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Senesse P, Briant J, Boisselier P, Bensadoun RJ, Vinches M, Faravel K. Head and neck cancer patients treated with concomitant chemoradiotherapy involving the oral cavity and oropharynx: is another choice possible than prophylactic gastrostomy? Curr Opin Oncol 2024; 36:128-135. [PMID: 38573201 DOI: 10.1097/cco.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Recent recommendations on cachexia highlight, in head and neck cancers, the heterogeneity of studies, focusing on weight loss and sequelae including swallowing disorders. The current national guidelines emphasize that, in cases of concurrent chemoradiotherapy (cCRT) involving the oral cavity and oropharynx, prophylactic gastrostomy placement should be carried out systematically. We review why this technique is particularly relevant in this specific location for the feasibility of cCRT. RECENT FINDINGS A randomized trial is underway on swallowing disorders and the quality of life of patients after prophylactic vs. reactive gastrostomy in advanced oropharyngeal cancer patients treated with CRT. Concurrently, recent literature reviews emphasize the importance of the cumulative dose of chemotherapy for local control and survival. In cases of cCRT involving the oral cavity or the oropharynx, nutritional support could have a beneficial or detrimental impact on chemotherapy. SUMMARY Specifically for patients treated with cCRT involving the oral cavity and oropharynx, prophylactic gastrostomy would be able to fulfill the three objectives of local control, survival, and quality of life, minimizing complications related to nutritional support. Studies need to be more homogeneous. In clinical practice, nutrition should primarily assist in carrying out cancer treatment when survival is the main goal.
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Affiliation(s)
- Pierre Senesse
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
| | - Jeanne Briant
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
| | - Pierre Boisselier
- Institut du Cancer Montpellier (ICM), Radiotherapy Department, University of Montpellier, France
| | | | - Marie Vinches
- Institut du Cancer Montpellier (ICM), Medical Oncology Department, University of Montpellier, France
| | - Kerstin Faravel
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
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2
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Chang C, Sun J, Zhao X, Chen S, Song D, Wang L, Yang Y, Huang R, Zhang H, Du J. Clinical practice guidelines for the nutrition of colorectal cancer patients: a systematic review. Support Care Cancer 2024; 32:187. [PMID: 38396102 DOI: 10.1007/s00520-024-08394-6] [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: 11/25/2023] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The aim of this study is to rigorously assess the methodological quality of published clinical practice guidelines (CPGs) related to nutrition among colorectal cancer patients, to compile consensus recommendations, and to evaluate the quality of the included CPGs. METHODS The systematic search covered eight electronic databases, two relevant professional association websites, and six guideline websites from their inception up to January 22, 2023. The methodological quality of the eligible guidelines was evaluated using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument, and then, consensus recommendations were synthesized. The scores for each domain were expressed as the mean ± standard deviation (SD). Using the mean score as the benchmark for comparison, they were subsequently ranked from highest to lowest. The included guidelines were then categorized as having "high," "moderate," or "low" quality based on their scores. RESULTS The literature search yielded ten guidelines. The findings indicated that the "Clarity of presentation" domain had the highest mean score (65.2 ± 7.7). This demonstrates how the guidelines effectively articulate recommendations. Additionally, the "Scope and purpose" domain achieved a mean score of 60.7 ± 10.9, followed by "Rigor of development" (51.7 ± 15.7), "Editorial independence" (51.1 ± 21), "Stakeholder involvement" (48 ± 16.8), and "Applicability" domains (47.5 ± 17.3). Two CPGs received an overall rating of "high quality" and were recommended; four CPGs received an overall rating of "moderate" and were recommended with modifications; and four CPGs received an overall rating of "low quality" and were not recommended. Furthermore, this study compiled twenty consensus recommendations related to nine distinct clinical issues. CONCLUSION This study identified disparities in the methodological quality of the included CPGs, particularly in the "Applicability" domain, thus emphasizing the need for advancement in clinical feasibility and implementation. Notably, there is few guidelines specifically targeting colorectal cancer nutrition. These synthesized findings provided an intuitive, convenient, and comprehensive reference for evaluating nutrition among colorectal cancer patients. When applying these results, users should make careful decisions based on their specific situations.
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Affiliation(s)
- Cheng Chang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, ChangchunJilin, 130021, China
| | - Xiaosu Zhao
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China.
| | - Si Chen
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Dongpo Song
- School of Nursing, Jilin University, No.965 Xinjiang Street, ChangchunJilin, 130021, China
| | - Lijie Wang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Yang Yang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Ruling Huang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Haijia Zhang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Jing Du
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
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3
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Faravel K, Jarlier M, Senesse P, Huteau ME, Janiszewski C, Stoebner A, Boisselier P. Trismus Occurrence and Link With Radiotherapy Doses in Head and Neck Cancer Patients Treated With Chemoradiotherapy. Integr Cancer Ther 2023; 22:15347354221147283. [PMID: 36625502 PMCID: PMC9834786 DOI: 10.1177/15347354221147283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Chemoradiotherapy (CRT) for head and neck cancer (HNC) induces side-effects, including trismus, which impairs quality of life by causing difficulty to eat, speak, and maintain good oral hygiene, and by altering social life. Given the wide variation of reported trismus prevalence and as a first mandatory step for the preventive physiotherapy OPEN program (NCT03979924) this study evaluated trismus occurrence and its link with radiation doses. METHODS Study population was non-larynx HNC patients with epidermoid carcinoma treated with CRT, with or without surgery. A physiotherapist measured maximal interincisal distance before, during and after CRT, at 10 weeks and 6 months. The proportion of patients with trismus (with a 95% confidence interval) was estimated. Irradiation doses were analyzed between patients with and without trismus using non-parametric Kruskal-Wallis test. RESULTS We included 45 patients (77.8% male), median age 61 years (range 41-77). The proportion of trismus at baseline was 24.4%, 26.8% at 10 weeks and 37.1% at 6 months. During radiotherapy, it was 27.9% at week 3 and increased to 41.9% at week 6. Trismus occurrence at 10 weeks was higher when the radiation dose to the ipsilateral lateral pterygoid muscle was above the median value, that is, 36.8 grays. CONCLUSION Trismus occurrence differed according to radiation dose and cancer location. These findings highlight the necessity of early preventive physiotherapy programs to reduce trismus occurrence. The second step, of the interventional multicenter OPEN program, is currently evaluating the impact of preventive physiotherapy and patient education on trismus in a sample of 175 patients.
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Affiliation(s)
- Kerstin Faravel
- University of Montpellier, Montpellier,
France,Kerstin Faravel, Department of Supportive
Care, Physiotherapy Unit, Institut du Cancer de Montpellier (ICM), 208 Avenue
des Apothicaires, Montpellier 34298, France.
| | | | - Pierre Senesse
- University of Montpellier, Montpellier,
France,University of Montpellier INSERM, IRCM,
IDESP, UMR 1302, Montpellier, France
| | | | | | - Anne Stoebner
- University of Montpellier, Montpellier,
France,University of Montpellier INSERM, IRCM,
IDESP, UMR 1302, Montpellier, France
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4
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Agate L, Minaldi E, Basolo A, Angeli V, Jaccheri R, Santini F, Elisei R. Nutrition in Advanced Thyroid Cancer Patients. Nutrients 2022; 14:nu14061298. [PMID: 35334955 PMCID: PMC8951395 DOI: 10.3390/nu14061298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023] Open
Abstract
In the last decade, multikinase inhibitors (MKIs) have changed the paradigm of treatment of advanced and progressive thyroid cancer. Compared with the traditional treatment with chemotherapy and radiotherapy, these new drugs have shown a good efficacy in controlling the neoplastic disease, and also a different toxicity profile compared to traditional chemotherapy, milder but still present and involving mainly the nutritional profile. Weight loss, nausea, anorexia, stomatitis, diarrhea may be associated with malnutrition and cancer-related cachexia. The latter is characteristic of the advanced cancer stage and may be present before starting MKIs, or may develop afterwards. Adverse events with nutritional impact may cause a significant impairment of quality of life, often requiring dose reduction and sometimes drug discontinuation, but with a lower efficacy on the neoplastic disease. The aim of this paper was to discuss the role of nutritional therapy in advanced thyroid cancer and the importance of prevention, early recognition and careful management of malnutrition and cachexia during systemic therapy with MKIs.
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Affiliation(s)
- Laura Agate
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (L.A.); (E.M.); (A.B.); (R.J.); (F.S.)
| | - Elisa Minaldi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (L.A.); (E.M.); (A.B.); (R.J.); (F.S.)
| | - Alessio Basolo
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (L.A.); (E.M.); (A.B.); (R.J.); (F.S.)
| | - Valentina Angeli
- Dietary Service, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Roberta Jaccheri
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (L.A.); (E.M.); (A.B.); (R.J.); (F.S.)
| | - Ferruccio Santini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (L.A.); (E.M.); (A.B.); (R.J.); (F.S.)
| | - Rossella Elisei
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (L.A.); (E.M.); (A.B.); (R.J.); (F.S.)
