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Soares CH, Beuren AG, Friedrich HJ, Gabrielli CP, Stefani GP, Steemburgo T. The Importance of Nutrition in Cancer Care: A Narrative Review. Curr Nutr Rep 2024; 13:950-965. [PMID: 39278864 DOI: 10.1007/s13668-024-00578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE OF REVIEW Cancer, a complex disease affecting millions globally, presents considerable challenges for both patients and health care providers. Within the broad spectrum of cancer care, nutrition plays a key role in supporting patients throughout their journey. This narrative review examines the role of nutrition in cancer care, exploring its impact on treatment outcomes, nutritional status, current dietary recommendations, physical activity, palliative care, and finally, as a nutritional encouragement for cancer survivors. RECENT FINDINGS Evidence indicates that cancer and anticancer treatments frequently cause malnutrition and loss of muscle mass, which can exacerbate symptoms, impair immune function, and hamper recovery. Therefore, adequate nutritional support is crucial for maintaining strength, controlling symptoms, and optimizing treatment tolerance in patients with cancer. Several factors influence nutritional needs and dietary recommendations, including cancer type, treatment, and individual patient characteristics. Nutritional care aims not only to ensure sufficient energy and protein intake, but also to manage specific symptoms such as dysgeusia, nausea, and dysphagia. Registered dietitians play a crucial role in providing personalized nutritional guidance, monitoring nutritional status, and implementing interventions to address emerging challenges in cancer care. Furthermore, recent research has underscored the benefits of dietary interventions in cancer treatment. From targeted nutritional supplements to more invasive nutritional support, interest in how nutrition can affect cancer risk and treatment outcomes is increasing. Overall, this review highlights the critical role of nutritional care in comprehensive cancer treatment. By recognizing and meeting dietary demands throughout the entire cancer journey, health care professionals can improve patients' well-being, response to treatment, and long-term prognosis.
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Affiliation(s)
- Camilla Horn Soares
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Amanda Guterres Beuren
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Heloisa Jacques Friedrich
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
- Department of Nutrition, Universidade Federal Do Rio Grande Do Sul, Porto Alegre , Rio Grande Do Sul, Brazil
| | - Carolina Pagnoncelli Gabrielli
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Giovanna Potrick Stefani
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Thais Steemburgo
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil.
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil.
- Department of Nutrition, Universidade Federal Do Rio Grande Do Sul, Porto Alegre , Rio Grande Do Sul, Brazil.
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Liu X, Xu X, Cheung DST, Chau PH, Ho MH, Takemura N, Lin CC. The effects of exercise with or without dietary advice on muscle mass, muscle strength, and physical functioning among older cancer survivors: a meta-analysis of randomized controlled trials. J Cancer Surviv 2024; 18:1548-1556. [PMID: 37266818 PMCID: PMC10236397 DOI: 10.1007/s11764-023-01396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/28/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the effect of exercise with or without dietary advice on muscle mass, muscle strength and physical functioning (including perceived physical functioning and physical performance) in old cancer survivors. METHODS A systematic literature search was undertaken in May 2022 by searching multiple databases. Randomized controlled trials (RCTs) that compared exercise with or without dietary advice to control group among old cancer survivors were screened. Meta-analyses were conducted to evaluate the effects of exercise with or without dietary advice on muscle mass, muscle strength, and physical functioning. RESULTS Data from 21 trials were included in this study, including 16 exercise trials and 5 exercise + dietary advice studies. Regarding exercise, evidence supported its significant benefits on muscle strength among old cancer survivors, while no effect was seen on physical functioning and muscle mass. Concerning exercise combined with dietary advice, meta-analysis showed overall benefits on physical functioning, while limited study examined muscle mass and strength. As for safety and feasibility of interventions, low recruitment rate, moderate compliance, and few adverse events were reported. CONCLUSIONS Exercise combined with dietary advice is a more effective approach for old cancer survivors in improving physical functioning compared with exercise alone. Future study is needed to explore the effects of exercise combined with dietary advice on combating sarcopenia. As recruitment and compliance among old cancer survivors were challenging, strategies to stimulate their motivation and promote habitual healthy behaviour are warranted. IMPLICATIONS FOR CANCER SURVIVORS It is necessary for old cancer survivors to receive exercise and dietary support to improve physical functioning.
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Affiliation(s)
- Xiaohang Liu
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
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Liu Z, Lei T, Guo Y, Zheng C. The impact of sarcopenia on the efficacy of PD-1 inhibitors in non-small cell lung cancer and potential strategies to overcome resistance. Front Pharmacol 2024; 15:1377666. [PMID: 39101140 PMCID: PMC11294093 DOI: 10.3389/fphar.2024.1377666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/18/2024] [Indexed: 08/06/2024] Open
Abstract
Recent studies have revealed that sarcopenia can adversely affect the efficacy of PD-1 inhibitors in the treatment of non-small cell lung cancer (NSCLC). PD-1 inhibitors are immune checkpoint inhibitors widely used in the treatment of various cancers. However, NSCLC patients may have poorer outcomes when receiving PD-1 inhibitor treatment, and sarcopenia may affect the efficacy of PD-1 inhibitors through immune and metabolic mechanisms. In this article, we summarize the reported negative impact of sarcopenia on the effectiveness of PD-1 inhibitors in the treatment of NSCLC in recent years. Based on existing research results, we analyze the possible mechanisms by which sarcopenia affects the efficacy of PD-1 inhibitors and discuss possible strategies to address this issue. This could help to understand the impact of sarcopenia on the treatment of PD-1 inhibitors and provide more accurate expectations of treatment outcomes for clinicians and patients. Additionally, we present tailored intervention strategies for sarcopenic patients undergoing PD-1 inhibitor therapy, aiming to optimize treatment efficacy and enhance patient quality of life. Nevertheless, further research is warranted to elucidate the mechanisms through which sarcopenia impacts PD-1 inhibitors and to identify more efficacious intervention approaches for improving the effectiveness of PD-1 inhibitor treatment in sarcopenic patients.
