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Crichton M, Marshall S, Isenring E, Lohning A, McCarthy AL, Molassiotis A, Bird R, Shannon C, Koh A, McPherson I, Marx W. Effect of a Standardized Ginger Root Powder Regimen on Chemotherapy-Induced Nausea and Vomiting: A Multicenter, Double-Blind, Placebo-Controlled Randomized Trial. J Acad Nutr Diet 2024; 124:313-330.e6. [PMID: 37699474 DOI: 10.1016/j.jand.2023.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 08/02/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND There is substantial interest in the role of ginger as an adjuvant therapy for chemotherapy-induced nausea and vomiting (CINV). However, available evidence lacks robust methodology. OBJECTIVE To assess the effect of adjuvant ginger compared with placebo on chemotherapy-induced nausea-related quality of life (QoL) and CINV-related outcomes. DESIGN A parallel, double-blind, placebo-controlled randomized trial with 1:1 allocation was conducted. PARTICIPANTS/SETTING One hundred three chemotherapy-naïve adults scheduled to receive moderately to highly emetogenic chemotherapy at two hospitals in Australia were enrolled and analyzed. INTERVENTION Four standardized ginger capsules (totaling 84 mg/day active gingerols/shogaols), or placebo, were administered commencing the day of chemotherapy and continuing for 5 days for chemotherapy cycles 1 through 3. MAIN OUTCOME MEASURES The primary outcome was chemotherapy-induced nausea-related QoL. Secondary outcomes were vomiting- and CINV-related QoL; anticipatory, acute, and delayed nausea and vomiting; fatigue; nutritional status; depression and anxiety; health-related QoL; and adverse events. STATISTICAL ANALYSES PERFORMED Intention-to-treat analysis was performed. Mixed analysis of variance with repeated measures determined differences between groups. The null hypothesis was no difference between groups. After applying a Bonferroni multiple testing correction, evidence against the null hypothesis was considered at P= 0.003. RESULTS One hundred three participants (ginger: n = 52; placebo: n = 51) were enrolled and analyzed. There was clinically relevant evidence against the null hypothesis, favoring ginger, in change scores for nausea-related QoL (F[df] = 9.34[1,101]; P = 0.003; partial η2 = 0.09), overall CINV-related QoL (F[df] = 12.26[1,101]; P < 0.001; partial η2 = 0.11), delayed nausea severity (F[df] = 9.46[1,101]; P = 0.003; partial η2 = 0.09), and fatigue (F[df] = 10.11[1,101]; P = 0.002; partial η2 = 0.09). There was a clinically meaningful lower incidence of delayed nausea and vomiting in the ginger group at Cycle 2 (53% vs 75%; P = 0.020 and 4% vs 27%; P = 0.001, respectively) and Cycle 3 (49% vs 79%; P = 0.002 and 2% vs 23%; P = 0.001, respectively). There was a clinically meaningful lower incidence of malnutrition in the ginger group at Cycle 3 (18% vs. 41%; P = 0.032) and in change scores for Patient-Generated Subjective Global Assessment (F[df)] = 4.32[1,100]; P = 0.040; partial η2 = 0.04). Change scores between groups favored ginger for vomiting-related QoL and number of vomiting episodes; however, findings were not clinically meaningful. There was no effect of ginger on anticipatory or acute CINV, health-related QoL, anxiety, or depression. No serious adverse events were reported. CONCLUSIONS Ginger supplementation was a safe adjuvant to antiemetic medications for CINV that enhanced QoL during chemotherapy treatment. Future trials are needed to examine dose-dependent responses to verify optimal dosing regimens.