- Correspondence: ; Tel.: +39-050-995120
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Gillis C, Hasil L, Kasvis P, Bibby N, Davies SJ, Prado CM, West MA, Shaw C. Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology. Front Nutr 2021; 8:644706. [PMID: 34249985 PMCID: PMC8264148 DOI: 10.3389/fnut.2021.644706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/26/2021] [Indexed: 12/21/2022] Open
Abstract
The nutrition care process is a standardized and systematic method used by nutrition professionals to assess, diagnose, treat, and monitor patients. Using the nutrition care process model, we demonstrate how nutrition prehabilitation can be applied to the pre-surgical oncology patient.
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Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Leslee Hasil
- Department of Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Popi Kasvis
- Department of Nutrition, McGill University Health Center, Montreal, QC, Canada
| | - Neil Bibby
- Manchester Royal Infirmary, Dietetics Department, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Sarah J Davies
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Malcolm A West
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Clare Shaw
- Department of Nutrition and Dietetics, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
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6
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Boisselier P, Thézénas S, Flori N, Vinches M, Bourhis J, Senesse P. Reply to Caccialanza et al. Am J Clin Nutr 2021; 113:1054-1055. [PMID: 33822866 DOI: 10.1093/ajcn/nqaa425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pierre Boisselier
- From the Radiotherapy Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Simon Thézénas
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, France
| | - Nicolas Flori
- Clinical Nutrition and Gastroenterology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Marie Vinches
- Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Jean Bourhis
- Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre Senesse
- Clinical Nutrition and Gastroenterology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France.,IRCM, University of Montpellier, INSERM, ICM, Montpellier, France
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7
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Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin 2021; 71:149-175. [PMID: 33107982 PMCID: PMC7988887 DOI: 10.3322/caac.21639] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology/Oncology Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kathleen D Lyons
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Geisel School of Medicine, Hanover, New Hampshire
| | - Karen Robb
- North East London Cancer Alliance, London, United Kingdom
- Transforming Cancer Services Team for London, Healthy London Partnership, London, United Kingdom
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
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8
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Boisselier P, Kaminsky MC, Thézenas S, Gallocher O, Lavau-Denes S, Garcia-Ramirez M, Alfonsi M, Cupissol D, de Forges H, Janiszewski C, Geoffrois L, Sire C, Senesse P. A double-blind phase III trial of immunomodulating nutritional formula during adjuvant chemoradiotherapy in head and neck cancer patients: IMPATOX. Am J Clin Nutr 2020; 112:1523-1531. [PMID: 32936874 DOI: 10.1093/ajcn/nqaa227] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 07/22/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In a previous phase II study an immunonutrient supplement was found to reduce severe acute toxicities for head and neck squamous cell cancer (HNSCC) patients treated with concomitant cisplatin and radiotherapy. OBJECTIVES The primary objective of the present study was to evaluate efficacy of the same immunonutrient supplement on severe mucositis. Secondary objectives included tolerance, compliance to oral supplementation, chemotherapy interruptions and delays, quality of life, and progression-free survival (PFS) and overall survival (OS) at 1, 2, and 3 y. METHODS Between November 2009 and June 2013, 180 HNSCC patients eligible for adjuvant chemotherapy after surgery with curative intent were included in our double-blind phase III multicenter trial. They were assigned to receive oral supplementation (3 sachets/d) of either a formula enriched with l-arginine and omega-3 (n-3) fatty and ribonucleic acids (experimental arm), or an isocaloric isonitrogenous control (control arm), for 5 d before each of 3 cycles of cisplatin. Intention-to-treat (ITT) and per-protocol (PP) analyses were undertaken, along with subgroup analyses of ≥75% compliant patients, to compare the incidence of acute mucositis (Radiation Therapy Oncology Group and WHO scales) and 36-mo survival. RESULTS At 1 mo after terminating chemoradiotherapy (CRT), no differences were observed in the incidence of grade 3-4 mucositis between treatment groups, in the ITT, PP (172 patients), and subgroup (≥75% compliance, n = 112) analyses. The immunomodulating supplement did not significantly improve survival in the ITT and PP analyses at 3 y after CRT. Among ≥75% compliant patients, however, OS at 3 y was significantly improved in the immunomodulating formula group (81%; 95% CI: 67%, 89%) compared with controls (61%; 95% CI: 46%, 73%; P = 0.034), as well as PFS (73%; 95% CI: 58%, 83% compared with 50%; 95% CI: 36%, 63%; P = 0.012). CONCLUSIONS Although this immunomodulating formula failed to reduce severe mucositis during CRT, the findings suggest that the long-term survival of compliant HNSCC patients was improved.This trial was registered at clinicaltrials.gov as NCT01149642.
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Affiliation(s)
- Pierre Boisselier
- Radiotherapy Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | | | - Simon Thézenas
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | | | | | | | - Marc Alfonsi
- Radiotherapy Department, Sainte Catherine Institute, Avignon, France
| | - Didier Cupissol
- Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Hélène de Forges
- Clinical Research and Innovation Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Chloé Janiszewski
- Clinical Research and Innovation Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Lionnel Geoffrois
- Radiotherapy Department, Lorraine Cancer Institute, Vandœuvre-Lès-Nancy, France
| | - Christian Sire
- Radiotherapy Department, Bretagne Sud Hospital, Lorient, France
| | - Pierre Senesse
- Clinical Nutrition and Gastroenterology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France.,IRCM, University of Montpellier, Inserm, and ICM, Montpellier, France
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9
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Protein intake, weight loss, dietary intervention, and worsening of quality of life in older patients during chemotherapy for cancer. Support Care Cancer 2020; 29:687-696. [PMID: 32435967 DOI: 10.1007/s00520-020-05528-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022]
Abstract
Decreased health-related quality of life (HRQoL) is common in patients with cancer. We investigated the effects of dietary intervention and baseline nutritional status on worsening of HRQoL in older patients during chemotherapy. In this randomized control trial assessing the effect on mortality of dietary advice to increase dietary intake during chemotherapy, this post hoc analysis included 155 patients with cancer at risk of malnutrition. The effects of dietary intervention, baseline Mini Nutritional Assessment item scores, weight loss, and protein and energy intake before treatment on the worsening of HRQoL (physical functioning, fatigue) and secondary outcomes (Timed Up and Go test, one-leg stance time, depressive symptoms, basic (ADL), or instrumental (IADL) activities of daily living) were analyzed by multinomial regressions. Dietary intervention increased total energy and protein intake but had no effect on any examined outcomes. Worsening of fatigue and ADL was predicted by very low protein intake (< 0.8 g kg-1 day-1) before chemotherapy (OR 3.02, 95% CI 1.22-7.46, p = 0.018 and OR 5.21, 95% CI 1.18-22.73, p = 0.029 respectively). Increase in depressive symptomatology was predicted by 5.0-9.9% weight loss before chemotherapy (OR 2.68, 95% CI 1.10-6.80, p = 0.038). Nutritional intervention to prevent HRQoL decline during chemotherapy should focus on patients with very low protein intake along with those with weight loss.
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10
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Krznaric Ž, Juretic A, Domislovic V, Barisic A, Kekez D, Vranesic Bender D. Ten years of Croatian national guidelines for use of eicosapentaenoic acid and megestrol acetate in cancer cachexia syndrome – Evaluation of awareness and implementation among Croatian oncologists. Clin Nutr ESPEN 2019; 33:202-206. [DOI: 10.1016/j.clnesp.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/02/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
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11
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Heterogeneity of nutrition care procedures in nutrition guidelines for cancer patients. Clin Nutr 2019; 39:1692-1704. [PMID: 31542246 DOI: 10.1016/j.clnu.2019.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/13/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to systematically assess the nutrition care procedures in nutrition guidelines for cancer patients and identify gaps limiting evidence-based practise. METHODS A systematic search of databases and websites was conducted to identify nutrition guidelines for cancer patients. The quality of the eligible guidelines was evaluated by using the Appraisal of Guidelines for Research and Evaluation (AGREE II). The Measurement Scale of Rate of Agreement (MSRA) was used to assess the scientific agreement of formulated recommendations for nutrition care procedures in the guidelines (2017-2019), and evidence supporting these recommendations was extracted and analysed. RESULTS Seventeen nutrition guidelines for cancer patients were identified. Only European Society for Clinical Nutrition and Metabolism (ESPEN) and Australian guidelines have a total quality score of more than 60%, which is worthy of clinical recommendation. Twelve guidelines (2017-2019) were included to further analyse the heterogeneity and causes of nutrition care procedures, and we found that the content and tools of nutrition screening and assessment, the application of immune nutrients, and the selection of nutritional support pathways were heterogeneous. The main reasons for the heterogeneity of nutrition care procedures were insufficient attention to nutrition risk screening, differences in recommendations for nutrition assessment, immune nutrients and nutritional support, unreasonable citation of screening and assessment evidence, preference of developers, and lack of evidence of high-quality research on energy and nitrogen demand. In addition, the fairness and propensity of the guidelines for the selection of evidence for different cancer patients are also potential reasons for the heterogeneity of nutritional care procedures. CONCLUSIONS The quality of the nutrition guidelines for cancer patients was highly variable. The nutrition care procedures were heterogeneous among the different guidelines in the last 3 years. Specific improvement of the factors leading to the heterogeneity of nutrition care procedures will be a reasonable and effective way for developers to upgrade the nutrition care procedures in the guidelines for cancer patients.