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Affiliation(s)
- Zhenchao Liu
- School of Pharmacy, Qingdao University, Qingdao, Shandong, China
| | - Tianxiang Lei
- Institute of Integrative Medicine, Qingdao University, Qingdao, Shandong, China
| | - Yunliang Guo
- Institute of Integrative Medicine, Qingdao University, Qingdao, Shandong, China
| | - Chongwen Zheng
- Department of Neurology, The 2nd Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Ford KL, Sawyer MB, Ghosh S, Trottier CF, Disi IR, Easaw J, Mulder K, Koski S, Porter Starr KN, Bales CW, Arends J, Siervo M, Deutz N, Prado CM. Feasibility of two levels of protein intake in patients with colorectal cancer: findings from the Protein Recommendation to Increase Muscle (PRIMe) randomized controlled pilot trial. ESMO Open 2024; 9:103604. [PMID: 38935990 PMCID: PMC11260369 DOI: 10.1016/j.esmoop.2024.103604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Low muscle mass (MM) predicts unfavorable outcomes in cancer. Protein intake supports muscle health, but oncologic recommendations are not well characterized. The objectives of this study were to evaluate the feasibility of dietary change to attain 1.0 or 2.0 g/kg/day protein diets, and the preliminary potential to halt MM loss and functional decline in patients starting chemotherapy for stage II-IV colorectal cancer. PATIENTS AND METHODS Patients were randomized to the diets and provided individualized counseling. Assessments at baseline, 6 weeks, and 12 weeks included weighed 3-day food records, appendicular lean soft tissue index (ALSTI) by dual-energy X-ray absorptiometry to estimate MM, and physical function by the Short Physical Performance Battery (SPPB) test. RESULTS Fifty patients (mean ± standard deviation: age, 57 ± 11 years; body mass index, 27.3 ± 5.6 kg/m2; and protein intake, 1.1 ± 0.4 g/kg/day) were included at baseline. At week 12, protein intake reached 1.6 g/kg/day in the 2.0 g/kg/day group and 1.2 g/kg/day in the 1.0 g/kg/day group (P = 0.012), resulting in a group difference of 0.4 g/kg/day rather than 1.0 g/kg/day. Over one-half (59%) of patients in the 2.0 g/kg/day group maintained or gained MM compared with 44% of patients in the 1.0 g/kg/day group (P = 0.523). Percent change in ALSTI did not differ between groups [2.0 g/kg/day group (mean ± standard deviation): 0.5% ± 4.6%; 1.0 g/kg/day group: -0.4% ± 6.1%; P = 0.619]. No differences in physical function were observed between groups. However, actual protein intake and SPPB were positively associated (β = 0.37; 95% confidence interval 0.08-0.67; P = 0.014). CONCLUSION Individualized nutrition counselling positively impacted protein intake. However, 2.0 g/kg/day was not attainable using our approach in this population, and group contamination occurred. Increased protein intake suggested positive effects on MM and physical function, highlighting the potential for nutrition to attenuate MM loss in patients with cancer. Nonetheless, muscle anabolism to any degree is clinically significant and beneficial to patients. Larger trials should explore the statistical significance and clinical relevance of protein interventions.
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Affiliation(s)
- K L Ford
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton
| | - M B Sawyer
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - S Ghosh
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - C F Trottier
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton
| | - I R Disi
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton; Department of Postgraduate Program of Anaesthesiology, Surgical Sciences and Perioperative Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J Easaw
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - K Mulder
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - S Koski
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - K N Porter Starr
- Durham VA Medical Centre, Durham; Department of Medicine, Duke University, Durham, USA
| | - C W Bales
- Durham VA Medical Centre, Durham; Department of Medicine, Duke University, Durham, USA
| | - J Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - M Siervo
- School of Population Health, Curtin University, Perth, Australia
| | - N Deutz
- Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, USA
| | - C M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton.
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Mascarella MA, Ferdus J, Vendra V, Sridharan S, Sultanem K, Tsien C, Shenouda G, Bouganim N, Esfahani K, Richardson K, Mlynarek A, Sadeghi N, Hier M, Kergoat MJ. Sarcopenia predicts short-term treatment-related toxicity in patients undergoing curative-intent therapy for head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1500-1509. [PMID: 38353170 DOI: 10.1002/hed.27688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/27/2023] [Accepted: 02/05/2024] [Indexed: 05/14/2024] Open
Abstract
Sarcopenia is an increasingly recognized biomarker associated with poorer outcomes. The objective of this study was to ascertain the effect of sarcopenia on treatment tolerance and short-term toxicity in head and neck cancer (HNC). A systematic review was performed using multiple databases. An inverse-variation, random-effects model was used to perform the meta-analysis to evaluate the effect of sarcopenia on severe treatment toxicity and poor treatment tolerance. Sixteen observational studies, including 3187 patients with HNC, were analyzed. The combined odds ratio (OR) for severe treatment toxicity and tolerance was 2.22 (95%CI 1.50-3.29) and 1.40 (95%CI 0.84-2.32), respectively. The effect of sarcopenia on short-term severe treatment toxicity was similar with upfront surgery (OR 2.03, 95%CI 1.22-3.37) and definitive radiotherapy (OR 2.24, 95%CI 1.18-4.27) Patients with sarcopenia are more than twice as likely to suffer a short-term treatment-related toxicity when undergoing curative-intent HNC treatment.