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Affiliation(s)
- Megan Crichton
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Skye Marshall
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; Research Institute for Future Health, Gold Coast, Queensland, Australia
| | - Elizabeth Isenring
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; Research Institute for Future Health, Gold Coast, Queensland, Australia
| | - Anna Lohning
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Alexandra L McCarthy
- School of Nursing, Midwifery, and Social Work, University of Queensland, and Mater Research Institute, Brisbane, Queensland, Australia
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong; College of Arts, Humanities and Education, Universtiy of Derby, Derby, UK
| | - Robert Bird
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Catherine Shannon
- Oncology Department, Mater Cancer Care Centre, South Brisbane, Queensland, Australia
| | - Andy Koh
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia; Department of Legal Medicine, Faculty of Medicine, KINDAI Univeristy, Osaka, Japan
| | - Ian McPherson
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Wolfgang Marx
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Deakin University Institute for Mental and Physical Health and Clinical Translation, Food and Mood Centre, Geelong, Victoria, Australia
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Phillips I, Allan L, Hug A, Westran N, Heinemann C, Hewish M, Mehta A, Saxby H, Ezhil V. Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial. BMJ Support Palliat Care 2023; 13:e213-e219. [PMID: 33563774 DOI: 10.1136/bmjspcare-2020-002838] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION European Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention. METHODS In this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA), RESULTS: 96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention. CONCLUSION A large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.
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Affiliation(s)
- Iain Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Adele Hug
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Naomi Westran
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Claudia Heinemann
- Department of Nutrition and Dietetics, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Madeleine Hewish
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Ajay Mehta
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Helen Saxby
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Veni Ezhil
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Zhao Z, Lin J, Chen S, Wang X, Wang H, Xu G, Wang J, Zhou R, Huang Z, Li Y, Zhang Y, Liu X, Wang P, Huang M, Luo Y, Yu H. Clinical atlas of rectal cancer highlights the barriers and insufficient interventions underlying the unfavorable outcomes in older patients. Heliyon 2023; 9:e15966. [PMID: 37215849 PMCID: PMC10196521 DOI: 10.1016/j.heliyon.2023.e15966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
Background Aging confers an increased risk of developing cancer, and the global burden of cancer is cumulating as human longevity increases. Providing adequate care for old patients with rectal cancer is challenging and complex. Method A total of 428 and 44,788 patients diagnosed with non-metastatic rectal cancer from a referral tertiary care center (SYSU cohort) and the Surveillance Epidemiology and End Results database (SEER cohort) were included. Patients were categorized into old (over 65 years) and young (aged 50-65 years) groups. An age-specific clinical atlas of rectal cancer was generated, including the demographic and clinicopathological features, molecular profiles, treatment strategies, and clinical outcomes. Results Old and young patients were similar in clinicopathological risk factors and molecular features, including TNM stage, tumor location, tumor differentiation, tumor morphology, lymphovascular invasion, and perineural invasion. However, old patients had significantly worse nutritional status and more comorbidities than young patients. In addition, old age was independently associated with less systemic cancer treatment (adjusted odds ratio 0.294 [95% CI 0.184-0.463, P < 0.001]). We found that old patients had significantly worse overall survival (OS) outcomes in both SYSU (P < 0.001) and SEER (P < 0.001) cohorts. Moreover, the death and recurrence risk of old patients in the subgroup not receiving chemo/radiotherapy (P < 0.001 for OS, and P = 0.046 for time to recurrence [TTR]) reverted into no significant risk in the subgroup receiving chemo/radiotherapy. Conclusions Although old patients had similar tumor features to young patients, they had unfavorable survival outcomes associated with insufficient cancer care from old age. Specific trials with comprehensive geriatric assessment for old patients are needed to identify the optimal treatment regimens and improve unmet cancer care. Study registration The study was registered on the research registry with the identifier of researchregistry 7635.
