Dietary intake, nutritional status and well-being of cancer patients: a prospective study

Dietary Habits of Women with Gynecological Cancer before, during and after Treatment: A Long-Term Prospective Cohort Study

BACKGROUND AND AIM

Over 21,000 new cases of gynecological cancer are diagnosed annually in the United Kingdom. There is evidence of cancer patients altering their eating habits before and during treatment. Some women with gynecological cancer make conscious decisions to change their diet as self-management for their cancer symptoms and to adopt a healthier lifestyle. Little is known about the impact of treatment on dietary habits. This study aimed to identify and describe the dietary habits of women with gynecological cancer before, during and after treatment.

METHODS

This was a longitudinal prospective cohort study using seven-day food diaries to collect dietary intake data before treatment and up to two years after gynecological cancer treatment. Nutritics© software was used for analysis of the diaries. A general linear mixed model was used for the statistical analysis, adjusted for multiple comparisons.

RESULTS

15 women with gynecological cancer participated; 69 food diaries were analyzed. There were no statistically significant changes in dietary habits or weight for this cohort during the two-year follow-up, except for caffeine intake which increased at 2 years (p < 0.05).

CONCLUSIONS

Despite the importance of maintaining a healthy dietary intake and weight after cancer treatment, participants' diets did not change.

A Systematic Review: Dietary Habits of Women with Gynecological Cancer before, during and after Treatment

INTRODUCTION

Cancer treatment can affect eating habits and some patients treated with pelvic radiotherapy develop chronic changes in their bowel function which may impact on dietary intake. This systematic review summarizes current research on dietary habits before, during and after treatment in women with a gynecological malignancy.

METHODS

MEDLINE, EMBASE, CINAHL and PubMed databases were searched until August 1, 2019, with no language restrictions. PRISMA guidelines for systematic reviews were used to ensure transparent and complete reporting (Liberati et al., 2009). Quantitative studies exploring dietary habits before, during or after treatment for gynecological cancer were included.

RESULTS

Three prospective cohort studies (98 participants) were included. All patients were treated with radiotherapy; some also had surgery and chemotherapy. Studies reported similar changes in weight, BMI and energy intake and found that patients lose weight during treatment, but this was not long-lasting. Long-term results suggest that fat and protein intake increase significantly (p < 0.01). There was no correlation of symptoms with any nutritional parameters.

CONCLUSION

Evidence from three studies suggests further studies including long-term assessment of dietary intake in women treated for a gynecological malignancy are warranted to explore the impact of cancer treatments on dietary intake and its relation to developing long-term gastrointestinal toxicity.

Impact of Hospitalization on the Nutritional Status of Cancer Patients

This study was undertaken to examine the influence of hospitalization on the nutritional status of cancer patients. We examined 126 patients consecutively admitted to the Istituto Nazionale Tumori of Milan. At admission, all patients underwent standard evaluations, including actual weight, percentage weight loss, arm circumference, triceps skinfold, serum proteins, serum albumin, total iron binding capacity, cholinesterase and peripheral lymphocytes. Finally, from all patients a 24-h dietary recall was obtained, in order to calculate calorie and protein intake. All the patients underwent another evaluation after 1 week of hospitalization; after 2 weeks only 37 of them were evaluated again, since some were operated, some were treated with radio-chemotherapy, some were discharged or had died. Results showed that after one week of hospitalization some variables were significantly altered, such as arm circumference in male patients, serum proteins, cholinesterase, total iron binding capacity, peripheral lymphocytes, calorie and protein intake. A significant weight loss was seen after 2 weeks. The reduced calorie and protein assumption was correlated with depletion of some of the nutritional variables (body weight, arm circumference in males, total iron binding capacity, serum albumin, cholinesterase, lymphocytes). Our data show that hospitalization plays an important role in deterioration of nutritional status in our patient population, and this problem is generally overlooked by the clinicians primarily involved in the care of cancer patients.

Non-surgical oncology - Guidelines on Parenteral Nutrition, Chapter 19

Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase.

Dietary intake and nutritional indicators are transiently compromised during radiotherapy for rectal cancer

OBJECTIVE

Patients with rectal cancer receive curative radiotherapy towards the pelvis for 5 weeks. Little is known about the impact of radiotherapy on dietary intake and nutritional status. The objective was to examine whether curative radiotherapy for rectal cancer promoted altered intake of energy and nutrients, and change in nutritional indicators.