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Affiliation(s)
- Marco A Mascarella
- Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Jannatul Ferdus
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Shaum Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Christina Tsien
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - George Shenouda
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Marie-Jeanne Kergoat
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-sud-de-l'Ile- de-Montréal, Montreal, Quebec, Canada
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Ispoglou T, McCullough D, Windle A, Nair S, Cox N, White H, Burke D, Kanatas A, Prokopidis K. Addressing cancer anorexia-cachexia in older patients: Potential therapeutic strategies and molecular pathways. Clin Nutr 2024; 43:552-566. [PMID: 38237369 DOI: 10.1016/j.clnu.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
Cancer cachexia (CC) syndrome, a feature of cancer-associated muscle wasting, is particularly pronounced in older patients, and is characterised by decreased energy intake and upregulated skeletal muscle catabolic pathways. To address CC, appetite stimulants, anabolic drugs, cytokine mediators, essential amino acid supplementation, nutritional counselling, cognitive behavioural therapy, and enteral nutrition have been utilised. However, pharmacological treatments that have also shown promising results, such as megestrol acetate, anamorelin, thalidomide, and delta-9-tetrahydrocannabinol, have been associated with gastrointestinal and cardiovascular complications. Emerging evidence on the efficacy of probiotics in modulating gut microbiota also presents a promising adjunct to traditional therapies, potentially enhancing nutritional absorption and systemic inflammation control. Additionally, low-dose olanzapine has demonstrated improved appetite and weight management in older patients undergoing chemotherapy, offering a potential refinement to current therapeutic approaches. This review aims to elucidate the molecular mechanisms underpinning CC, with a particular focus on the role of anorexia in exacerbating muscle wasting, and to propose pharmacological and non-pharmacological strategies to mitigate this syndrome, particularly emphasising the needs of an older demographic. Future research targeting CC should focus on refining appetite-stimulating drugs with fewer side-effects, specifically catering to the needs of older patients, and investigating nutritional factors that can either enhance appetite or minimise suppression of appetite in individuals with CC, especially within this vulnerable group.
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Affiliation(s)
| | | | - Angela Windle
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; School of Medicine, University of Leeds, Leeds, UK
| | | | - Natalie Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen White
- School of Health, Leeds Beckett University, Leeds, UK
| | - Dermot Burke
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Konstantinos Prokopidis
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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Staxen CS, Andersen SE, Pedersen LM, Poulsen CB, Andersen JR. Nutrition and Lifestyle-Related Factors as Predictors of Muscle Atrophy in Hematological Cancer Patients. Nutrients 2024; 16:283. [PMID: 38257176 PMCID: PMC10819894 DOI: 10.3390/nu16020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cancer and side effects from cytostatic treatment commonly affect nutritional status manifested as a decrease in muscle mass. We aimed to investigate the impact of nutrition and lifestyle-related factors on muscle mass in patients with hematological cancer. METHODS Dietary intake, food preferences, quality of life (QoL), and physical activity level (PAL) were monitored during 1-2 cytostatic treatment series. Body composition was estimated using bioelectrical impedance analysis (BIA). RESULTS 61 patients were included. Weight loss and loss of muscle mass were detected in 64% and 59% of the patients, respectively. Muscle mass was significantly positively correlated to increasing PAL (p = 0.003), while negatively correlated to increasing age (p = 0.03), physical QoL (p = 0.007), functional QoL (p = 0.05), self-perceived health (p = 0.004), and self-perceived QoL (p = 0.007). Weight was significantly positively correlated to increased intake of soft drinks (p = 0.02) as well as the favoring of bitter grain and cereal products (p = 0.03), while negatively correlated to increasing age (p = 0.03) and increasing meat intake (p = 0.009) Conclusions: Several nutritional and lifestyle-related factors affected change in body composition. The clinical significance of these changes should be investigated in controlled, interventional studies.
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Affiliation(s)
- Christiane S. Staxen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Sara E. Andersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Lars M. Pedersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christian B. Poulsen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens R. Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
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Andreazzoli F, Levy Yurkovski I, Ben-Arye E, Bonucci M. Conceptualizing an Integrative Multiple Myeloma Care: The Role of Nutrition, Supplements, and Complementary Modalities. Nutrients 2024; 16:237. [PMID: 38257130 PMCID: PMC10818534 DOI: 10.3390/nu16020237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple Myeloma (MM) is the second most prevalent hematologic malignancy, and its incidence has been increasing enormously in recent years. The prognosis of MM has changed radically with the introduction of new drugs that have improved life expectancy; recurrences are a common occurrence during the course of the disease and are characterized by an increase in refractory to treatment. Moreover, MM patients are challenged by quality of life-related concerns while limited conventional therapy may be offered. This includes bone pain and dialysis due to the complications of acute renal failure. We, therefore, believe that it is very important to add new treatment modalities, including supplements, nutritional modifications, acupuncture, and mind-body therapies, with the goal of improving treatment tolerance, effectiveness, and patients' quality of life. Moreover, many patients use some of these supplements on their own, in the hope of reducing the side effects, so it is even more important to know their action and potential. The purpose of this review is to illustrate all these strategies potentially available to enrich our approach to this, to date, incurable disease.