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Affiliation(s)
- Zhuoyang Zhao
- Department of Spine Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Jinxin Lin
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Shunlun Chen
- Department of Spine Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Xiaolin Wang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Heng Wang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Gaopo Xu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Jianru Wang
- Department of Spine Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ruwen Zhou
- Department of Biostatistics, the Joseph L. Mailman School of Public Health, Columbia University, New York, 10032, United States
| | - Zenghong Huang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Yingjie Li
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Yu Zhang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Xiaoxia Liu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Puning Wang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Meijin Huang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Yanxin Luo
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
| | - Huichuan Yu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
- Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China
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Zhang L, Chen S, Huang M, Wang W, Liang Y, Wang Y. Prognostic value of the nutritional risk index in patients with newly diagnosed multiple myeloma. Ann Hematol 2023; 102:125-132. [PMID: 36441260 PMCID: PMC9807469 DOI: 10.1007/s00277-022-05059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022]
Abstract
The nutritional risk index (NRI), which is based on weight and albumin levels, is closely associated with the prognosis of many cancers. However, its prognostic value has not been investigated in patients with newly diagnosed multiple myeloma (NDMM). We aimed to assess the association between the NRI and survival outcomes in patients with NDMM. We retrospectively collected and analyzed clinical and laboratory data from patients with NDMM between 2005 and 2019 at our center. Patients were stratified into the high NRI (> 89) and low NRI (≤ 89) groups for prognostic analysis. The NRI and other variables were also explored to evaluate their prognostic value for overall survival (OS). A total of 638 patients diagnosed with NDMM were retrospectively included. Patients in the high NRI group had a significantly better median OS than those in the low NRI group (64 months vs 43 months, p < 0.001). In the multivariate analysis, a high NRI was shown to be an independent prognostic factor for OS (hazard ratio, 0.758; 95% confidence interval, 0.587-0.977; p = 0.033). Age, performance status, transplant status, and lactate dehydrogenase level were also independent prognostic factors for OS. In conclusion, our study demonstrates that the NRI is a simple and useful predictor of survival outcomes in patients with NDMM.
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Affiliation(s)
- Limei Zhang
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China ,grid.488530.20000 0004 1803 6191Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060 People’s Republic of China
| | - Shuzhao Chen
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China ,grid.488530.20000 0004 1803 6191Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060 People’s Republic of China
| | - Mayan Huang
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China ,grid.488530.20000 0004 1803 6191Department of Pathology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Weida Wang
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China ,grid.488530.20000 0004 1803 6191Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060 People’s Republic of China
| | - Yang Liang
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China ,grid.488530.20000 0004 1803 6191Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060 People’s Republic of China
| | - Yun Wang
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China ,grid.488530.20000 0004 1803 6191Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060 People’s Republic of China
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Percy KL, Ooi YX, Nahm CB, Simpson F, Hickey G, Sahni S, Chesher D, Itchins M, Pavlakis N, Tsang VH, Clifton-Bligh R, Gill AJ, Samra JS, Mittal A. Defining the rate of nutritional and metabolic derangements after pancreatic resection. Pancreatology 2022; 22:1028-1034. [PMID: 35948507 DOI: 10.1016/j.pan.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Pancreatic resection is associated with pancreatic exocrine insufficiency (PEI) leading to nutritional consequences. The Pancreatic Nutrition Clinic was established to diagnose and manage PEI through standardised nutritional assessment. In this prospective observational study, we aimed to define the rate of PEI, diabetes mellitus and nutritional abnormalities in patients who underwent pancreatic resection. METHODS All Pancreatic Nutrition Clinic patients were included for analysis. Clinical data were prospectively obtained at initial assessment. Biochemical data included micronutrient levels, faecal elastase-1 and haemoglobin A1c. Bone mineral density and nutritional assessment were undertaken. RESULTS Ninety-eight patients were included. Fifty-nine per cent (58/98) had undergone a pancreatoduodenectomy. Ninety-three patients had a faecal elastase-1 result, 65% (60/93) of which had a faecal elastase-1 less than 200 μg/g of faeces. Seventy-five patients (76%) of the total population required PERT, and thirty-nine (40%) were classified as malnourished using the patient-generated subjective global assessment tool. Seventy-two per cent (70/97) had a biochemical deficiency of one or more micronutrients. Thirty-eight people (39%) had diabetes mellitus. Of the seventy-eight patients with a bone mineral density scan available for analysis, 29% (23/78) had osteoporosis and 49% (38/78) osteopenia. CONCLUSIONS Pancreatic exocrine insufficiency, micronutrient deficiency, bone disease, diabetes mellitus and malnutrition are highly prevalent in patients who have undergone pancreatic resection.