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12
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Lorton CM, Griffin O, Higgins K, Roulston F, Stewart G, Gough N, Barnes E, Aktas A, Walsh TD. Late referral of cancer patients with malnutrition to dietitians: a prospective study of clinical practice. Support Care Cancer 2019; 28:2351-2360. [PMID: 31485981 DOI: 10.1007/s00520-019-05042-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Malnutrition (MN) in cancer is common but underdiagnosed. Dietitian referrals may not occur until MN is established. We investigated cancer patient characteristics (demographics, nutritional status, and nutrition barriers) on referral to oncology dietitians. We also examined referral practices and prevalence of missed referral opportunities. METHODS This was a naturalistic multi-site study of clinical practice. Data from consecutive referrals were collected in inpatient and outpatient settings. Demographics, nutritional status (weight, body mass index (BMI), weight loss in the preceding 3-6 months, oral intake, nutrition barriers), referral reasons, and use of screening were recorded. Missed opportunities for earlier referral were also noted. RESULTS Two hundred patients were included (60% male, 51% inpatients). Half had gastrointestinal and hepatobiliary cancers. The majority were on antitumor treatment. Two-thirds had lost ≥ 5% body weight. Forty percent were overweight or obese. Seventy percent had ≥ 2 nutritional barriers. Most common nutrition barriers were anorexia, nausea, and early satiety. Greater weight loss and lower food intake were associated with ≥ 2 barriers. Weight loss was the most common referral reason. Screening was used in 35%. Referrals should have occurred sooner in nearly half (45%, n = 89). CONCLUSIONS Cancer patients were referred late to a dietitian, with multiple nutritional barriers. Most referrals were for established weight loss (WL). WL may be masked by pre-existing obesity. Almost half had missed earlier referral opportunities; screening was infrequent. Over one-quarter should have been re-referred sooner. There is a clear need for clinician education. Future research should investigate the optimal timing of dietitian referral and the best nutrition screening tools for use in cancer.
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Affiliation(s)
- Cliona M Lorton
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6W EV82, Ireland.
- Trinity College Dublin, Dublin, Ireland.
| | - O Griffin
- Trinity College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - K Higgins
- Tallaght University Hospital, Dublin, Ireland
| | - F Roulston
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - G Stewart
- St Vincent's Private Hospital, Dublin, Ireland
| | - N Gough
- Mater Private Mid-Western Radiation Oncology Centre, Limerick, Ireland
| | - E Barnes
- St Vincent's University Hospital, Dublin, Ireland
| | - A Aktas
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - T D Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6W EV82, Ireland
- Trinity College Dublin, Dublin, Ireland
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
- University College Dublin, Dublin, Ireland
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13
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Nutritional diagnosis of patients with hepatocellular carcinoma: what is the best method? NUTR HOSP 2019; 36:884-889. [PMID: 31192693 DOI: 10.20960/nh.02542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: malnutrition is a frequent finding among cancer patients. Despite its prognostic significance, there are still few studies evaluating the nutritional status of patients with hepatocellular carcinoma (HCC). Objectives: to evaluate the nutritional status of patients with HCC by different methods. Methods: patients with HCC were evaluated in an outpatient clinic at the Hospital Santa Casa de Misericórdia de Porto Alegre. The methods used for the nutritional assessment were body mass index (BMI), tricipital skinfold (TSF), arm circumference (AC), arm muscle circumference (AMC), hand grip strength (HGS), adductor pollicis muscle (APM), patient-generated subjective global assessment (PG-SGA) and phase angle (PA). Results: forty-three patients with HCC were evaluated; all of them were cirrhotic. The mean age was 64.0 ± 5.8 years and the prevalent gender was male (72.1%). APM, PA, PG-SGA and AMC were the most sensitive methods for the diagnosis of malnutrition. There was a negative correlation between TSF and Child-Pugh score (p = 0.004) and a positive correlation between APM and BCLC stage (Barcelona Clinic Liver Cancer Group) (p = 0.006). Conclusions: there was high variation in the diagnosis of malnutrition among the methods studied. APM, AMC, PA and PG-SGA can be indicated as tools of choice in the nutritional assessment of the HCC patient because they were the most sensitive methods in the diagnosis of malnutrition. TSF and APM correlate with disease severity.
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Ravasco P. Nutrition in Cancer Patients. J Clin Med 2019; 8:jcm8081211. [PMID: 31416154 PMCID: PMC6723589 DOI: 10.3390/jcm8081211] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using “OR” as a Boolean function and the results of the four components were combined by utilizing the “AND” Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1–2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.
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Affiliation(s)
- Paula Ravasco
- University Hospital of Santa Maria, 1649-035 Lisbon, Portugal.
- University of Lisbon, 1649-028 Lisbon, Portugal.
- Centre for Interdisciplinary Research in Health (CIIS) of the Portuguese Catholic University, 1649-023 Lisbon, Portugal.
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15
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Gonçalves SEAB, Ribeiro AAF, Hirose EY, Santos FPDS, Ferreira FM, Koch LDOM, Tanaka M, de Souza MS, Souza PMR, Gonçalves TJM, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly. EINSTEIN-SAO PAULO 2019; 17:eAE4340. [PMID: 31116236 PMCID: PMC6533077 DOI: 10.31744/einstein_journal/2019ae4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
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Affiliation(s)
| | - Andreza Alice Feitosa Ribeiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Centro de Transplante de Medula Óssea, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Márcia Tanaka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Boulahssass R, Gonfrier S, Champigny N, Lassalle S, François E, Hofman P, Guerin O. The Desire to Better Understand Older Adults with Solid Tumors to Improve Management: Assessment and Guided Interventions-The French PACA EST Cohort Experience. Cancers (Basel) 2019; 11:cancers11020192. [PMID: 30736406 PMCID: PMC6406576 DOI: 10.3390/cancers11020192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 12/17/2022] Open
Abstract
Todays challenge in geriatric oncology is to screen patients who need geriatric follow-up. The main goal of this study was to analyze factors that identify patients, in a large cohort of patients with solid tumors, who need more geriatric interventions and therefore specific follow-up. Between April 2012 and May 2018, 3530 consecutive patients were enrolled in the PACA EST cohort (France). A total of 3140 patients were finally enrolled in the study. A Comprehensive Geriatric Assessment (CGA) was performed at baseline. We analyzed the associations between factors at baseline (geriatric and oncologic factors) and the need to perform more than three geriatric interventions. The mean age of the population was 82 years old with 59% of patients aged older than 80 years old. A total of 8819 geriatric interventions were implemented for the 3140 patients. The percentage of patients with three or more geriatric interventions represented 31.8% (n = 999) of the population. In multivariate analyses, a Mini Nutritional assessment (MNA) <17, an MNA ≤23·5 and ≥17, a performans status (PS) >2, a dependence on Instrumental Activities of Daily Living (IADL), a Geriatric Depression Scale (GDS) ≥5, a Mini Mental State Examination (MMSE) <24, and a Screening tool G8 ≤14 were independent risk factors associated with more geriatric interventions. Factors associated with more geriatric interventions could assist practitioners in selecting patients for specific geriatric follow-up.
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Affiliation(s)
- Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
| | - Sebastien Gonfrier
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
| | - Noémie Champigny
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
| | - Sandra Lassalle
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, 06000 Nice, France.
- Hospital-related Biobank (BB-0033-00025), 06000 Nice, France.
| | - Eric François
- Department of Medical Oncology, Lacassagne Center, 06000 Nice, France.
| | - Paul Hofman
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, 06000 Nice, France.
- Hospital-related Biobank (BB-0033-00025), 06000 Nice, France.
| | - Olivier Guerin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
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17
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Guerdoux-Ninot E, Flori N, Janiszewski C, Vaillé A, de Forges H, Raynard B, Baracos VE, Thezenas S, Senesse P. Assessing dietary intake in accordance with guidelines: Useful correlations with an ingesta-Verbal/Visual Analogue Scale in medical oncology patients. Clin Nutr 2018; 38:1927-1935. [PMID: 30355527 DOI: 10.1016/j.clnu.2018.06.974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/16/2018] [Accepted: 06/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Energy intake and food ingesta are central in nutritional screening and assessment. Cancer patients are at nutritional risk of losing weight, and clinicians need quick and easy tools to identify patients for nutritional support. This study aimed to evaluate the feasibility and the accuracy of a Visual/Verbal Analogue Scale of food ingesta (ingesta-VVAS) to assess energy food intake and nutritional risk in medical oncology patients. METHODS Dieticians administered prospectively the ingesta-VVAS in 1762 medical oncology patients. The external validity of the ingesta-VVAS was determined against daily energy intake based on a 24-h dietary recall. Patients had to estimate how they currently ate on a scale from 0 "nothing at all" to 10 "as usual". Area Under the Receiver-Operating Characteristics (ROC) curve served as determine the optimal cut-off and provide the discriminative power of the tool to detect patients who ingested less or more than 25 kcal kg-1 day-1. RESULTS The feasibility of the ingesta-VVAS was 97.7%. The scores were significantly correlated with energy intake (ρ = .67, p < .05), whatever the specific situation (i.e. malnutrition or not). With a cut-off of ≤7, the ingesta-VVAS exhibited a good power discrimination (AUC = .804) to detect patients who ingested less or more than 25 kcal kg-1 day-1, with a sensitivity of 80.8%, a positive predictive value of 83.6%, a specificity of 67.5%, and a negative predictive value of 63.3%. Patients with a score ≤7 on the ingesta-VVAS score were at 12-fold higher probability of nutritional risk [OR 12.3; 95% CI (8.7-17.4); p < .001]. Sensitivity to detect patients with a significant weight loss was 71%, and a positive predictive value of 75.9%. CONCLUSIONS This easy-to-use ingesta-VVAS is well-correlated with energy intake and may be useful in clinical practice. An ingesta-VVAS score is ≤ 7 could be used to detect patients with nutritional risk of weight loss in medical oncology.