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Affiliation(s)
- Francesca Andreazzoli
- Department of Hematology, Versilia’s Hospital, Viale Aurelia, 335, 55049 Camaiore, Italy
| | - Ilana Levy Yurkovski
- Hematology Unit, Bnai Zion Medical Center, Haifa 3339419, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel;
- Complementary and Integrative Medicine Service, Bnai Zion Medical Center, Haifa 3339419, Israel
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel;
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa 3535152, Israel
| | - Massimo Bonucci
- Artoi Foundation, Via Ludovico Micara, 73, 00165 Rome, Italy;
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Siqueira JM, Vega MCMD, Pimentel GD. Amino acids and cancer: potential for therapies? Curr Opin Clin Nutr Metab Care 2024; 27:47-54. [PMID: 37997812 DOI: 10.1097/mco.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW Cancer patients may have a variety of disorders associated with systemic inflammation caused by disease progression. Consequently, we have protein hypercatabolism. In view of this, protein and amino acid adequacy should be considered in relation to nutritional behavior. Therefore, this review aims to evaluate the influence of protein and amino acids in the nutritional therapy of cancer. RECENT FINDINGS Diets with adequate protein levels appear to be beneficial in the treatment of cancer; guidelines suggest consumption of greater than 1.0-1.5 g/kg body weight/day. In patients diagnosed with malnutrition, sarcopenia, or cachexia, it is recommended to use the maximum amount of protein (1.5 g/kg of weight/day) to adapt the diet. In addition, based on the evidence found, there is no consensus on the dose and effects in cancer patients of amino acids such as branched-chain amino acids, glutamine, arginine, and creatine. SUMMARY When evaluating the components of the diet of cancer patients, the protein recommendation should be greater than 1.0-1.5 g/kg of weight/day, with a distribution between animal and vegetable proteins. We found little evidence demonstrating clinical benefits regarding individual or combined amino acid supplementation. Still, it is unclear how the use, dose, and specificity for different types of cancer should be prescribed or at what stage of treatment amino acids should be prescribed.
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Cotogni P, Shaw C, Jimenez-Fonseca P, Partridge D, Pritchett D, Webb N, Crompton A, Garcia-Lorda P, Shepelev J. High-protein home parenteral nutrition in malnourished oncology patients: a systematic literature review. Support Care Cancer 2023; 32:52. [PMID: 38129578 PMCID: PMC10739567 DOI: 10.1007/s00520-023-08218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Up to 83% of oncology patients are affected by cancer-related malnutrition, depending on tumour location and patient age. Parenteral nutrition can be used to manage malnutrition, but there is no clear consensus as to the optimal protein dosage. The objective of this systematic literature review (SLR) was to identify studies on malnourished oncology patients receiving home parenteral nutrition (HPN) where protein or amino acid delivery was reported in g/kg bodyweight/day, and to compare outcomes between patients receiving low (< 1 g/kg bodyweight/day), standard (1-1.5 g/kg/day), and high-protein doses (> 1.5 g/kg/day). METHODS Literature searches were performed on 5th October 2021 in Embase, MEDLINE, and five Cochrane Library and Centre for Reviews and Dissemination databases. Searches were complemented by hand-searching of conference proceedings, a clinical trial registry, and bibliographic reference lists of included studies and relevant SLRs/meta-analyses. RESULTS Nineteen publications were included; sixteen investigated standard protein, two reported low protein, and one included both, but none assessed high-protein doses. Only one randomised controlled trial (RCT) was identified; all other studies were observational studies. The only study to compare two protein doses reported significantly greater weight gain in patients receiving 1.15 g/kg/day than those receiving 0.77 g/kg/day. CONCLUSION At present, there is insufficient evidence to determine the optimal protein dosage for malnourished oncology patients receiving HPN. Data from non-HPN studies and critically ill patients indicate that high-protein interventions are associated with increased overall survival and quality of life; further studies are needed to establish whether the same applies in malnourished oncology patients.
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Affiliation(s)
- Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital and University of Turin, Turin, Italy.
| | - Clare Shaw
- Biomedical Research Centre at The Royal Marsden and Institute of Cancer Research, London and Sutton, UK
| | | | | | | | | | | | | | - Julian Shepelev
- Worldwide Medical, Health Economics and Outcomes Research, Baxter Healthcare SA, Zurich, Switzerland
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Dingemans AM, van Walree N, Schramel F, Soud MYE, Baltruškevičienė E, Lybaert W, Veldhorst M, van den Berg CA, Kaasa S. High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study. Nutrients 2023; 15:5030. [PMID: 38140289 PMCID: PMC10745925 DOI: 10.3390/nu15245030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
ESPEN guidelines recommend a minimum protein intake of 1.0 g/kg body weight (BW) per day to maintain or restore lean body mass in patients with cancer. During anti-cancer treatment, optimal protein intake is difficult to achieve. We investigated whether a high-protein, low-volume oral nutritional supplement (ONS) supports patients in meeting recommendations. A multi-centre, randomised, controlled, open-label, parallel-group study was carried out in nine hospitals (five countries) between January 2019 and July 2021 in colorectal and lung cancer patients undergoing first-line systemic treatment with chemo(radio-) or immunotherapy. Subjects were randomised (2:1) to receive Fortimel Compact Protein® or standard care. Protein intake was assessed with a 3-day food diary (primary outcome). BW was a secondary outcome. Due to challenges in recruitment, the study was terminated prematurely with 42 patients randomised (intervention group (IG) 28; control group (CG) 14). At T1 and T2, protein intake was statistically significantly higher in the IG compared to the CG (1.40 vs. 1.07 g/kg/day at T1, p = 0.008; 1.32 vs. 0.94 g/kg/day at T2, p = 0.002). At baseline, only 65% (IG) and 45% (CG) of patients met ESPEN minimum protein intake recommendations. However, at T1 and T2 in the IG, a higher proportion of patients met recommendations than in the CG (88% vs. 55% and 40%). No statistically significant difference between study groups was observed for BW. Mean compliance to the ONS was 73.4%. A high-protein, low-volume ONS consumed twice daily enables the majority of patients to reach minimal ESPEN protein recommendations.