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Affiliation(s)
- K L Percy
- Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia.
| | - Y X Ooi
- Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia; Sydney Vital, Sydney, NSW, Australia
| | - C B Nahm
- Sydney Vital, Sydney, NSW, Australia; Upper GI Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - F Simpson
- Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - G Hickey
- Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - S Sahni
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - D Chesher
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Biochemistry, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - M Itchins
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - N Pavlakis
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - V H Tsang
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Endocrinology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - R Clifton-Bligh
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Endocrinology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - A J Gill
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Australian Pancreatic Centre, Sydney, NSW, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute, The University of Sydney, Australia
| | - J S Samra
- Upper GI Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia; NSW Health Pathology, Macquarie University, North Ryde, NSW, Australia; Australian Pancreatic Centre, Sydney, NSW, Australia
| | - A Mittal
- Upper GI Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Australian Pancreatic Centre, Sydney, NSW, Australia; University of Notre Dame Australia, Australia
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Gala D, Wright HH, Zigori B, Marshall S, Crichton M. Dietary strategies for chemotherapy-induced nausea and vomiting: A systematic review. Clin Nutr 2022; 41:2147-2155. [PMID: 36067586 DOI: 10.1016/j.clnu.2022.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/14/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing cancer treatment side effects, affecting 20-70% of patients despite routine antiemetic prescription. Although dietary modifications are routinely recommended in clinical practice, there is lack of data synthesis to determine which dietary strategies for managing CINV are supported by quality evidence. This systematic review was conducted to examine the effect of dietary strategies on incidence and severity of CINV in adults compared with no intervention, usual care, or alternative strategies. METHODS Five electronic databases were searched from inception to 15th July 2021 for original research studies of interventional or observational design assessing dietary strategies for CINV. The quality of evidence was appraised, data were synthesized narratively, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment of the certainty of the evidence was applied. RESULTS Twenty-one studies were included, 10 (48%) interventional studies and 11 (52%) observational studies. Most interventional and observational studies had a high or neutral risk of bias (70% and 72%, respectively). Of the interventions studied, strongest evidence with highest certainty was found for the very large positive effect of CINV-specific education and support with a personalized meal plan from a dietician, implemented in person or in writing, for reducing the severity of nausea and overall CINV (effect size: very large; GRADE: high). A statistically significant very large positive effect of ginger tea consumption was also found on overall CINV severity; however, certainty in this effect was very low. Although confidence in the findings from observational studies was very low to low, a statistically significant positive association was also found between a moderate intake of alcohol and incidence of nausea, vomiting, or overall CINV as well as nausea severity; the Mediterranean diet and nausea incidence and severity; and adequate intake of energy, protein, fat, or carbohydrate and nausea or vomiting incidence. CONCLUSION Improved CINV was associated with CINV-specific nutrition education and support from health professionals. Non-restrictive dietary patterns that include adequate energy and macronutrient intakes, particularly protein, and include ginger, and Mediterranean diet concepts may benefit CINV; however, the confidence in the body of evidence to inform these conclusions is mostly very low to moderate. Future rigorous trials with adequate sample sizes, clearly defined dietary strategies, and valid outcome measures are warranted prior to dietary strategies being routinely prescribed alongside antiemetic regimens.
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Affiliation(s)
- Devanshi Gala
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science & Medicine, Bond University, Robina, Queensland, Australia.
| | - Hattie H Wright
- School of Health, University of the Sunshine Coast, Queensland, Australia; Sunshine Coast Health Institute, Birtinya, Queensland, Australia.
| | - Bekhinkosi Zigori
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science & Medicine, Bond University, Robina, Queensland, Australia.
| | - Skye Marshall
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science & Medicine, Bond University, Robina, Queensland, Australia; Research Institute for Future Health, Gold Coast, Queensland, Australia.