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Affiliation(s)
- Estelle Guerdoux-Ninot
- Department of Supportive Care, Cancer Institute of Montpellier (ICM), Montpellier, University of Montpellier, France; Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France.
| | - Nicolas Flori
- Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Chloé Janiszewski
- Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Arnaud Vaillé
- Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Hélène de Forges
- Clinical Research Department, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Bruno Raynard
- Department of Supportive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Simon Thezenas
- Department of Biostatistics, Cancer Institute of Montpellier (ICM), University of Montpellier, France
| | - Pierre Senesse
- Department of Supportive Care, Cancer Institute of Montpellier (ICM), Montpellier, University of Montpellier, France; Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), University of Montpellier, France
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18
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Deshayes E, de Forges H, Fraisse J, Eberlé MC, Guillemard S, Fallières A, Pouget JP, Tétreau R, Kotzki PO, Santoro L, Senesse P, Flori N. Artificial nutrition in patients with cancer has no impact on tumour glucose metabolism: Results of the PETANC Study. Clin Nutr 2018; 38:2121-2126. [PMID: 30209026 DOI: 10.1016/j.clnu.2018.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/16/2018] [Accepted: 08/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Nutrition support is recommended in cachexic patients with cancer. However, there is no clear evidence about its impact on tumour growth. Glycolysis, which is usually higher in cancer than normal cells, can be monitored by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging that is widely used for cancer staging and therapy efficacy assessment. Here, we used 18F-FDG PET/CT imaging to investigate whether artificial nutrition has an impact on tumour glucose metabolism in patients with cancer and cachexia. METHODS This prospective study included ten patients with histologically proven head and neck or oesophageal cancer. All patients underwent 18F-FDG PET/CT imaging at baseline and after (parenteral and/or enteral) nutrition support on average for 7 days. Tumour glucose metabolism changes were evaluated using static (SUVmax, SUVmean and SULpeak) and dynamic (glucose metabolic rate and transport constant rates, k) parameters computed from the 18F-FDG PET/CT data. RESULTS Artificial nutrition (median energy intake of 21.83 kcal/kg/day [13.16-45.90], protein intake of 0.84 g/kg/day [0.56-1.64]) was administered. Eight patients (80%) received enteral nutrition and two patients (20%) parenteral support. Comparison of 18F-FDG PET/CT parameters did not highlight any significant difference in tumour glucose metabolism before and after the period of nutrition support. CONCLUSIONS In cachexic patients with head and neck or oesophageal cancer, nutrition support administered according to the current guidelines shows no impact on tumour glucose metabolism, assessed by 18F-FDG PET/CT.
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Affiliation(s)
- Emmanuel Deshayes
- Nuclear Medicine Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Univ. Montpellier, Institut du Cancer de Montpellier (ICM), Montpellier, France.
| | - Hélène de Forges
- Clinical Research Unit, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Julien Fraisse
- Biometrics Unit, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Marie-Claude Eberlé
- Nuclear Medicine Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Sophie Guillemard
- Nuclear Medicine Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Anne Fallières
- Clinical Nutrition and Gastroenterology Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Jean-Pierre Pouget
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Univ. Montpellier, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Raphaël Tétreau
- Radiology Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Pierre-Olivier Kotzki
- Nuclear Medicine Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Univ. Montpellier, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Lore Santoro
- Nuclear Medicine Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Pierre Senesse
- Clinical Nutrition and Gastroenterology Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
| | - Nicolas Flori
- Clinical Nutrition and Gastroenterology Department, Institut du Cancer de Montpellier, Univ. Montpellier, Montpellier, France
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Kirov KM, Xu HP, Crenn P, Goater P, Tzanis D, Bouhadiba MT, Abdelhafidh K, Kirova YM, Bonvalot S. Role of nutritional status in the early postoperative prognosis of patients operated for retroperitoneal liposarcoma (RLS): A single center experience. Eur J Surg Oncol 2018; 45:261-267. [PMID: 30174162 DOI: 10.1016/j.ejso.2018.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To assess the nutritional status and its role in the outcome of patients operated for retroperitoneal liposarcoma (RLS). MATERIAL AND METHODS Retrospective study on consecutive patients operated with en bloc compartment resection for primary or local recurrence of RLS between 2016 and 2017. Preoperative nutritional and laboratory assessment comprising serum albumin, serum transthyretin, orosomucoid, and CRP was systematically performed. The following preoperative parameters were analysed: weight, body mass index (BMI), significant weight loss (>5% in one month and/or >10% in 6 months), serum albumin, transthyretin, CRP, orosomucoid. PINI (prognostic inflammatory and nutritional index) was calculated. RESULTS There were 40 patients operated for RLS: 22 women and 18 men with a median age of 61 years (34-90). Median tumour was 280 mm (80-530). Median preoperative BMI was 24.8 (18-42) and median postoperative BMI was 23 (17.8-44). Twenty-one patients (52.5%) were considered to be malnourished: 3 with biological signs of malnutrition and 18 with weight loss. Eleven (47.6%) in the group of malnourished patients and 4 (26.3%) in the group with satisfactory nutritional status developed postoperative complications (p = 0.042). A PINI score>1 was related to significantly longer hospitalisation time 21.8 days (10-58) in comparison with 14.9 [9-30] in patients with PINI < 1, p = 0.003. CONCLUSIONS The malnourished patients with RLS experienced more postoperative complications and longer hospitalisation. Nutritional status and biological markers contribute to the global management of RLS with improved postoperative behaviour including fewer complications and shorter hospitalisation. A prospective larger study with longer follow-up is necessary to refine these results.
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Affiliation(s)
- Krassen M Kirov
- Department of Anesthesiology and Reanimation, Institut Curie, Paris, France.
| | - Hao Ping Xu
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Pascal Crenn
- Unit of Nutrition, Hôpital Raymond Poincaré (APHP), Garches, France
| | - Philippe Goater
- Department of Anesthesiology and Reanimation, Institut Curie, Paris, France
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institut Curie, Paris, France
| | | | | | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Paris, France
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20
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Boulahssass R, Gonfrier S, Ferrero JM, Sanchez M, Mari V, Moranne O, Rambaud C, Auben F, Hannoun Levi JM, Bereder JM, Bereder I, Baque P, Turpin JM, Frin AC, Ouvrier D, Borchiellini D, Largillier R, Sacco G, Delotte J, Arlaud C, Benchimol D, Durand M, Evesque L, Mahamat A, Poissonnet G, Mouroux J, Barriere J, Benizri E, Piche T, Guigay J, Francois E, Guerin O. Predicting early death in older adults with cancer. Eur J Cancer 2018; 100:65-74. [PMID: 30014882 DOI: 10.1016/j.ejca.2018.04.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Predicting early death after a comprehensive geriatric assessment (CGA) is very difficult in clinical practice. The aim of this study was to develop a scoring system to estimate risk of death at 100 days in elderly cancer patients to assist the therapeutic decision. METHODS This was a multicentric, prospective cohort study approved by an ethics committee. Elderly cancer patients aged older than 70 years were enrolled before the final therapeutic decision. A standardised CGA was made before the treatment decision at baseline. Within 100 days, event (death), oncologic and geriatric data were collected. Multivariate logistic regression was used to select the risk factors for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the mean c-statistic. FINDINGS One thousand fifty patients (mean age: 82 years) joined the study from April 2012 to December 2014. The independent predictors were metastatic cancers (odds ratio [OR] 2.5; 95% confidence interval [CI], [1.7-3.5] p<0 .001); gait speed<0.8 m/s (OR 2.1; 95% CI [1.3-3.3] p=0.001); Mini Nutritional Assessment (MNA) < 17 (OR 8; 95% CI; [3.7-17.3] p<0.001), MNA ≤23.5 and ≥ 17 (OR 4.4; 95% CI, [2.1-9.1) p<0.001); performance status (PS) > 2 (OR 1.7; 95% CI, [1.1-2.6)] p=0.015) and cancers other than breast cancer (OR 4; 95% CI, [2.1-7.9] p<0.001). We attributed 4 points for MNA<17, 3 points for MNA between ≤23.5 and ≥ 17, 2 points for metastatic cancers, 1 point for gait speed <0.8 m/s, 1 point for PS > 2 and 3 points for cancers other than breast cancer. The risk of death at 100 days was 4% for 0 to 6 points, 24% for 7 to 8 points, 39% for 9 to 10 points and 67% for 11 points. INTERPRETATION To our knowledge, this is the first score which estimates early death in elderly cancer patients. The system could assist in the treatment decision for elderly cancer patients.