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Affiliation(s)
- Anne-Marie Dingemans
- Department of Pulmonology, Erasmus Medical Center Cancer Institute, 3015 CN Rotterdam, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Franz Schramel
- Department of Pulmonary Diseases, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | | | | | - Willem Lybaert
- Department of Medical Oncology, VITAZ, 9100 Sint-Niklaas, Belgium;
| | - Margriet Veldhorst
- Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.V.); (C.A.v.d.B.)
| | | | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, 0379 Oslo, Norway;
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Boutière M, Cottet‐Rousselle C, Coppard C, Couturier K, Féart C, Couchet M, Corne C, Moinard C, Breuillard C. Protein intake in cancer: Does it improve nutritional status and/or modify tumour response to chemotherapy? J Cachexia Sarcopenia Muscle 2023; 14:2003-2015. [PMID: 37667552 PMCID: PMC10570073 DOI: 10.1002/jcsm.13276] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 02/10/2023] [Accepted: 04/25/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Combating malnutrition and cachexia is a core challenge in oncology. To limit muscle mass loss, the use of proteins in cancer is encouraged by experts in the field, but it is still debated due to their antagonist effects. Indeed, a high protein intake could preserve lean body mass but may promote tumour growth, whereas a low-protein diet could reduce tumour size but without addressing cachexia. Here we used a realistic rodent model of cancer and chemotherapy to evaluate the influence of different protein intakes on cachexia, tumour response to chemotherapy and immune system response. The goal is to gain a closer understanding of the effect of protein intake in cancer patients undergoing chemotherapy. METHODS Female Fischer 344 rats were divided into six groups: five groups (n = 14 per group) with cancer (Ward colon tumour) and chemotherapy were fed with isocaloric diets with 8%, 12%, 16%, 24% or 32% of caloric intake from protein and one healthy control group (n = 8) fed a 16% protein diet, considered as a standard diet. Chemotherapy included two cycles, 1 week apart, each consisting of an injection of CPT-11 (50 mg/kg) followed by 5-fluorouracil (50 mg/kg) the day after. Food intake, body weight, and tumour size were measured daily. On day 9, the rats were euthanized and organs were weighed. Body composition was determined and protein content and protein synthesis (SUnSET method) were measured in the muscle, liver, intestine, and tumour. Immune function was explored by flow cytometry. RESULTS Cancer and chemotherapy led to a decrease in body weight characterized by a decrease of both fat mass (-56 ± 3%, P < 0.05) and fat-free mass (-8 ± 1%, P < 0.05). Surprisingly, there was no effect of protein diet on body composition, muscle or tumour parameters (weight, protein content, or protein synthesis) but a high cumulative protein intake was positively associated with a high relative body weight and high fat-free mass. The immune system was impacted by cancer and chemotherapy but not by the different amount of protein intake. CONCLUSIONS Using a realistic model of cancer and chemotherapy, we demonstrated for the first time that protein intake did not positively or negatively modulate tumour growth. Moreover, our results suggested that a high cumulative protein intake was able to improve moderately nutritional status in chemotherapy treated cancer rodents. Although this work cannot be evaluated clinically for ethical reasons, it nevertheless brings an essential contribution to nutrition management for cancer patients.
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Affiliation(s)
- Martin Boutière
- Université Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetics (LBFA)GrenobleFrance
| | - Cécile Cottet‐Rousselle
- Université Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetics (LBFA)GrenobleFrance
| | - Céline Coppard
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB)GrenobleFrance
| | - Karine Couturier
- Université Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetics (LBFA)GrenobleFrance
| | | | - Morgane Couchet
- Université Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetics (LBFA)GrenobleFrance
| | - Christelle Corne
- Université Grenoble Alpes, Grenoble Alpes University Hospital, Institute of Biology, Laboratory of Metabolic DiseasesGrenobleFrance
| | - Christophe Moinard
- Université Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetics (LBFA)GrenobleFrance
| | - Charlotte Breuillard
- Université Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetics (LBFA)GrenobleFrance
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13
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Johnston EA, Ibiebele TI, Friedlander ML, Grant PT, van der Pols JC, Webb PM. Association of protein intake with recurrence and survival following primary treatment of ovarian cancer. Am J Clin Nutr 2023:S0002-9165(23)48895-8. [PMID: 37146759 DOI: 10.1016/j.ajcnut.2023.05.002] [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: 08/31/2022] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Malnutrition is common during treatment for ovarian cancer and one in three report multiple symptoms affecting food intake after primary treatment. Little is known about diet post-treatment in relation to ovarian cancer survival, however, general recommendations for cancer survivors are to maintain a higher level of protein intake to support recovery and minimize nutritional deficits. OBJECTIVE To investigate whether intake of protein and protein food sources following primary treatment for ovarian cancer is associated with recurrence and survival. DESIGN Intake levels of protein and protein food groups were calculated from dietary data collected about 12 months post-diagnosis using a validated food frequency questionnaire in an Australian cohort of females with invasive epithelial ovarian cancer. Disease recurrence and survival status were abstracted from medical records (median 4.9 years follow-up). Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for protein intake and progression-free and overall survival. RESULTS Among 591 females who were progression-free at 12-months follow-up, 329 (56%) subsequently experienced cancer recurrence and 231 (39%) died. A higher level of protein intake was associated with better progression-free survival (>1-1.5 vs. ≤1 grams per kilogram body weight (g/kg): HRadjusted=0.69, 95% CI 0.48, 1.00; >1.5 vs. ≤1g/kg: HRadjusted=0.61, 95% CI 0.41, 0.90; >20% vs. ≤20% total energy intake from protein: HRadjusted=0.77, 95% CI 0.61, 0.96). There was no evidence for better progression-free survival with any particular protein food sources. There was a suggestion of better overall survival among those with higher total intakes of animal-based protein foods, particularly dairy products (HR=0.71, 95% CI 0.51, 0.99 for highest vs. lowest tertiles of total dairy intake). CONCLUSIONS After primary treatment for ovarian cancer, a higher level of protein intake may benefit progression-free survival. Ovarian cancer survivors should avoid dietary practices that limit intake of protein-rich foods.