| | - Megan Crichton
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science & Medicine, Bond University, Robina, Queensland, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
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7
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Khorasanchi A, Nemani S, Pandey S, Del Fabbro E. Managing Nutrition Impact Symptoms in Cancer Cachexia: A Case Series and Mini Review. Front Nutr 2022; 9:831934. [PMID: 35308290 PMCID: PMC8928189 DOI: 10.3389/fnut.2022.831934] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/07/2022] [Indexed: 12/31/2022] Open
Abstract
Malnutrition is common in cancer patients and can occur throughout a patient’s disease course. The contributors to the clinical syndrome of cancer cachexia are often multifactorial, and produced by the cancer and associated pro-inflammatory response. Since cancer cachexia is a multifactorial syndrome, a multimodal therapeutic approach is ideal. A key component of therapy is identifying and managing symptom barriers to adequate oral intake, known as nutritional impact symptoms (NIS). NIS are associated with reduced intake and weight loss in patients with advanced cancer, and aggregate NIS are a predictor of survival in patients with Head and Neck Cancer and in patients undergoing surgery for esophageal cancer. Currently, there are no guidelines regarding the specific management of NIS in oncology patients. Experience from specialist centers suggest relatively simple assessments and inexpensive interventions are available for the diagnosis and treatment of NIS. We present three patient cases from a cachexia clinic, where NIS management decreased symptom burden and improved clinical outcomes such as weight and physical performance.
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Affiliation(s)
- Adam Khorasanchi
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
| | - Srinidhi Nemani
- Virginia Commonwealth University, Richmond, VA, United States
| | - Sudeep Pandey
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
| | - Egidio Del Fabbro
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Egidio Del Fabbro,
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8
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Kadakia KC, Symanowski JT, Aktas A, Szafranski ML, Salo JC, Meadors PL, Walsh D. Malnutrition risk at solid tumor diagnosis: the malnutrition screening tool in a large US cancer institute. Support Care Cancer 2022; 30:2237-2244. [PMID: 34709459 PMCID: PMC8551662 DOI: 10.1007/s00520-021-06612-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/30/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND In cancer, malnutrition is common and negatively impacts tolerance and outcomes of anti-tumor therapies. The aim of this study was to evaluate the prevalence of malnutrition risk and compare the clinicodemographic features between those with high malnutrition screening tool (MST) scores (i.e., ≥ 2 of 5 = high risk for malnutrition, H-MST) to low scores (L-MST). METHODS A cohort of 3585 patients (May 2017 through December 2018), who completed the MST at least once at the time of diagnosis of any stage solid tumor, were analyzed. Logistic regression tested for associations between clinicodemographic factors, symptom scores, and H-MST prevalence. RESULTS The median age was 64 years (25-75 IQR, 55-72), with 62% females and 81% White. Most common tumor primary sites were breast (28%), gastrointestinal (GI) (21%), and thoracic (13%). Most had non-metastatic disease (80%). H-MST was found in 28%-most commonly in upper (58%) and lower GI (42%), and thoracic (42%) tumors. L-MST was most common in breast (90%). Multivariable regression confirmed that Black race (OR 1.9, 95% CI 1.5-2.4, p = < 0.001), cancer primary site (OR 1.6-5.7, p = < 0.001), stage IV disease (OR 1.8, 95% CI 1.4-2.2, p = < 0.001), low BMI (OR 4.2, 95% CI 2.5-6.9 p = < 0.001), and higher symptom scores were all independently associated with H-MST. CONCLUSIONS Twenty-eight percent of solid tumor oncology patients at diagnosis were at high risk of malnutrition. Patients with breast cancer rarely had malnutrition risk at diagnosis. Significant variation was found in malnutrition risk by cancer site, stage, race, and presence of depression, distress, fatigue, and trouble eating/swallowing.
