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Peinoit A, Muzellec L, Som M, Edeline J, Thibault R, Neveu E, Vauleon E. Evolution of parenteral nutrition practices in a comprehensive cancer center: Comparative audits. Bull Cancer 2023:S0007-4551(23)00138-8. [PMID: 36935318 DOI: 10.1016/j.bulcan.2023.02.021] [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: 05/31/2022] [Revised: 02/03/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Malnutrition affects 20% to 70% of oncology patients depending on the patient's age, type and stage of cancer. Two audits were carried out in 2016 and 2019 to evaluate the practice of Parenteral Nutrition (PN). METHODS Records of adult medical inpatients who received PN between January 1, 2018 and April 30, 2019 were retrospectively analysed. Twenty criteria were defined. We conducted a statistical analysis to compare the two audit data. RESULTS Between January 1, 2018 and April 30, 2019, 86 hospitalizations with a PN prescription were analysed. Of the 69 patients, 66% were female, the mean and median age was 60 years. These were most often medical oncology patients in palliative care. Gynecological and digestive tumors were the two main tumor localization. Bowel obstruction and palliative care management were the two main reasons for hospitalization. Nutritional assessment, amount of energy prescribed, monitoring, and duration of PN remain with poor results. CONCLUSION Our study seems to show improvements in the relevance of PN indications, the prescription, and monitoring in patients due to the computerization of prescription and training of professionals. PN remains often prescribed in exclusive palliative situations. We need to continue our improvements, particularly for the initial clinical and biological assessment, and the monitoring. It requires a referral team to improve management of patients treated with PN.
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Affiliation(s)
- Alexandre Peinoit
- Centre Eugène Marquis, Service d'oncologie médicale, Avenue de la Bataille Flandres-Dunkerque, 35042 Rennes, France.
| | - Léa Muzellec
- Centre Eugène Marquis, Service d'oncologie médicale, Avenue de la Bataille Flandres-Dunkerque, 35042 Rennes, France
| | - Mickael Som
- Service de nutrition, Centre Hospitalier Privé Saint Grégoire, 6 Boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Julien Edeline
- Centre Eugène Marquis, Service d'oncologie médicale, Avenue de la Bataille Flandres-Dunkerque, 35042 Rennes, France
| | - Ronan Thibault
- CHU Rennes, Nutrition unit, NuMeCan, Nutrition Metabolisms and Cancer, INSERM, INRAE, Univ Rennes, Rennes, France
| | - Estelle Neveu
- Centre Eugène Marquis, Service d'oncologie médicale, Avenue de la Bataille Flandres-Dunkerque, 35042 Rennes, France
| | - Elodie Vauleon
- Centre Eugène Marquis, Service d'oncologie médicale, Avenue de la Bataille Flandres-Dunkerque, 35042 Rennes, France
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Chen L, Zhao M, Tan L, Zhang Y. Effects of Five-Step Nutritional Interventions Conducted by a Multidisciplinary Care Team on Gastroenteric Cancer Patients Undergoing Chemotherapy: A Randomized Clinical Trial. Nutr Cancer 2022; 75:197-206. [PMID: 35903847 DOI: 10.1080/01635581.2022.2104329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present study aims to report a five-step nutritional intervention conducted by a multidisciplinary care team as well as to investigate its effects on the nutritional status and quality of life of gastroenteric cancer patients undergoing chemotherapy. A total of 176 patients with newly diagnosed gastroenteric cancer were enrolled in the observational study. The nutritional status of the patients was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening-2002 (NRS-2002), and anthropometry and biological tests were performed. Patients were randomly divided into intervention group (n = 40) and control group (n = 38). Patients in the intervention group received five-step nutrition intervention, while the control group received routine nutrition management. In the newly diagnosed patients with gastroenteric cancer, 50% presented mild to moderate malnutrition, 29.5% presented severe malnutrition, while only 20.5% of patients were in good nutritional status. Nutritional interventions reduced the progression of malnutrition after 10 weeks. Anthropometric parameters increased as well as function and symptoms improved; therefore, controlled the decline in quality of life. To sum up, five-step nutritional interventions conducted by a multidisciplinary care team improved the nutritional status of patients with gastroenteric cancer undergoing chemotherapy, and showed positive impacts on quality of life.