DESIGN

Prospective study.

SETTING

Department of Oncology in a tertiary care hospital.

SUBJECTS

A total of 31 consecutive patients receiving radiotherapy for rectal cancer (50 Gray).

INTERVENTIONS

A 7-day food intake registration, body weight, upper arm circumference, and analyses of blood samples were performed at the start and the end of radiotherapy, and at follow-up 4-6 weeks and 1 year after the end of radiotherapy.

RESULTS

At the end of 5 weeks of radiotherapy, the mean daily energy intake was reduced by 15% from 8.9 to 7.6 MJ as compared with baseline (P = 0.002), and the intake of several nutrients was reduced (P < 0.01). The percentages of energy derived from fat, protein, and carbohydrates did not change, nor did the nutrient density. A transient body weight reduction of < 1 kg was observed (P = 0.009). Serum concentrations of vitamin A and 25-OH vitamin D did not change during radiotherapy. The daily intake of energy and nutrients, and body weight, had increased towards pretreatment values 4-6 weeks after radiotherapy.

CONCLUSIONS

Radiotherapy for rectal cancer caused a transient reduction in energy intake and nutritional indicators. The nutritional quality of the diet was unchanged during radiotherapy.

Body composition and time course changes in regional distribution of fat and lean tissue in unselected cancer patients on palliative care—Correlations with food intake, metabolism, exercise capacity, and hormones

BACKGROUND

Several investigations that yielded different results in terms of net changes in body composition of weight-losing cancer patients have been reported that employed a variety of methods based on fundamentally different technology. Most of those reports were cross-sectional, whereas to the authors' knowledge there is sparse information available on longitudinal follow-up measurements in relation to other independent methods for the assessment of metabolism and performance.

METHODS

For the current report, the authors evaluated time course changes in body composition (dual-energy X-ray absorptiometry) with measurements of whole body and regional distribution of fat and lean tissue in relation to food and dietary intake, host metabolism (indirect calorimetry), maximum exercise capacity (walking test), and circulating hormones in cancer patients who were receiving palliative care during 4-62 months of follow-up. The entire cohort comprised 311 patients, ages 68 years +/- 3 years who were diagnosed with solid gastrointestinal tumors (84 colorectal tumors, 74 pancreatic tumors, 73 upper gastrointestinal tumors, 51 liver-biliary tumors, 3 breast tumors, 5 melanomas, and 21 other tumor types).

RESULTS

Decreased body weight was explained by loss of body fat, preferentially from the trunk, followed by leg tissue and arm tissue, respectively. Lean tissue (fat-free mass) was lost from arm tissue, whereas trunk and leg tissue compartments increased, all concomitant with declines in serum albumin, increased systemic inflammation (C-reactive protein, erythrocyte sedimentation rate), increased serum insulin, and elevated daily caloric intake; whereas serum insulin-like growth factor 1 (IGF-1), resting energy expenditure, and maximum exercise capacity remained unchanged in the same patients. Serum albumin levels (P < 0.001), whole body fat (P < 0.02), and caloric intake (P < 0.001) predicted survival, whereas lean tissue mass did not. Daily intake of fat and carbohydrate was more important for predicting survival than protein intake. Survival also was predicted by serum IGF-1, insulin, leptin, and ghrelin levels (P < 0.02 - P < 0.001). Serum insulin, leptin, and ghrelin (total) levels predicted body fat (P < 0.001), whereas IGF-1 and thyroid hormone levels (T3, free T3) predicted lean tissue mass (P < 0.01). Systemic inflammation primarily explained variation in lean tissue and secondarily explained loss in body fat. Depletion of lean arm tissue was related most to short survival compared with the depletion of lean leg and trunk tissue.

CONCLUSIONS

The current results demonstrated that body fat was lost more rapidly than lean tissue in progressive cancer cachexia, a phenomenon that was related highly to alterations in the levels of circulating classic hormones and food intake, including both caloric amount and diet composition. The results showed importance in the planning of efficient palliative treatment for cancer patients.

Influence of dietary factors on colorectal cancer survival

BACKGROUND

Diet has been identified as a major determinant of colorectal cancer (CRC) but little is known of its influence on CRC survival.

AIMS

To study the influence of dietary factors on survival in patients who had undergone potentially curative CRC surgery.