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Affiliation(s)
- Kunal C. Kadakia
- Department of Solid Tumor Oncology and Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC 28204 USA
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC USA
| | - James T. Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC USA
| | - Aynur Aktas
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC USA
| | - Michele L. Szafranski
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC USA
| | - Jonathan C. Salo
- Department of Surgery, Division of Surgical Oncology, Levine Cancer Institute, Charlotte, NC USA
| | - Patrick L. Meadors
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC USA
| | - Declan Walsh
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC USA
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9
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Loeliger J, Dewar S, Kiss N, Drosdowsky A, Stewart J. Patient and carer experiences of nutrition in cancer care: a mixed-methods study. Support Care Cancer 2021; 29:5475-5485. [PMID: 33710413 DOI: 10.1007/s00520-021-06111-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/24/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Evidence-based guidelines exist to guide health professionals and services about cancer nutrition care; however, the views of cancer patients and carers are not well understood. This study aimed to understand the experience and needs of cancer patients and carers regarding nutrition care across the care continuum. METHODS Using a mixed-methods approach, cancer patients and carers completed a cross-sectional online survey and focus groups. Participants were recruited through health services and cancer organisation consumer networks via email distribution lists, e-newsletters, and social media. Focus groups were audio-recorded, transcribed, and analysed using content analysis. RESULTS Of 165 survey respondents, only 51% (n=84) reported they talked to a health professional about their nutrition care at any time-point, and only 32% with a dietitian. The majority (84%) of patients and carers felt nutrition was important at one or more time-points in their cancer path, indicating during and after cancer treatment the most important. However, perceived support from health professionals for nutrition care was deemed low at all time-points. Five focus groups were held (n=20; 16 patients, 2 carers, 2 both patients/carers) and five themes emerged: nutrition information, experiences and need; control over diet and nutrition; importance and value of nutrition; access to support; what optimal nutrition care looks like. CONCLUSION Patients and carers felt nutrition was important during their cancer path, but perceived support from health professionals for nutrition care was low. This study has highlighted patient and carer nutrition experiences that will inform development of a co-designed optimal cancer nutrition care pathway.
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Affiliation(s)
- Jenelle Loeliger
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - Sarah Dewar
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicole Kiss
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Allison Drosdowsky
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jane Stewart
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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10
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Johnston EA, Ibiebele TI, van der Pols JC, Webb PM. Dietitian encounters after treatment for ovarian cancer. J Hum Nutr Diet 2021; 34:1053-1063. [PMID: 33749900 DOI: 10.1111/jhn.12898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND After ovarian cancer treatment, women report health issues that may be amenable to change with dietary support. The present study investigated how many women encounter a dietitian post-treatment and the factors associated with dietitian service use. METHODS We used data from a cohort of women with invasive epithelial ovarian cancer to identify socio-economic, clinical and personal factors associated with dietitian encounter after treatment completion. Data were collected at regular intervals using validated questionnaires up to 4 years post-treatment completion. Logistic regression (LR) and generalised linear mixed models (GLMM) were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) to assess factors associated with dietitian encounter at any time-point post-treatment (LR), as well as in the 3 months prior to a follow-up questionnaire (GLMM) to assess time-varying factors. RESULTS Of 819 women, 97 (12%) reported seeing a dietitian post-treatment. Factors associated with dietitian encounter were being overweight (ORLR = 1.7, CI = 1.1-2.8), having poorer self-rated health (ORLR = 2.5, CI = 1.2-5.2; ORGLMM = 2.3, CI = 1.2-4.4) or poorer diet quality (ORLR = 0.5, CI = 0.2-1.0) pre-diagnosis, treatment within the public health system (ORGLMM = 1.8, CI = 1.2-2.7), previous support from dietetic (ORLR = 3.1, CI = 1.8-5.4; ORGLMM = 2.8, CI = 1.8-4.2) or other allied health services (ORLR = 2.0, CI = 1.2-3.2; ORGLMM = 3.7, CI = 2.4-5.5), and having progressive disease at follow-up (ORGLMM = 2.2, CI = 1.4-3.3). Most women (86%) with ≥ 3 moderate-to-severe nutrition impact symptoms did not report a dietitian encounter post-treatment. CONCLUSIONS Few women encounter a dietitian post-treatment for ovarian cancer, including those with multiple nutrition impact symptoms. Further work is needed to engage those likely to benefit from dietitian support but less likely to seek or receive it.
