1
|
Bakaloudi DR, Papaemmanouil A, Vadarlis A, Makrakis D, Germanidis G, Timotheadou E, Chourdakis M. Critical evaluation and comparison of nutritional clinical practice guidelines for cancer patients. Clin Nutr 2023; 42:670-686. [PMID: 36944289 DOI: 10.1016/j.clnu.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The growing incidence of cancer globally, and the importance of nutrition support for these patients, emphasize the need for the development of nutritional clinical practice guidelines and consensus papers (CPGs) in the field. Numerous relevant CPGs have been published by several organizations worldwide. The aim of this systematic review was to compare the content of the existing CPGs and evaluate the quality of their development using the AGREE-II tool. METHODS A systematic literature search in PubMed, Embase and Web of Science databases was conducted for the identification of relevant CPGs and consensus papers. Eligible CPGs was blindly evaluated by four appraisers according to the Appraisal of Guidelines for Research and Evaluation ΙΙ (AGREE-II) tool. RESULTS In total 15 CPGs were identified and were evaluated. All but one set of CPGs underlined the importance of nutritional screening and assessment, whereas recommendations on nutritional interventions, supplements, management of complications and nutritional follow-up were also reported by several organizations. AGREE-II results showed that two CPGs were characterized as high, eight as moderate and five as low regarding their quality of development. CONCLUSIONS Variety on recommendations could be observed between CPGs that should be considered when applied into clinical practice. Limitations of the existing CPGs could be the fact that they are non-specific and only a minority of them are focused to specific cancer types. Frequent updates for CPGs and inclusion of more nutritional topics should be considered for some CPGs. Improvement of the quality of the CPGs development should also be pursued in future.
Collapse
Affiliation(s)
- Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece; Division of Medical Oncology, Department οf Medicine, University of Washington, Seattle, WA, USA
| | - Androniki Papaemmanouil
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Andreas Vadarlis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Gastroenterology and Hepatology, General Hospital of Thessaloniki ''G. Papanikolaou", Greece
| | - Dimitrios Makrakis
- Department of Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
| |
Collapse
|
2
|
Gouez M, Delrieu L, Bouleuc C, Girard N, Raynard B, Marchal T. Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study. Cancers (Basel) 2022; 14:cancers14143439. [PMID: 35884500 PMCID: PMC9322139 DOI: 10.3390/cancers14143439] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary It is estimated that 73% of advanced non-small cell lung cancers (NSCLC) will become malnourished and develop cachexia which is considered as an independent prognostic factor. Therefore, this study aimed to investigate the association between nutritional assessments and (i) immunotherapy efficacy, (ii) tolerance, and (iii) survival in patients with an advanced NSCLC stage of lung cancer treated with immunotherapy. In total, 67% of the 120 patients analysed were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status and the toxicity of immunotherapy. However, severe malnutrition was significantly associated with treatment efficacy and with a lower survival rate. Malnutrition appears to have a negative impact in the case of immunotherapy, in contrast to a high body mass index, which seems to be protective. In addition to confirming the benefits of early and appropriate nutritional management, research must also focus on catabolism and the uncontrolled inflammatory mechanisms. Abstract Malnutrition is associated with a greater risk of morbidity and mortality and lower tolerance to chemotherapy. Our purpose was to study the association between nutritional status and the efficiency and tolerance of immunotherapy in non-small cell lung cancer (NSCLC). Nutritional and oncological data were reported at 2 months (M2) and 4 months (M4) after the initiation of immunotherapy (M0). The influence of nutritional status at M0 was estimated with the efficacy and toxicity of immunotherapy at M2 to M4. In total, 127 patients were included in the study, and nutritional status was estimated at M0 for 120 patients: 67% were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status at M0 and the toxicity of immunotherapy at M2 and M4. However, severe malnutrition was significantly associated with treatment efficacy at M2 (p = 0.04) and with a lower survival rate with an HR (Hazard Ratio) = 2.32–95% C.I: 1.13–4.75 (p = 0.02). Furthermore, a monthly decrease of 1% of the weight had an HR = 1.17–95% C.I: 1.13–1.21 (p = 0.0001). Severe malnutrition and weight loss are independent factors associated with lower survival. Studies integrating the systemic detection of sarcopenia with a closer nutritional follow-up could highlight an improvement in survival.
Collapse
Affiliation(s)
- Manon Gouez
- Department of Prevention Cancer Environment, Léon Bérard Cancer Centre, 69008 Lyon, France;
| | - Lidia Delrieu
- Residual Tumour & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France;
| | - Carole Bouleuc
- Department of Supportive Care, Institut Curie, 75005 Paris, France;
| | - Nicolas Girard
- Institut Curie, Institut du Thorax Curie Montsouris, 75005 Paris, France;
| | - Bruno Raynard
- Department of Supportive Care, Unité Transversale de Diététique et de Nutrition Centre Gustave-Roussy, 94800 Villejuif, France;
| | - Timothée Marchal
- Department of Supportive Care, Institut Curie, 75005 Paris, France;
- Correspondence:
| |
Collapse
|
4
|
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017. [DOI: 10.1016/j.clnu.2016.07.015 10.1016/j.clnu.2016.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
7
|
Abstract
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|