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Affiliation(s)
- Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; FHU ONCOAGE; Nice, France.
| | - Sebastien Gonfrier
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Jean-Marc Ferrero
- University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Marine Sanchez
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Véronique Mari
- Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Olivier Moranne
- Department of Nephrology, Hopital Caremeau Nimes, France; Institut Universitaire de Recherche Clinique - EA2415 - Epidémiologie, Biostatistiques et Santé Publique/University of Montpellier; Nice, France.
| | - Cyrielle Rambaud
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Francine Auben
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Jean-Michel Hannoun Levi
- University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Jean-Marc Bereder
- Department of Surgical Digestive Oncology, CHU de Nice; Nice, France.
| | | | - Patrick Baque
- University of Nice Sophia Antipolis, France; University of Nice Sophia Antipolis, Emergency Surgery Unit, CHU de Nice; Nice, France.
| | - Jean Michel Turpin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Anne-Claire Frin
- Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | - Delphine Ouvrier
- Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | | | - Remy Largillier
- Cancer Center: Centre Azuréen de Cancérologie; Mougins, France.
| | - Guillaume Sacco
- University of Nice Sophia Antipolis, France; Geriatric Department CHU de NICE, France; CoBtek, France.
| | - Jerome Delotte
- University of Nice Sophia Antipolis, France; Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice; Nice, France.
| | | | - Daniel Benchimol
- University of Nice Sophia Antipolis, France; Department of Surgical Digestive Oncology, CHU de Nice; Nice, France.
| | - Matthieu Durand
- University of Nice Sophia Antipolis, France; Department of Urology, CHU de Nice, University of Nice Sophia-Antipolis; Nice, France.
| | - Ludovic Evesque
- Department of Medical Oncology, Lacassagne Center; Nice, France.
| | | | | | - Jérôme Mouroux
- University of Nice Sophia Antipolis, France; Department of Thoracic and Cardiovascular Surgery, Hopital Pasteur, CHU Nice, Nice, France.
| | - Jérôme Barriere
- Department of Medical Oncology: Clinic Saint Jean; Cagnes sur Mer France.
| | - Emmanuel Benizri
- University of Nice Sophia Antipolis, France; Geriatric Department CHU de NICE, France.
| | - Thierry Piche
- University of Nice Sophia Antipolis, France; Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | - Joel Guigay
- FHU ONCOAGE; Nice, France; University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Eric Francois
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Olivier Guerin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; FHU ONCOAGE; Nice, France; University of Nice Sophia Antipolis, France.
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Pouillart P, Battu C. La prise en charge précoce des effets secondaires en oncologie par une alimentation dédiée. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Prevalence of malnutrition in adult patients previously treated with allogeneic hematopoietic stem-cell transplantation. Clin Nutr 2018; 37:739-745. [DOI: 10.1016/j.clnu.2017.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 12/16/2022]
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Deluche E, Leobon S, Desport JC, Venat-Bouvet L, Usseglio J, Tubiana-Mathieu N. Impact of body composition on outcome in patients with early breast cancer. Support Care Cancer 2018; 26:861-868. [PMID: 28948392 PMCID: PMC5785600 DOI: 10.1007/s00520-017-3902-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE We investigated the impact of body composition on outcomes of patients with early breast cancer. Skeletal muscle mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and muscle fat infiltration or inter-muscular adipose tissue areas (IMAT), obtained by computed tomography (CT), were assessed. METHODS A total of 119 female patients who had breast cancer were included in this retrospective study. The total skeletal muscle and fat tissue areas were evaluated in two adjacent axial slices obtained at the third lumbar vertebra by CT used for disease staging. The women were assigned to either a sarcopenia or non-sarcopenia group based on their skeletal muscle index (cut-off 41.0 cm2/m2). They also were classified into high and low VAT/SAT ratio groups and assigned to either the high or low IMAT index group. The association of the body composition parameters and prognosis was statistically analyzed. RESULTS Among the 119 evaluable patients, 58 were sarcopenic (48.8%), 55 (46.2%) had a high VAT/SAT ratio, and 62 (52.1%) had a high IMAT index. Median follow-up was 52.4 months. Multivariate analysis revealed sarcopenia and IMAT index as independent prognostic factors for disease-free survival (p = 0.02 and p = 0.04, respectively) and overall survival (p = 0.05 and p = 0.02, respectively). BMI was not significantly associated with disease-free survival, but a trend was observed (p = 0.09). CONCLUSIONS Sarcopenia and IMAT index are independent prognostic factors in early breast cancer; therefore, assessing body composition could be a simple and useful approach to integrate into patient management.
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Affiliation(s)
- Elise Deluche
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | | | - Laurence Venat-Bouvet
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Julie Usseglio
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Nicole Tubiana-Mathieu
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
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Mislang AR, Di Donato S, Hubbard J, Krishna L, Mottino G, Bozzetti F, Biganzoli L. Nutritional management of older adults with gastrointestinal cancers: An International Society of Geriatric Oncology (SIOG) review paper. J Geriatr Oncol 2018; 9:382-392. [PMID: 29396234 DOI: 10.1016/j.jgo.2018.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/28/2017] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
Malnutrition is one of the most common physical manifestations of gastrointestinal (GI) cancers and is often under-diagnosed and under-treated. Like cancers, malnutrition occurs more commonly in older adults, with potential negative consequences to quality of life, functional status, tolerance to treatment, and prognosis. Nutritional assessment and management require a proactive and systematic, multi-disciplinary approach. Early assessment, detection, and prompt intervention of cancer-associated malnutrition and cachexia are equally essential to achieve better quality nutritional care for older oncology patients. This article aims to provide an overview of the evidence associated with poor nutrition and outcomes in older adults with GI cancers, and recommends a management approach from a geriatric oncologist's perspective.
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Affiliation(s)
- Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy; Cancer Clinical Trials Unit, Department of Medical Oncology, Royal Adelaide Hospital, 1 Port Road, Thebarton, South Australia 5000, Australia
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy
| | - Joleen Hubbard
- Mayo Clinic Medical Oncology, 200 First St. SW, Rochester, MN 55905, United States
| | - Lalit Krishna
- Duke-NUS Graduate Medical School, Singapore; National Cancer Centre Singapore, Singapore; Centre of Biomedical Ethics at National University Singapore, Singapore
| | - Giuseppe Mottino
- Geriatric Medicine, Nuovo Ospedale-Santo Stefano, 59100 Prato, Italy
| | - Federico Bozzetti
- Faculty of Medicine, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy.
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Lacau St Guily J, Bouvard É, Raynard B, Goldwasser F, Maget B, Prevost A, Seguy D, Romano O, Narciso B, Couet C, Balon JM, Vansteene D, Salas S, Grandval P, Gyan E, Hebuterne X. NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer. J Geriatr Oncol 2018; 9:74-80. [DOI: 10.1016/j.jgo.2017.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/11/2017] [Accepted: 08/11/2017] [Indexed: 01/19/2023]
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Gyan E, Raynard B, Durand JP, Lacau Saint Guily J, Gouy S, Movschin ML, Khemissa F, Flori N, Oziel-Taieb S, Bannier Braticevic C, Zeanandin G, Hebert C, Savinelli F, Goldwasser F, Hébuterne X. Malnutrition in Patients With Cancer: Comparison of Perceptions by Patients, Relatives, and Physicians-Results of the NutriCancer2012 Study. JPEN J Parenter Enteral Nutr 2017; 42:255-260. [PMID: 29505137 DOI: 10.1177/0148607116688881] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 12/20/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malnutrition is a critical predictor of toxicity and outcome in patients with cancer and may be perceived differently by patients, relatives, and physicians. AIMS To assess the prevalence of malnutrition in oncology departments and to compare it with the perceptions of nutrition status by patients themselves, their closest relatives, and attending physicians. MATERIALS AND METHODS A 1-day multicentric cross-sectional survey on the prevalence of malnutrition was conducted in different oncology departments using patient-, relative-, and physician-specific questionnaires. Malnutrition was defined by a weight loss ≥5% within 1 month or ≥10% within 6 months, a body mass index ≤18.5 kg/m2 in patients aged <70 years or ≤21 kg/m2 in patients aged ≥70 years, and/or albuminemia <35 g/L. Questionnaires for assessing medical condition, knowledge of nutrition status, and perceptions of the impact of malnutrition on daily life were distributed to consenting patients, attending physicians, and closest relatives. RESULTS A total of 2197 patients were included, and 2071 and 976 questionnaires were collected from patients and relatives, respectively. Prevalence of malnutrition was 39%. Physicians overestimated malnutrition (44%), whereas patients and relatives underestimated it (22% and 23%, respectively, P < .001). Conversely, malnutrition-associated symptoms were underestimated by physicians compared with patients and relatives. CONCLUSION We found a prevalence of malnutrition of 39%: it was underestimated by patients and relatives and overestimated by physicians.