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Affiliation(s)
- Elizabeth A Johnston
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Torukiri I Ibiebele
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Jolieke C van der Pols
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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11
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Chen L, Wu X, Chen X, Zhou C. Efficacy of Auricular Acupressure in Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:8868720. [PMID: 34394394 PMCID: PMC8357499 DOI: 10.1155/2021/8868720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 06/14/2021] [Accepted: 07/22/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND More than 40% of patients with cancer have reported that chemotherapy-induced nausea and vomiting (CINV) remained the most debilitating side effects of treatment even in the era of new antiemetics. OBJECTIVE The purpose of this review was to systematically evaluate the clinical effect of auricular acupressure (AA) in prevention and treatment of chemotherapy-induced nausea and vomiting. METHODS The following databases were searched: PubMed, Cochrane Library, EMBASE, the Web of Science, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang, and VIP (from database inception to April 2020). Eligible randomized controlled trials of auricular acupressure in treating CINV were collected, including crossover randomized design study. The meta-analysis was carried out by RevMan software (5.3). RESULTS Totally 19 RCTs with 1449 patients met the inclusion criteria. Compared with control groups, the relief efficiency of overall CINV was enhanced by AA combined with antiemetics (RR = 1.31, CI 1.22 to 1.41, p ≤ 0.001). Although the therapeutic effect on acute nausea and vomiting was not obvious, AA still played an important role in reducing delayed nausea and vomiting (delayed nausea frequency: RR = 0.68, CI -1.01 to -1.35, p ≤ 0.001; delayed vomiting frequency: RR = 0.91, CI -1.22 to -0.61, p ≤ 0.001). The likelihood of adverse reactions related to antiemetics was reduced by AA combined with antiemetics (RR = 0.62, CI 0.53 to 0.74, p ≤ 0.001). Statistically significant association was found between AA and incidence of constipation, diarrhea, and tiredness, while there was no statistically significant association between AA and abdominal distension or headache. CONCLUSION Auricular acupressure supplementation benefited delayed chemotherapy-induced nausea and vomiting as well as constipation, diarrhea, and tiredness. AA alone or AA supplementation has little effect on acute nausea and acute vomiting. There is no conclusion on whether AA alone is superior to antiemetics in the management of delayed CINV. Further studies are needed to confirm the efficacy of auricular acupressure alone in delayed CINV and anticipatory CINV. The results of this review provided the basis for further research with more rigorous study designs, adequate sample sizes, and standardized implementation to confirm the efficacy of auricular acupressure.
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Affiliation(s)
- Lichan Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Xiaohong Wu
- Shantou University Medical College, Shantou, China
| | - Xisui Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Chunjiao Zhou
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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12
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Kiss N, Loeliger J, Findlay M, Isenring E, Baguley BJ, Boltong A, Butler A, Deftereos I, Eisenhuth M, Fraser SF, Fichera R, Griffin H, Hayes S, Jeffery E, Johnson C, Lomma C, van der Meij B, McIntyre C, Nicholls T, Pugliano L, Skinner T, Stewart J, Bauer J. Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia. Nutr Diet 2020; 77:416-425. [PMID: 32803904 PMCID: PMC7540290 DOI: 10.1111/1747-0080.12631] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/30/2022]
Abstract
This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer‐related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence‐based guidelines, systematic reviews and meta‐analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as “at risk” of malnutrition or with a high‐risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment; people identified as “at risk” of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer‐related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer‐related malnutrition and sarcopenia should be individualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer‐related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenelle Loeliger
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Anna Boltong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Butler
- GP Liaison, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery Western Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition and Dietetics, Western Health, Melbourne, Victoria, Australia
| | - Michelle Eisenhuth
- Nutrition and Dietetics Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Fichera
- Nutrition and Dietetics Departments, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hayley Griffin
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Jeffery
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Catherine Johnson
- Gastrointestinal Cancer Service, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Chris Lomma
- Medical Oncology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Barbara van der Meij