PATIENTS

Among 171 patients included in a case control study of CRC aetiological factors, 10 year survival data on 148 patients who underwent resection of the tumour for potential cure were obtained from a Registry of Digestive Tumours.

METHODS

Tertiles of food and nutrient intakes were entered into Cox proportional hazards survival models, controlling for age, sex, tumour stage, and tumour location.

RESULTS

Only five year survival was influenced by the pre-diagnosis diet. High energy intake, as a result of high carbohydrate, protein, and lipid intake, was strongly related to increased survival. Five year relative risk of death for the highest versus the two lowest tertiles of energy intake was 0.18 (95% confidence interval 0.07; 0.44). This effect was similar in both sexes, for the colon and for the rectum. It was stronger in patients with N+/M+ tumours (relative risk 0.06) than in those with less advanced tumours (relative risk 0.37; stage-energy interaction term non-significant). No specific food or nutrient could be identified as having prognostic significance.

CONCLUSIONS

Whether high energy intake selects less severe tumoral clones or modifies antitumoral immunity remains unclear. Larger series need to be investigated before conducting intervention studies but our findings should prompt nutritional follow up in CRC patients.

A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia

PURPOSE/OBJECTIVES

To evaluate and synthesize the evidence regarding cancer-related anorexia and cachexia symptom management and make recommendations for future directions.

DATA SOURCES

Cochrane Library, MEDLINE, CANCERLIT, CINAHL, Dissertation Abstracts, EBM Reviews--Best Evidence, EMBASE, and the Computer Retrieval of Information on Scientific Projects. Current overviews, clinical trials, systematic research reviews, and meta-analyses.

DATA SYNTHESIS

All studies focused on increasing food intake. Nonpharmacologic clinical trials increased caloric and protein intake but resulted in no improvement in nutritional status, weight, tumor response, survival, or quality of life. Weight, appetite, and well-being were improved with megestrol acetate, but nutritional status was not improved. Some exercise studies demonstrated improvements in nutrition-related outcomes, but these were not primary research outcomes.

CONCLUSIONS

Symptom management of anorexia and cachexia should focus on decreasing energy expenditure or minimizing factors creating a negative energy balance, as well as improving food intake. Increased measurement sensitivity also is needed.

IMPLICATIONS FOR NURSING

Improved nutritional assessment skills are needed with an emphasis on anticipated problems and current status.

The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast, and ovary

One hundred four consecutive patients with newly diagnosed small cell lung cancer, metastatic breast cancer, and ovarian cancer in good physical functional condition (performance rating 0-1 on Eastern Cooperative Oncology Group scale) were divided into a weight-losing group (> or = 5% unintentional weight loss within 3 mo; n = 48) and a weight-stable group (n = 56). Dietary intakes in relation to fat-free mass were not different in the two groups. According to the Quality of Life index and the General Health Questionnaire, weight-losing patients had significantly lower quality of life than weight-stable patients. In patients with weight loss, daily intakes of energy and protein correlated significantly with scores on the General Health Questionnaire. This study has shown that many ambulatory cancer patients do not eat enough to maintain weight and that even a moderate weight loss is associated with psychological distress and lower quality of life.

Nutritional behaviour and quality of life during oncological polychemotherapy: results of a prospective study on the efficacy of oral nutrition therapy in patients with acute leukaemia

A total of 29 patients with acute leukaemia were prospectively randomized before starting cytostatic treatment to be nourished either with intensified oral nutrition (intervention group) or ad libitum nutritional intake during the whole tumour therapy (median 22 weeks). All received menus of free choice (daily offer of 1.0-2.0 g protein, 30-50 kcal kg-1 body weight (BW)). Beyond this, intervention patients received nutrition education, daily visits by the dietician and record of food intake, as well as a weekly assessment of subjective well-being (linear analogue self assessment 'LASA'). From the LASA items, the factors: 'malaise', 'psychological distress', 'therapy side-effects' were extracted by principal component analysis, and correlated to nutrient intake and nutritional status. At the end of antineoplastic induction therapy, after continuous hospitalization of 10 weeks (median), 31.3% of the controls had regained their initial nutritional status, and 68.8% of the intervention group. Mean daily energy intake was 23.2 kcal kg-1 BW during weeks with weight loss (constant weight: 30.9, weight gain: 39.3 kcal kg-1 BW). Nutritional behaviour correlated with subjective well-being, low intake with complaints of tumour treatment side effects and weight loss with malaise.