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Affiliation(s)
- Elizabeth A Johnston
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia; Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Kelvin Grove, Queensland, Australia; Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.
| | - Torukiri I Ibiebele
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia
| | - Michael L Friedlander
- University of New South Wales Clinical School, Prince of Wales Hospital, Randwick, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Peter T Grant
- University of Melbourne, Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jolieke C van der Pols
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia; Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Kelvin Grove, Queensland, Australia
| | - Penelope M Webb
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia
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14
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Bakaloudi DR, Papaemmanouil A, Vadarlis A, Makrakis D, Germanidis G, Timotheadou E, Chourdakis M. Critical evaluation and comparison of nutritional clinical practice guidelines for cancer patients. Clin Nutr 2023; 42:670-686. [PMID: 36944289 DOI: 10.1016/j.clnu.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The growing incidence of cancer globally, and the importance of nutrition support for these patients, emphasize the need for the development of nutritional clinical practice guidelines and consensus papers (CPGs) in the field. Numerous relevant CPGs have been published by several organizations worldwide. The aim of this systematic review was to compare the content of the existing CPGs and evaluate the quality of their development using the AGREE-II tool. METHODS A systematic literature search in PubMed, Embase and Web of Science databases was conducted for the identification of relevant CPGs and consensus papers. Eligible CPGs was blindly evaluated by four appraisers according to the Appraisal of Guidelines for Research and Evaluation ΙΙ (AGREE-II) tool. RESULTS In total 15 CPGs were identified and were evaluated. All but one set of CPGs underlined the importance of nutritional screening and assessment, whereas recommendations on nutritional interventions, supplements, management of complications and nutritional follow-up were also reported by several organizations. AGREE-II results showed that two CPGs were characterized as high, eight as moderate and five as low regarding their quality of development. CONCLUSIONS Variety on recommendations could be observed between CPGs that should be considered when applied into clinical practice. Limitations of the existing CPGs could be the fact that they are non-specific and only a minority of them are focused to specific cancer types. Frequent updates for CPGs and inclusion of more nutritional topics should be considered for some CPGs. Improvement of the quality of the CPGs development should also be pursued in future.
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Affiliation(s)
- Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece; Division of Medical Oncology, Department οf Medicine, University of Washington, Seattle, WA, USA
| | - Androniki Papaemmanouil
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Andreas Vadarlis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Gastroenterology and Hepatology, General Hospital of Thessaloniki ''G. Papanikolaou", Greece
| | - Dimitrios Makrakis
- Department of Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
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15
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Hatt J, Smart TF, Hardy EJ, Doleman B, Lund JN, Philips BE. The impact of low muscle mass on prognosis following neoadjuvant chemotherapy for resectable locally advanced rectal cancer: a systematic review and meta‐analysis. JCSM CLINICAL REPORTS 2023. [DOI: 10.1002/crt2.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
- Jacob Hatt
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Thomas F.F. Smart
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Edward J. Hardy
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Brett Doleman
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
- Department of Anaesthetics Royal Derby Hospital Derby UK
| | - Jonathan N. Lund
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Bethan E. Philips
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre University of Nottingham Derby UK
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16
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Andreazzoli F, Bonucci M. Integrative Hematology: State of the Art. Int J Mol Sci 2023; 24:ijms24021732. [PMID: 36675247 PMCID: PMC9864076 DOI: 10.3390/ijms24021732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Blood cancers are a group of diseases with thus far frequently poor prognosis. Although many new drugs, including target therapies, have been developed in recent years, there is still a need to expand our therapeutic armamentarium to better deal with these diseases. Integrative hematology was conceived as a discipline that enriches the patient's therapeutic possibilities with the use of supplements, vitamins and a nutritional approach aiming at improving the response to therapies and the clinical outcome. We will analyze the substances that have proved most useful in preclinical and clinical studies in some of the most frequent blood diseases or in those where these studies are more numerous; the importance of the nutritional approach and the role of the intestinal microbiota will also be emphasized.