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Affiliation(s)
- Emmanuel Gyan
- Hematology and Cell Therapy, Tours Teaching Hospital (CHRU), Tours, France and Faculty of Medicine of Tours, University François Rabelais, Tours, France
| | - Bruno Raynard
- Dietetic and Nutrition Unit, Gustave Roussy, Cancer Campus, Grand Paris, France
| | - Jean-Philippe Durand
- Medical Oncology, Cochin Teaching Hospital, AP-HP, Paris, France and University Paris Descartes, Paris, France
| | - Jean Lacau Saint Guily
- Otolaryngology Head and Neck Surgery, Tenon Teaching Hospital, AP-HP, Paris, France and University Pierre et Marie Curie, Paris VI, France
| | - Sébastien Gouy
- Gynecological Surgery, Gustave Roussy, Cancer Campus, Grand Paris, France
| | - Marie Lespiau Movschin
- Digestive and Hepatobiliary Surgery, Pitié-Salpêtrière Teaching Hospital, AP-HP, Paris, France and University Pierre et Marie Curie, Paris VI, France
| | | | - Nicolas Flori
- Clinical Nutrition and Gastroenterology, Cancer Institute (ICM Val d'Aurelle), Montpellier, France
| | | | | | - Gilbert Zeanandin
- Gastroenterology and Clinical Nutrition, Nice Teaching Hospital (CHU) and University of Nice Sophia-Antipolis Nice, France
| | | | - Francesco Savinelli
- Medical Oncology, Saint-Joseph Hospital, Paris, France. A complete list of collaborators is presented in the acknowledgment section
| | - François Goldwasser
- Medical Oncology, Cochin Teaching Hospital, AP-HP, Paris, France and University Paris Descartes, Paris, France
| | - Xavier Hébuterne
- Gastroenterology and Clinical Nutrition, Nice Teaching Hospital (CHU) and University of Nice Sophia-Antipolis Nice, France
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Flori N, Lecornu H, Arnac S, Clavie B, Fallières A, Francioni L, Vaille A, Georges G, Lacroix C, Senesse P. Cancer chez le sujet obèse : impact sur la survie et sur la prise en charge oncologique. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Deluche E, Girault S, Jesus P, Monzat S, Turlure P, Leobon S, Abraham J, Daly N, Dauriac O, Bordessoule D. Assessment of the nutritional status of adult patients with acute myeloid leukemia during induction chemotherapy. Nutrition 2017; 41:120-125. [DOI: 10.1016/j.nut.2017.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 12/18/2022]
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Senesse P, Isambert A, Janiszewski C, Fiore S, Flori N, Poujol S, Arroyo E, Courraud J, Guillaumon V, Mathieu-Daudé H, Colasse S, Baracos V, de Forges H, Thezenas S. Management of Cancer Cachexia and Guidelines Implementation in a Comprehensive Cancer Center: A Physician-Led Cancer Nutrition Program Adapted to the Practices of a Country. J Pain Symptom Manage 2017; 54:387-393.e3. [PMID: 28778558 DOI: 10.1016/j.jpainsymman.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 01/13/2023]
Abstract
CONTEXT Cancer-associated cachexia is correlated with survival, side-effects, and alteration of the patients' well-being. OBJECTIVES We implemented an institution-wide multidisciplinary supportive care team, a Cancer Nutrition Program (CNP), to screen and manage cachexia in accordance with the guidelines and evaluated the impact of this new organization on nutritional care and funding. METHODS We estimated the workload associated with nutrition assessment and cachexia-related interventions and audited our clinical practice. We then planned, implemented, and evaluated the CNP, focusing on cachexia. RESULTS The audit showed a 70% prevalence of unscreened cachexia. Parenteral nutrition was prescribed to patients who did not meet the guideline criteria in 65% cases. From January 2009 to December 2011, the CNP team screened 3078 inpatients. The screened/total inpatient visits ratio was 87%, 80%, and 77% in 2009, 2010, and 2011, respectively. Cachexia was reported in 74.5% (n = 2253) patients, of which 94.4% (n = 1891) required dietary counseling. Over three years, the number of patients with artificial nutrition significantly decreased by 57.3% (P < 0.001), and the qualitative inpatients enteral/parenteral ratio significantly increased: 0.41 in 2009, 0.74 in 2010, and 1.52 in 2011. Between 2009 and 2011, the CNP costs decreased significantly for inpatients nutritional care from 528,895€ to 242,272€, thus financing the nutritional team (182,520€ per year). CONCLUSION Our results highlight the great benefits of implementing nutritional guidelines through a physician-led multidisciplinary team in charge of nutritional care in a comprehensive cancer center.
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Affiliation(s)
- Pierre Senesse
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; Epsylon, EA 4556 Dynamics of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France.
| | - Agnès Isambert
- Epsylon, EA 4556 Dynamics of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France
| | - Chloé Janiszewski
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Stéphanie Fiore
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Nicolas Flori
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Sylvain Poujol
- Department of Pharmacy, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Eric Arroyo
- Computer Information Organisation, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Julie Courraud
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Vanessa Guillaumon
- SIRIC Montpellier Cancer, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Hélène Mathieu-Daudé
- Medical Information Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Sophie Colasse
- Financial Affairs, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Vickie Baracos
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - Hélène de Forges
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Simon Thezenas
- Biometrics Unit, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
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Bourdel-Marchasson I, Duc S, Terrebonne E. Nutrition, traitement du cancer et maintien de l’indépendance fonctionnelle à long terme d’une patiente âgée. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kapoor N, Naufahu J, Tewfik S, Bhatnagar S, Garg R, Tewfik I. A Prospective Randomized Controlled Trial to Study the Impact of a Nutrition-Sensitive Intervention on Adult Women With Cancer Cachexia Undergoing Palliative Care in India. Integr Cancer Ther 2017; 16:74-84. [PMID: 27252077 PMCID: PMC5736069 DOI: 10.1177/1534735416651968] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Advanced cancer patients with disease progression develop cachexia. Nevertheless, cancer patients at nutritional risk have shown improved body weight and quality of life with oral nutritional supplements. METHOD This was a randomized controlled trial in adult female cancer patients (n = 63) attending palliative clinics, with symptoms of cachexia. Eligible patients were randomly distributed into control (n = 33) and intervention (n = 30) groups. Both groups were provided with nutritional and physical activity counseling, but the intervention group received an additional 100 g of Improved Atta (IAtta) for 6 months daily consumption. This study was designed to assess the efficacy of IAtta (with counseling) in enhancing the health status of cachexic patients. Anthropometric measurements, dietary intake, physical activity level and quality of life parameters were assessed at baseline, after 3 months, and at the end of 6 months. RESULTS Patients in the control group (n = 15) had significantly decreased body weight ( P = .003), mid-upper-arm circumference ( P = .002), and body fat ( P = .002) by the end of intervention. A trend of body weight gain in the intervention group (n = 17; P = .08) and significant increase of body fat ( P = .002) was observed; moreover, patients reported a significant improvement in fatigue ( P = .002) and appetite scores ( P = .006) under quality-of-life domains at the end of intervention. CONCLUSIONS Embedding a nutrition-sensitive intervention ( IAtta ) within Indian palliative care therapy may improve quality of life and stabilize body weight in cancer cachexia patients.
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Affiliation(s)
| | | | | | - Sushma Bhatnagar
- The All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Garg
- The All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Bilan pour la nutrition artificielle à domicile d’une année de consultations externes de l’unité transversale de nutrition du CHU de Limoges. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Som M, Chelle F, Vauleon E, Lebrun F, Bertrand C, Thibault R. Évaluation des pratiques professionnelles (EPP) en nutrition parentérale au Centre régional de lutte contre le cancer (CRLCC) de Rennes. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The Janus-Faced Role of Antioxidants in Cancer Cachexia: New Insights on the Established Concepts. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:9579868. [PMID: 27642498 PMCID: PMC5013212 DOI: 10.1155/2016/9579868] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/28/2016] [Accepted: 07/17/2016] [Indexed: 12/14/2022]
Abstract
Chronic inflammation and excessive loss of skeletal muscle usually occur during cancer cachexia, leading to functional impairment and delaying the cure of cancer. The release of cytokines by tumor promotes the formation of reactive oxygen species (ROS), which in turn regulate catabolic pathways involved in muscle atrophy. ROS also exert a dual role within tumor itself, as they can either promote proliferation and vascularization or induce senescence and apoptosis. Accordingly, previous studies that used antioxidants to modulate these ROS-dependent mechanisms, in cancer and cancer cachexia, have obtained contradictory results, hence the need to gather the main findings of these studies and draw global conclusions in order to stimulate more oriented research in this field. Based on the literature reviewed in this paper, it appears that antioxidant supplementation is (1) beneficial in cancer cachectic patients with antioxidant deficiencies, (2) most likely harmful in cancer patients with adequate antioxidant status (i.e., lung, gastrointestinal, head and neck, and esophageal), and (3) not recommended when undergoing radiotherapy. At the moment, measuring the blood levels of antioxidants may help to identify patients with systemic deficiencies. This approach is simple to realize but could not be a gold standard method for cachexia, as it does not necessarily reflect the redox state in other organs, like muscle.
