 weeks after T0 (T2) and 3 months after T2 (T3). All information regarding recruitment, dropout and study procedures was recorded. Patient satisfaction was assessed by in-depth interviews.

RESULTS

Over 7 months, 20 of 41 approached patients (49%) were included, followed by a dropout rate of 35%. At baseline, hand grip strength (n = 8/16), the Short Physical Performance Battery (n = 12/16) and nutritional intake (n = 8/16) had the highest rate of missing values. Study procedures were not experienced as burdensome and planning of these procedures in line with fixed hospital appointments contributed to this low burden. Keeping the symptom diary was mentioned as being burdensome.

CONCLUSIONS

It is feasible to conduct a RCT on a home delivered meal service in advanced cancer patients during chemotherapy, although recruitment is challenging. Close contact of patients with recruiting personnel is essential to sustain motivation. To increase compliance with the study protocol it is important to carefully instruct participants on how to complete questionnaires and to emphasize to use these in the communication with their practitioners.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03382171 .

Impact of the antifermentative diet during radiotherapy for prostate cancer in elderly, SÃO Paulo, Brazil

OBJECTIVE

Assess the impact of the antifermentative diet on the dietary intake and body composition of elderly prostate cancer patients in radiotherapy.

METHODS

Observational and prospective study involving 45 men aged 60 years or older, receiving radiotherapy for prostate cancer treatment. The dietary intake was assessed at four times during radiotherapy: onset (T_Pre), between the 11th and 16th day (T₁), between the 24th and 28th day (T₂), and on the last day (T_Last). The body composition was assessed before and on the last day of radiotherapy, by means of the body weight and height, mid-arm circumference, triceps and subscapular skin folds, phase angle, resistance, and reactance. The data were statistically treated, considering a 5% significance level.

RESULTS

The intake of energy, dietary fibers, and some nutrients decreased during the radiotherapy (p < 0.05). The intake of vitamins E, B1, B2, and folate, of the minerals calcium, magnesium, potassium, sodium, and phosphorus, and of the amino acid leucine dropped when the four assessment times were compared (p < 0.05). As regards the body composition, an impact was observed at the end of the radiotherapy, with lower body weight, arm circumference, subscapular cutaneous fold, phase angle and reactance (p < 0.05).

CONCLUSION

The antifermentative diet negatively influenced the food consumption and body composition of elderly patients submitted to radiotherapy for prostate cancer.

Psychosocial Support in Cancer Cachexia Syndrome: The Evidence for Supported Self-Management of Eating Problems during Radiotherapy or Chemotherapy Treatment

People receiving cancer treatment are at nutritional risk. Their eating problems can lead to malnutrition and weight loss. Involuntary weight loss is also a defining characteristic of tumor-induced cachexia. Weight loss is associated with poor tolerance of treatment, poor treatment outcomes, morbidity, and mortality. Support for self-management of nutritional risk may protect against malnutrition and be important in multimodal therapies to arrest the progression of cachexia. Nurses can help patients by supporting self-management of eating problems. This scoping review is about eating problems during cancer treatment. It considers patient experience and self-management of eating problems during cancer treatment for the proactive management of malnutrition and cachexia. It draws on a systematic search of Medline, CINAHL, PsycINFO, and the Cochrane Library for publications about people with cancer who have eating problems during treatment. Limits were English language; January 2000 to December 2017; adults. The search found studies about eating problems in patients treated with chemotherapy or radiotherapy for head-and-neck cancer, lung cancer, gastrointestinal cancer, breast cancer, testicular cancer, and ovarian cancer. Nutritional counseling can improve nutritional intake, quality of life, and weight. However, the patient perspective on self-management and how to motivate engagement in nutritional care is unexplored. There is a potential for reducing nutritional risk during cancer treatment using psychoeducation to support behavioral change, thus empower self-management of eating problems. Benefits are likely in subgroups of people receiving cancer treatment, such as those with head and neck, gastrointestinal, and lung cancers.

Link between diet and chemotherapy related gastrointestinal side effects

AIM OF THE STUDY

To evaluate an association between food products consumption, dietary intake and the incidence of selected gastrointestinal symptoms (nausea, vomiting, diarrhea and constipation) in cancer patients undergoing chemotherapy.

MATERIAL AND METHODS

Fifty six women receiving chemotherapy for ovarian cancer were eligible for the study. Anthropometrical measurements were assessed. The dietary intake was evaluated by 24-hours food records. The association between the consumption of selected food products and gastrointestinal symptoms incidences was assessed by modified semi-quantitative food frequency questionnaire including 77-different food items that was developed and applied in cancer patients undergoing chemotherapy.

RESULTS

BMI values indicated 9%, 45%, 30% and 16% of patients as underweight, normal weight, overweight and obese respectively. Only 23% and 32% of patients never experienced nausea and constipation when 43% and 45% never experienced vomiting and diarrhea. Nausea was promoted by oils, constipation by chocolate and chocolate products and diarrhea by dairy products, stone fruit and apple. Significant inverse correlations were found between vomiting and the intake of energy, fat, protein, carbohydrates, B groups vitamins, vitamin D, phosphorus and zinc. The difference in energy intake between marginal values of vomiting incidence exceeded 400 kcal.

CONCLUSIONS

Dietary intake as well as specific food products influence on gastrointestinal side effect of chemotherapy in cancer patients. The dietary approach based on either exclusion or limited intake of selected food products and improvement of diet could reduce and prevent chemotherapy induced gastrointestinal symptoms therefore should be taken under consideration in clinical practice.

Differences in dietary intake during chemotherapy in breast cancer patients compared to women without cancer

Purpose

Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect dietary habits. This study assessed the intake of energy, macronutrients and food groups before and during chemotherapy in breast cancer patients compared with women without cancer, and determined the association between symptoms and energy and macronutrient intake.

Methods

This study included 117 newly diagnosed breast cancer patients scheduled for chemotherapy and 88 women without cancer. Habitual intake before chemotherapy was assessed with a food frequency questionnaire. Two 24-h dietary recalls were completed on random days for each participant during the whole chemotherapy treatment for patients and within 6 months after recruitment for women without cancer. Shortly, after the dietary recall, participants filled out questionnaires on symptoms.

Results

Before chemotherapy, habitual energy and macronutrient intake was similar for breast cancer patients and women without cancer. During chemotherapy, breast cancer patients reported a significantly lower total energy, fat, protein and alcohol intake than women without cancer, as shown by a lower intake of pastry and biscuits, cheese, legumes and meat products. A decline in subjective taste perception, appetite and hunger and experiencing a dry mouth, difficulty chewing, lack of energy and nausea were associated with a lower energy intake.

Conclusions

Symptoms induced by chemotherapy are associated with lower dietary intake and manifested by a lower intake of specific food groups. To ensure an optimal dietary intake during chemotherapy, it is important to monitor nutritional status and symptom burden during chemotherapy in breast cancer patients.

Electronic supplementary material

The online version of this article (doi:10.1007/s00520-017-3668-x) contains supplementary material, which is available to authorized users.