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Affiliation(s)
- Lijia Chen
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Minyan Zhao
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Liping Tan
- Department of Nursing, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Yusong Zhang
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, PR China
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Caccialanza R, Laviano A, Bosetti C, Nardi M, Casalone V, Titta L, Mele R, De Pergola G, De Lorenzo F, Pedrazzoli P. Clinical and economic value of oral nutrition supplements in patients with cancer: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. Support Care Cancer 2022; 30:9667-9679. [PMID: 35792925 DOI: 10.1007/s00520-022-07269-y] [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: 02/15/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
Malnutrition is a common clinical and public health problem that can frequently affect patients in hospital and community settings. In particular, cancer-related malnutrition results from a combination of metabolic dysregulation and anorexia, caused both by the tumor itself and by its treatment. Patients with head-neck cancer, or with gastroesophageal, pancreatic, lung, and colorectal cancer, are particularly at risk of developing malnutrition, with a prevalence varying between 30 and 50% depending on tumor location and anti-cancer treatment complications. Prevention and adequate management of malnutrition is now considered an essential key point of therapeutic pathways of patients with cancer, with the aim to enhance their quality of life, reduce complications, and improve clinical outcomes. Oral nutritional supplements (ONS) are part of the nutritional therapy and represent an effective tool to address cancer-related malnutrition, as supported by growing literature data. However, patients' access to ONS - which is regulated by different national and regional policies in terms of reimbursement - is quite heterogeneous. This narrative review aims to summarize the current knowledge about the role of ONS in terms of cost-effectiveness in the management of actively treated patients with cancer, following surgery and/or radiotherapy/chemotherapy treatment and to present the position on this issue of the Alliance Against Cancer, the Italian National Oncology Network, coming up from a focused virtual roundtable of the Survivorship Care and Nutritional Support Working Group.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Cristina Bosetti
- Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mariateresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valentina Casalone
- Clinical Nutrition and Dietetics Unit, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Lucilla Titta
- Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | - Roberto Mele
- Hospital Health Direction, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | | | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
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Dechaphunkul T, Arundon T, Raungkhajon P, Jiratrachu R, Geater SL, Dechaphunkul A. Benefits of immunonutrition in patients with head and neck cancer receiving chemoradiation: A phase II randomized, double-blind study. Clin Nutr 2021; 41:433-440. [PMID: 35007812 DOI: 10.1016/j.clnu.2021.12.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS The benefits of immunonutrition in patients with head and neck cancer (HNC), especially for those undergoing definitive concurrent chemoradiation (CCRT), remain unclear. We evaluated the benefits of immunonutrition regarding the prevention of severe oral mucositis. Secondary objectives included assessments of other treatment-related toxicities, changes of nutritional and inflammatory marker levels, treatment tolerance, and survival. METHODS In total, 110 patients with HNC undergoing definitive CCRT including 3-week cycles of cisplatin were enrolled in our double-blind phase II study. Patients were randomly assigned to receive an immunonutrient formula containing omega-3-fatty acids, arginine, dietary nucleotides, and soluble fiber (n = 55) or an isocaloric isonitrogenous control (n = 55). All patients received the assigned product 5 consecutive days before each chemotherapy session. The proportion of patients with severe oral mucositis was compared between the immunonutrients and control groups. RESULTS The rates of nasopharyngeal cancer (NPC) were 67% and 51% in the immunonutrients and control groups, respectively. All patients had 100% compliance to the assigned product. There was no difference of the proportion of patients with grade 3-4 oral mucositis between the two groups (62% vs. 67%, p = 0.690). At the time of analyses, survival tended to be better in the immunonutrients group. The 3-year progression-free survival rates were 69% (95% confidence interval [CI] = 55%-80%) and 44% (95% CI = 30%-57%) in the immunonutrients and control groups, respectively (p = 0.056), whereas the 3-year overall survival rates in these groups were 69% (95% CI = 54%-80%) and 50% (95% CI = 36%-66%; p = 0.065), respectively. In subgroup analyses according to the primary tumor location, the survival benefits were apparently maintained in patients with NPC. CONCLUSIONS Although our study did not demonstrate a reduced risk of severe oral mucositis, we found that immunonutrition might improve survival. Larger studies are needed to determine the optimal dose and schedule of immunonutrition to prevent oral mucositis. In addition, randomized phase III trials evaluating the survival benefits of immunonutrition in patients with cancer are required, and NPC might be a primary malignancy of interest. TRIAL REGISTRATION ClinicalTrials.gov ID NCT05101889.
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Affiliation(s)
- Tanadech Dechaphunkul
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Hatyai, Songkhla, 90110, Thailand.
| | - Tippawan Arundon
- Holistic Center for Cancer Study and Care (HOCC-PSU), Unit of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Hatyai, Songkhla, 90110, Thailand.
| | - Ponpis Raungkhajon
- Nutrition Dietetics Division, Songklanagarind Hospital, Prince of Songkla University, 15 Kanjanavanich Rd, Hatyai, Songkhla, 90110, Thailand.
| | - Rungarun Jiratrachu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Hatyai, Songkhla, 90110, Thailand.
| | - Sarayut Lucien Geater
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Hatyai, Songkhla, 90110, Thailand.
| | - Arunee Dechaphunkul
- Holistic Center for Cancer Study and Care (HOCC-PSU), Unit of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Hatyai, Songkhla, 90110, Thailand.
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