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Affiliation(s)
- Francesca Andreazzoli
- Department of Hematology, Versilia’s Hospital, Viale Aurelia, 335, 55049 Camaiore, Italy
- Correspondence:
| | - Massimo Bonucci
- Association for Research on Integrative Oncology Therapies (ARTOI), Via Ludovico Micara, 73, 00165 Rome, Italy
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17
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Wang F, Zhen HN, Wang HP, Yu K. Measurement of sarcopenia in lung cancer inpatients and its association with frailty, nutritional risk, and malnutrition. Front Nutr 2023; 10:1143213. [PMID: 37139454 PMCID: PMC10149728 DOI: 10.3389/fnut.2023.1143213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Background Sarcopenia, frailty, and malnutrition are associated with undesirable clinical outcomes in cancer patients. Sarcopenia-related measurements may be promising fast biomarkers for frailty. Our objectives were to assess the prevalence of nutritional risk, malnutrition, frailty, and sarcopenia in lung cancer inpatients, and describe the relationship of them. Methods Stage III and IV lung cancer inpatients were recruited before chemotherapy. The skeletal muscle index (SMI) was assessed by multi-frequency bioelectric impedance analysis (m-BIA). Sarcopenia, frailty, nutritional risk, and malnutrition were diagnosed according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019), Fried Frailty Phenotype (FFP), nutritional risk screening-2002 (NRS-2002), and Global Leadership Initiative on Malnutrition criteria (GLIM), and correlation analysis was performed between them with Pearson's r correlation coefficients. A univariate and multivariate logistic regression analysis was conducted for all patients, gender and age-stratified subgroups to obtain odds ratios (ORs) and 95% confidence intervals (95%CIs). Results The cohort included 97 men (77%) and 29 women (23%), with mean age of 64.8 ± 8.7 years. Among the 126 patients, 32 (25.4%) and 41 (32.5%) had sarcopenia and frailty, and the prevalence of nutritional risk and malnutrition was 31.0% (n = 39) and 25.4% (n = 32). Adjusted for age and gender, SMI was correlated with FFP (r = -0.204, p = 0.027), and did not remain significantly when stratified by gender. Stratification according to age revealed in ≥65-years-old population, SMI and FFP were significantly correlated (r = -0.297, p = 0.016), which is not seen in <65-years-old group (r = 0.048, p = 0.748). The multivariate regression analysis showed FFP, BMI, and ECOG were the independent variables associated with sarcopenia (OR 1.536, 95%CI 1.062-2.452, p = 0.042; OR 0.625, 95%CI 0.479-0.815, p = 0.001; OR 7.286, 95%CI 1.779-29.838, p = 0.004). Conclusion Comprehensively assessed sarcopenia is independently associated with frailty based on FFP questionnaire, BMI, and ECOG. Therefore, sarcopenia assessment including m-BIA based SMI, and muscle strength and function could be used to indicate frailty to help select the targeting patients for care. Moreover, in addition to muscle mass, muscle quality should not be ignored in clinical practice.
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Affiliation(s)
- Fang Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-nan Zhen
- Department of Radiotherapy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han-ping Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Kang Yu,
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18
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Medici F, Rizzo S, Buwenge M, Arcelli A, Ferioli M, Macchia G, Deodato F, Cilla S, De Iaco P, Perrone AM, Strolin S, Strigari L, Ravegnini G, Bazzocchi A, Morganti AG. Everything You Always Wanted to Know about Sarcopenia but Were Afraid to Ask: A Quick Guide for Radiation Oncologists (Impact of Sarcopenia in Radiotherapy: The AFRAID Project). Curr Oncol 2022; 29:8513-8528. [PMID: 36354731 PMCID: PMC9689889 DOI: 10.3390/curroncol29110671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022] Open
Abstract
Sarcopenia (SP) is a syndrome characterized by age-associated loss of skeletal muscle mass and function. SP worsens both acute and late radiation-induced toxicity, prognosis, and quality of life. Myosteatosis is a pathological infiltration of muscle tissue by adipose tissue which often precedes SP and has a proven correlation with prognosis in cancer patients. Sarcopenic obesity is considered a "hidden form" of SP (due to large fat mass) and is independently related to higher mortality and worse complications after surgery and systemic treatments with worse prognostic impact compared to SP alone. The evaluation of SP is commonly based on CT images at the level of the middle of the third lumbar vertebra. On this scan, all muscle structures are contoured and then the outlined surface area is calculated. Several studies reported a negative impact of SP on overall survival in patients undergoing RT for tumors of the head and neck, esophagus, rectum, pancreas, cervix, and lung. Furthermore, several appetite-reducing side effects of RT, along with more complex radiation-induced mechanisms, can lead to SP through, but not limited to, reduced nutrition. In particular, in pediatric patients, total body irradiation was associated with the onset of SP and other changes in body composition leading to an increased risk of cardiometabolic morbidity in surviving adults. Finally, some preliminary studies showed the possibility of effectively treating SP and preventing the worsening of SP during RT. Future studies should be able to provide information on how to prevent and manage SP before, during, or after RT, in both adult and pediatric patients.
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Affiliation(s)
- Federica Medici
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Milly Buwenge
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessio G. Morganti
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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19
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Laviano A. High protein diet in digestive cancers. Curr Opin Clin Nutr Metab Care 2022; 25:348-353. [PMID: 35787591 DOI: 10.1097/mco.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Recent advances in the nutritional management of patients with digestive cancers suggest that modulation of protein intake may significantly contribute to achieve nutritional and clinical benefits. By reviewing the available evidence, a quantitatively and qualitatively optimal protein intake could be derived. RECENT FINDINGS High protein diets (i.e., 1-1.5 g/kg body weight/day) appear key to maintain the adequate nutritional status, and may also contribute to achieve clinical benefits. This target appears particularly relevant in patients with digestive cancers at risk or already malnourished, or in older patients. During active cancer treatments, protein intake should be closer to the upper limit of the recommended intake. Also, high protein intake should be maintained beyond the periods of catabolic crisis associated with active treatments. In contrast with general reasoning, animal proteins should represent the majority of the recommended intake. Based on the available evidence, the intake of no specific amino acid can be strongly recommended to enhance anabolic potentials or the immune modulating effects of high protein diets. SUMMARY High protein intake, mostly based on animal proteins, should be recommended to patients with digestive cancers. However, this target should be translated into clinical prescription after considering the clinical and metabolic needs of the patients. The quest for the optimal protein intake of patients with cancer at different time points of their clinical journey is still open.