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Guerdoux-Ninot E, Kilgour RD, Janiszewski C, Jarlier M, Meuric J, Poirée B, Buzzo S, Ninot G, Courraud J, Wismer W, Thezenas S, Senesse P. Meal context and food preferences in cancer patients: results from a French self-report survey. SPRINGERPLUS 2016; 5:810. [PMID: 27390650 PMCID: PMC4916076 DOI: 10.1186/s40064-016-2538-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/08/2016] [Indexed: 01/01/2023]
Abstract
Purpose The present study examined patient self-reports of descriptions, experiences and consequences of meal disturbances and food preferences within a cultural context (i.e., French meal traditions) in various treated cancer patients along their disease trajectory. Methods Over 800 questionnaires were sent to 20 cancer treatment centres in France. During a 9-month period, 255 questionnaires were received from five centres. Inclusion criteria included those French patients over 18 years of age, could read and understand French, had an Eastern Cooperative Oncology Group score between 0 and 2, experienced treatment-induced nutrition changes and/or had decreased oral intake. Dietetic staff assessed clinical characteristics while patients completed a 17-item questionnaire. Results The majority of patients were diagnosed with breast, gastro-intestinal (GI) tract and head and neck cancers (62 %). Half of the patients (49 %) experienced weight loss >5 %. The main treatment-induced side effects were fatigue, nausea, dry mouth, hypersensitivity to odors and GI tract transit disorders. These discomforts affected eating and drinking in 83 % of patients, inducing appetite loss and selected food aversion. Food preference appeared heterogeneous. Food taste, odor and finally appearance stimulated appetite. Finally, dietary behaviors and satisfaction were driven by the extent to which food was enjoyed. Conclusions During oncologic treatments, eating and drinking were affected in more than three-quarters of patients. As recommended by practice guidelines, nutritional assessment and follow-up are required. Personalized nutritional counseling should include the role of the family, patient’s meal traditions, and food habits.
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Affiliation(s)
- Estelle Guerdoux-Ninot
- SIRIC Montpellier Cancer, Cancer Institute of Montpellier (ICM)-Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France ; Epsylon Research Unit EA 4556 Laboratory, Departments of Sport Sciences, Medicine and Psychology, University of Montpellier and University Paul Valery, Rue du Pr. Henri Serre, 34000 Montpellier, France
| | - Robert D Kilgour
- Department of Exercise Science, The Richard J. Renaud Science Complex, Room SP-165-17, Concordia University, Loyola Campus, 7141 Sherbrooke Street West, Montreal, QC H4B 1R6 Canada ; McGill Nutrition and Performance Laboratory (MNUPAL), McGill University Health Centre, Suite 105B, Place Vendome, 5252 de Maisonneuve Ouest, Montreal, QC H4A 3S5 Canada
| | - Chloé Janiszewski
- Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France ; Department of Clinical Research, Cancer Institute of Montpellier (ICM), Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France
| | - Marta Jarlier
- Biostatistics Unit, Cancer Institute of Montpellier (ICM), Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France
| | - Jocelyne Meuric
- Department of Dietetic and Nutrition, Curie Institute of Paris, 26 rue d'Ulm, 75248 Paris Cedex 05, France ; Group of Nutrition and Dietary Committees of Anti-Cancer Centers (Interclan CLCC), Villejuif, France
| | - Brigitte Poirée
- Department of Dietetic, Centre Francois Baclesse of Caen, 3 avenue du Général Harris, BP5026, 14076 Caen, France ; Group of Nutrition and Dietary Committees of Anti-Cancer Centers (Interclan CLCC), Villejuif, France
| | - Solange Buzzo
- Department of Dietetic, Centre Antoine Lacassagne of Nice, 33 Avenue de Valombrose, 06189 Nice Cedex 2, France ; Group of Nutrition and Dietary Committees of Anti-Cancer Centers (Interclan CLCC), Villejuif, France
| | - Grégory Ninot
- SIRIC Montpellier Cancer, Cancer Institute of Montpellier (ICM)-Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France ; Epsylon Research Unit EA 4556 Laboratory, Departments of Sport Sciences, Medicine and Psychology, University of Montpellier and University Paul Valery, Rue du Pr. Henri Serre, 34000 Montpellier, France
| | - Julie Courraud
- SIRIC Montpellier Cancer, Cancer Institute of Montpellier (ICM)-Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France
| | - Wendy Wismer
- Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5 Canada
| | - Simon Thezenas
- Biostatistics Unit, Cancer Institute of Montpellier (ICM), Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France
| | - Pierre Senesse
- SIRIC Montpellier Cancer, Cancer Institute of Montpellier (ICM)-Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France ; Epsylon Research Unit EA 4556 Laboratory, Departments of Sport Sciences, Medicine and Psychology, University of Montpellier and University Paul Valery, Rue du Pr. Henri Serre, 34000 Montpellier, France ; Department of Clinical Nutrition and Gastroenterology, Cancer Institute of Montpellier (ICM), Val d'Aurelle, 208 avenue des Apothicaires, Parc Euromédecine, 34298 Montpellier Cedex 5, France ; Group of Nutrition and Dietary Committees of Anti-Cancer Centers (Interclan CLCC), Villejuif, France
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Khemissa F, Mineur L, Amsellem C, Assenat E, Ramdani M, Bachmann P, Janiszewski C, Cristiani I, Collin F, Courraud J, de Forges H, Dechelotte P, Senesse P. A phase III study evaluating oral glutamine and transforming growth factor-beta 2 on chemotherapy-induced toxicity in patients with digestive neoplasm. Dig Liver Dis 2016; 48:327-32. [PMID: 26776879 DOI: 10.1016/j.dld.2015.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/13/2015] [Accepted: 11/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with gastrointestinal (GI) cancer are exposed to cachexia, which is highly correlated with chemotherapy-induced side effects. Research suggests that specific immunonutrients could prevent such toxicities. AIMS The primary objective of this phase III study was to evaluate the efficacy of glutamine and transforming growth factor-β2 (TGF-β2) in the prevention of grade 3-4 non-hematological toxicities induced by chemotherapy in patients with GI cancer. PATIENTS AND METHODS We designed a double-blind, randomized, controlled and multicenter trial stratified according to center, type of chemotherapy, presence of cachexia, and age. Patients were randomized to receive either Clinutren Protect(®) (CP) or a control isocaloric diet (without TGF-β2 or glutamine). RESULTS Between November 2007 and October 2011, 210 patients were enrolled in the study, of which 201 were included in the intention-to-treat analysis. Grade 3-4 non-hematological toxicities were not significantly different between the CP and control groups when evaluated by univariate and multivariate analyses. Likewise, no difference was observed regarding grade 3-4 hematological toxicities or reasons for treatment interruption. CONCLUSION This randomized study does not support the hypothesis that oral glutamine and TGF-β2 supplementation is effective to reduce grade 3 or 4 non-hematological toxicities induced by chemotherapy in patients with GI neoplasm.
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Affiliation(s)
- Faïza Khemissa
- Gastroenterology Department, Centre Hospitalier de Perpignan, Perpignan, France
| | - Laurent Mineur
- Digestive Oncology and Radiotherapy Unit, Institut Sainte Catherine, Avignon Cedex 9, Avignon, France
| | - Caroline Amsellem
- Nutrition Department, INSERM U1073, Institut de Recherche et d'Innovation Biomédicale, Université de Rouen, Rouen, France
| | - Eric Assenat
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Mohamed Ramdani
- Gastroenterology Department, Centre Hospitalier de Béziers, Béziers, France
| | - Patrick Bachmann
- Department of Clinical Nutrition, Centre Léon Bérard, Lyon, France
| | - Chloé Janiszewski
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | | | - Fideline Collin
- Clinical Research Department, Centre Hospitalier de Perpignan, Perpignan, France
| | - Julie Courraud
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Hélène de Forges
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Pierre Dechelotte
- Nutrition Department, INSERM U1073, Institut de Recherche et d'Innovation Biomédicale, Université de Rouen, Rouen, France
| | - Pierre Senesse
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; SIRIC Montpellier Cancer, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; Epsylon Laboratory, EA 4556 Dynamics of Human Abilities & Health Behaviors, Université de Montpellier, Montpellier, France.