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Affiliation(s)
- Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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20
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Medici F, Bazzocchi A, Buwenge M, Zamagni A, Macchia G, Deodato F, Cilla S, De Iaco P, Perrone AM, Strigari L, Rizzo S, Morganti AG. Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses. Front Oncol 2022; 12:887156. [PMID: 35692790 PMCID: PMC9177942 DOI: 10.3389/fonc.2022.887156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/26/2022] [Indexed: 12/11/2022] Open
Abstract
Background Sarcopenia (SP) is defined as the quantitative and functional impairment of skeletal muscles. SP is commonly related to older age and is frequent in patients with cancer. To provide an overview of SP in patients treated with radiotherapy (RT) and to evaluate the current evidence, we analyzed the available systematic reviews and meta-analyses. Methods Reviews were identified using PubMed, Scopus, and Cochrane library databases, without date restriction. Only systematic reviews and meta-analyses on the prognostic impact of SP and on any treatments aimed at reducing SP effect, in patients undergoing RT, were included in this review. The analyses not separately reporting the results in patients treated with RT were excluded. The quality assessment was performed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Results From the 84 papers identified, five reviews met the inclusion criteria with four reports mainly including non-randomized trials. Three reviews on the effect of SP showed a significantly negative impact on overall survival in patients undergoing RT and/or chemoradiation for H&N cancers (HR: 1.63-2.07). Two reviews on interventional studies showed the possibility of 1) improving physical functions through nutritional and physical interventions and 2) avoiding muscle wasting by means of sufficient protein intake. The quality assessment of the included review showed that two and three analyses are classifiable as having low and moderate overall confidence rating, respectively. Conclusions The analyzed reviews uniformly confirmed the negative impact of SP in patients with H&N tumors undergoing RT and the possibility of improving muscle mass and function through nutritional and physical interventions. These results justify further research on this topic based on a more uniform SP definition and on a complete evaluation of the potentially confounding parameters.
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Affiliation(s)
- Federica Medici
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
- *Correspondence: Federica Medici,
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alice Zamagni
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Alessio G. Morganti
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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21
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Gastrointestinal Cancer Patient Nutritional Management: From Specific Needs to Novel Epigenetic Dietary Approaches. Nutrients 2022; 14:nu14081542. [PMID: 35458104 PMCID: PMC9024975 DOI: 10.3390/nu14081542] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Nutritional habits impinge on the health of the gastrointestinal (GI) tract, contributing to GI disorder progression. GI cancer is a widespread and aggressive tumor sensitive to nutritional changes. Indeed, specific nutritional expedients can be adopted to prevent GI cancer onset and to slow down disease activity. Moreover, the patient’s nutritional status impacts prognosis, quality of life, and chemotherapy tolerance. These patients encounter the highest frequency of malnourishment risk, a condition that can progressively evolve into cachexia. Clinical studies dealing with this topic stressed the importance of nutritional counseling and put under the spotlight nutrient delivery, the type of nutrient supplementation, and timing for the start of nutritional management. A medical practitioner well-prepared on the topic of nutrition and cancer should operate in the clinical team dedicated to these oncological patients. This specific expertise needs to be implemented as soon as possible to adopt nutritional interventions and establish a proper patient-tailored dietary regimen. The nutritional gap closure should be prompt during anticancer treatment to stabilize weight loss, improve treatment tolerability, and ameliorate survival rate. Recently, novel nutritional approaches were investigated to target the bidirectional link between epigenetics and metabolism, whose alteration supports the onset, progression, and therapeutic response of GI cancer patients.
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22
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Bland KA, Kouw IWK, van Loon LJC, Zopf EM, Fairman CM. Exercise-Based Interventions to Counteract Skeletal Muscle Mass Loss in People with Cancer: Can We Overcome the Odds? Sports Med 2022; 52:1009-1027. [PMID: 35118634 DOI: 10.1007/s40279-021-01638-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/15/2022]
Abstract
Addressing skeletal muscle mass loss is an important focus in oncology research to improve clinical outcomes, including cancer treatment tolerability and survival. Exercise is likely a necessary component of muscle-mass-preserving interventions for people with cancer. However, randomized controlled trials with exercise that include people with cancer with increased susceptibility to more rapid and severe muscle mass loss are limited. The aim of the current review is to highlight features of cancer-related skeletal muscle mass loss, discuss the impact in patients most at risk, and describe the possible role of exercise as a management strategy. We present current gaps within the exercise oncology literature and offer several recommendations for future studies to support research translation, including (1) utilizing accurate and reliable body composition techniques to assess changes in skeletal muscle mass, (2) incorporating comprehensive assessments of patient health status to allow personalized exercise prescription, (3) coupling exercise with robust nutritional recommendations to maximize the impact on skeletal muscle outcomes, and (4) considering key exercise intervention features that may improve exercise efficacy and adherence. Ultimately, the driving forces behind skeletal muscle mass loss are complex and may impede exercise tolerability and efficacy. Our recommendations are intended to foster the design of high-quality patient-centred research studies to determine whether exercise can counteract muscle mass loss in people with cancer and, as such, improve knowledge on this topic.
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Affiliation(s)
- Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.,The Szalmuk Family Department of Medical Oncology, Cabrini Cancer Institute, Cabrini Health, Melbourne, VIC, Australia
| | - Imre W K Kouw
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science To Good Health, The University of Adelaide, Adelaide, SA, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Luc J C van Loon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.,Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.,The Szalmuk Family Department of Medical Oncology, Cabrini Cancer Institute, Cabrini Health, Melbourne, VIC, Australia
| | - Ciaran M Fairman
- Exercise Science Department, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, PHRC 220, Columbia, SC, 29208, USA.
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