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One-Year Mortality in Older Patients with Cancer: Development and External Validation of an MNA-Based Prognostic Score. PLoS One 2016; 11:e0148523. [PMID: 26859298 PMCID: PMC4747505 DOI: 10.1371/journal.pone.0148523] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/20/2016] [Indexed: 12/26/2022] Open
Abstract
Purpose The MNA (Mini Nutritional Assessment) is known as a prognosis factor in older population. We analyzed the prognostic value for one-year mortality of MNA items in older patients with cancer treated with chemotherapy as the basis of a simplified prognostic score. Methods The prospective derivation cohort included 606 patients older than 70 years with an indication of chemotherapy for cancers. The endpoint to predict was one-year mortality. The 18 items of the Full MNA, age, gender, weight loss, cancer origin, TNM, performance status and lymphocyte count were considered to construct the prognostic model. MNA items were analyzed with a backward step-by-step multivariate logistic regression and other items were added in a forward step-by-step regression. External validation was performed on an independent cohort of 229 patients. Results At one year 266 deaths had occurred. Decreased dietary intake (p = 0.0002), decreased protein-rich food intake (p = 0.025), 3 or more prescribed drugs (p = 0.023), calf circumference <31cm (p = 0.0002), tumor origin (p<0.0001), metastatic status (p = 0.0007) and lymphocyte count <1500/mm3 (0.029) were found to be associated with 1-year mortality in the final model and were used to construct a prognostic score. The area under curve (AUC) of the score was 0.793, which was higher than the Full MNA AUC (0.706). The AUC of the score in validation cohort (229 subjects, 137 deaths) was 0.698. Conclusion Key predictors of one-year mortality included cancer cachexia clinical features, comorbidities, the origin and the advanced status of the tumor. The prognostic value of this model combining a subset of MNA items and cancer related items was better than the full MNA, thus providing a simple score to predict 1-year mortality in older patients with an indication of chemotherapy.
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Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, Beretta GD, Nardi M, Laviano A, Zagonel V. Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer 2016; 7:131-5. [PMID: 26819635 PMCID: PMC4716844 DOI: 10.7150/jca.13818] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/01/2015] [Indexed: 12/23/2022] Open
Abstract
Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support. We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. "Alternative hypocaloric anti-cancer diets" (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status. Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients.
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Affiliation(s)
- Riccardo Caccialanza
- 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- 2. Division of Medical Oncology, Department of Hemato-Oncology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cecilia Gavazzi
- 3. Clinical Nutrition Unit, National Cancer Institute, Milan, Italy
| | - Carmine Pinto
- 4. Medical Oncology, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Agostino Paccagnella
- 5. Endocrinology, Metabolism and Nutrition Unit, Local Health Authority ULSS 9, Treviso, Italy
| | | | - Mariateresa Nardi
- 7. Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padova, Italy
| | | | - Vittorina Zagonel
- 9. Medical Oncology 1, Veneto Institute of Oncology-IRCCS, Padova, Italy
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Abdel-Rahman O, ElHalawani H, Essam-Eldin S. S-1-based regimens and the risk of oral and gastrointestinal mucosal injury: a meta-analysis with comparison to other fluoropyrimidines. Expert Opin Drug Saf 2015; 15:5-20. [PMID: 26513339 DOI: 10.1517/14740338.2016.1105959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND We performed a meta-analysis of the risk of oral and gastrointestinal (GI) mucosal injury associated with S-1-based regimens. PATIENTS AND METHODS Randomized phase II and III trials of patients with solid tumors on S-1; describing events of all-grade and high-grade stomatitis and diarrhea constituted the eligible studies. RESULTS After exclusion of ineligible studies, a total of 26 clinical trials were considered eligible for the meta-analysis. The odds ratio (OR) of all-grade and high-grade stomatitis for S-1 vs. non-fluoropyrimidine controls was 4.39 [95% CI: 1.05, 18.37; p = 0.04] and 5.64 [95% CI: 1.46, 21.77; p = 0.01], respectively; while the OR of all-grade and high-grade stomatitis for S-1 vs. infusional 5-fluorouracil (5-FU) control was -1.01 [95% CI: 0.22, 4.63; p = 0.99] and 0.32 [95% CI: 0.20, 0.49; p < 0.00001], respectively. The OR of all-grade and high-grade diarrhea for S-1 vs. non-fluoropyrimidine controls was 2.48 [95% CI: 2.12, 2.90; p < 0.00001] and 1.95 [95% CI: 1.29, 2.96; p = 0.002], respectively; while the OR of all-grade and high-grade diarrhea for S-1 vs. infusional 5-FU control was -1.03 [95% CI: 0.87, 1.22; p = 0.76] and 2.52 [95% CI: 1.80, 3.52; p < 0.00001], respectively. CONCLUSIONS Compared to non-fluoropyrimidine control, patients treated with S-1-based regimens have an increased risk of all-grade and high-grade stomatitis and diarrhea; while on the other hand, patients treated with infusional 5-FU have a greater risk of high-grade stomatitis and diarrhea compared to patients treated with S-1-based regimens.
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Affiliation(s)
- Omar Abdel-Rahman
- a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo 11665 , Egypt
| | - Hesham ElHalawani
- a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo 11665 , Egypt
| | - Shaimaa Essam-Eldin
- a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo 11665 , Egypt
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Duchosal S. Tolérance muqueuse et laser de basse énergie : la délégation aux manipulateurs en radiothérapie est-elle possible ? Cancer Radiother 2015; 19:548-51. [DOI: 10.1016/j.canrad.2015.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
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Peterson DE, Boers-Doets CB, Bensadoun RJ, Herrstedt J. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2015; 26 Suppl 5:v139-51. [PMID: 26142468 DOI: 10.1093/annonc/mdv202] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- D E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, Program in Head and Neck Cancer and Oral Oncology Program, Neag Comprehensive Cancer Center, UConn Health, Farmington, USA
| | - C B Boers-Doets
- Department of Clinical Oncology, Leiden University Medical Center, Leiden and IMPAQTT, Wormer, The Netherlands
| | | | - J Herrstedt
- Department of Oncology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Thureau S, Lefebvre L, Dandoy S, Guérault F, Ebran M, Lebreton M, Veresezan O, Rigal O, Clatot F. [Nutritional management of patients with head and neck cancer treated with radiation]. Cancer Radiother 2015; 19:552-5. [PMID: 26321684 DOI: 10.1016/j.canrad.2015.07.153] [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: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Abstract
Radiotherapy and chemotherapy are standard treatment of head and neck cancer alone or associated to surgical treatment. Early (during treatment or the following weeks) and late side effects contribute to malnutrition in this population at risk. In this context, nutritional support adapted by dietary monitoring and enteral nutrition (nasogastric tube or gastrostomy) are often necessary. The early identification of the patients with high malnutrition risk and requiring enteral nutrition is necessary to improve the tolerance and efficacy of treatment.
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Affiliation(s)
- S Thureau
- Quantif-Litis EA 4108, département de radiothérapie et de physique médicale, département de médecine nucléaire, centre Henri-Becquerel, 76038 Rouen, France.
| | - L Lefebvre
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - S Dandoy
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - F Guérault
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - M Ebran
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - M Lebreton
- Service de soins de support, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - O Veresezan
- Quantif-Litis EA 4108, département de radiothérapie et de physique médicale, département de médecine nucléaire, centre Henri-Becquerel, 76038 Rouen, France
| | - O Rigal
- Service de soins de support, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; Département d'oncologie médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - F Clatot
- Département d'oncologie médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
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Galmiche M, Besnard I, Palomba K, Eyraud E, Frin AC, Ouvrier D, Piche T, Schneider S, Hebuterne X. P262: Évaluation du caractère prédictif de l’échelle visuelle analogique (EVA) pour la détermination des ingesta des malades atteints d’un cancer. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: a two-year randomized controlled trial. PLoS One 2014; 9:e108687. [PMID: 25265392 PMCID: PMC4181649 DOI: 10.1371/journal.pone.0108687] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/22/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy, versus usual care, on one-year mortality. METHOD We conducted a multicentre, open-label interventional, stratified (centre), parallel randomised controlled trial, with a 1∶1 ratio, with two-year follow-up. Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition (MNA, Mini Nutritional Assessment 17-23.5). Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d, by face-to-face discussion targeting the main nutritional symptoms, compared to usual care. Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months. The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality, toxicities and chemotherapy outcomes. RESULTS Between April 2007 and March 2010 we randomised 341 patients and 336 were analysed: mean (standard deviation) age of 78.0 y (4·9), 51.2% male, mean MNA 20.2 (2.1). Distribution of cancer types was similar in the two groups; the most frequent were colon (22.4%), lymphoma (14.9%), lung (10.4%), and pancreas (17.0%). Both groups increased their dietary intake, but to a larger extent with intervention (p<0.01). At the second visit, the energy target was achieved in 57 (40.4%) patients and the protein target in 66 (46.8%) with the intervention compared respectively to 13 (13.5%) and 20 (20.8%) in the controls. Death occurred during the first year in 143 patients (42.56%), without difference according to the intervention (p = 0.79). No difference in nutritional status changes was found. Response to chemotherapy was also similar between the groups. CONCLUSION Early dietary counselling was efficient in increasing intake but had no beneficial effect on mortality or secondary outcomes. Cancer cachexia antianabolism may explain this lack of effect. TRIAL REGISTRATION ClinicalTrials.gov NCT00459589.
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