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Dietetics and Food Services, Mater Health, Brisbane, Queensland, Australia
| | - Carolyn McIntyre
- School of Medical and Health Science, Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Tracey Nicholls
- Department of ENT Otolaryngology Head and Neck Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lina Pugliano
- Medical Oncology, Northern Cancer Institute, Sydney, New South Wales, Australia
| | - Tina Skinner
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Jane Stewart
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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13
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Marshall AP, Tobiano G, Roberts S, Isenring E, Sanmugarajah J, Kiefer D, Fulton R, Cheng HL, To KF, Ko PS, Lam YF, Lam W, Molassiotis A. End-user perceptions of a patient- and family-centred intervention to improve nutrition intake among oncology patients: a descriptive qualitative analysis. BMC Nutr 2020; 6:29. [PMID: 32699640 PMCID: PMC7372777 DOI: 10.1186/s40795-020-00353-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background People with cancer are at high risk of malnutrition. Nutrition education is an effective strategy to improve patient outcomes, however, little is known regarding the impact of family and/or carer involvement in nutrition education and requires investigation. The purpose of the study was to evaluate PIcNIC (Partnering with families to promote nutrition in cancer care) intervention acceptability from the perspective of patients, families and health care providers. Methods A descriptive qualitative study was undertaken at an inpatient and an outpatient hospital setting in Australia and an outpatient/home setting in Hong Kong. A patient-and-family centred intervention including nutrition education, goals setting/nutrition plans, and food diaries, was delivered to patients and/or families in the inpatient, outpatient or home setting. Semi-structured interviews were used to explore perceptions of the intervention. 64 participants were interviewed; 20 patients, 15 family members, and 29 health care professionals. Data were analysed using deductive and inductive content analysis. Results Two categories were identified; 1) ‘context and intervention acceptability’; and 2) ‘benefits of patient- and family-centred nutrition care’. Within each category redundant concepts were identified. For category 1 the redundant concepts were: the intervention works in outpatient settings, the food diary is easy but needs to be tailored, the information booklet is a good resource, and the intervention should be delivered by a dietitian, but could be delivered by a nurse. The redundant concepts for category 2 were: a personalised nutrition plan is required, patient and family involvement in the intervention is valued and the intervention has benefits for patients and families. Converging and diverging perceptions across participant groups and settings were identified. Conclusions In this paper we have described an acceptable patient- and family-centred nutrition intervention, which may be effective in increasing patient and family engagement in nutrition care and may result in improved nutrition intakes. Our study highlights important contextual considerations for nutrition education; the outpatient and home setting are optimal for engaging patients and families in learning opportunities.
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Affiliation(s)
- Andrea P Marshall
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215 Australia.,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD 4215 Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast Campus Parklands Drive, Southport, QLD 4215 Australia
| | - Georgia Tobiano
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215 Australia.,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD 4215 Australia
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD 4215 Australia.,Division of Allied Health, Gold Coast Health 1 Hospital Blvd, Southport, QLD 4215 Australia.,School of Allied Health, Griffith University, Parklands Drive, Southport, QLD 4215 Australia
| | - Elisabeth Isenring
- Nutrition & Dietetics, Faculty of Health Sciences & Medicine, Bond University Level 2, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD 4226 Australia
| | - Jasotha Sanmugarajah
- Medical Oncology, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215 Australia
| | - Deborah Kiefer
- Division of Allied Health, Gold Coast Health 1 Hospital Blvd, Southport, QLD 4215 Australia
| | - Rachael Fulton
- School of Allied Health, Griffith University, Parklands Drive, Southport, QLD 4215 Australia
| | - Hui Lin Cheng
- School of Nursing, Faculty of Health and Social Sciences, Room A401, Chung Sze Yuen Building, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ki Fung To
- Dietetics Department, Alice Ho Miu Ling Nethersole Hospital Hospital Authority, Chuen On Rd, Tai Po, Hong Kong
| | - Po Shan Ko
- Kowloon East Cluster, Hospital Authority, Hong Kong, China
| | - Yuk Fong Lam
- Department of Medicine, Haven of Hope Hospital, Haven of Hope Rd, 8, Tseung Kwan O, Hong Kong
| | - Wang Lam
- Dietetics Department, Haven of Hope Hospital, Haven of Hope Rd, 8, Tseung Kwan O, Hong Kong
| | - Alex Molassiotis
- School of Nursing, Faculty of Health and Social Sciences, Room A401, Chung Sze Yuen Building, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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14
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Zhang X, Pang L, Sharma SV, Li R, Nyitray AG, Edwards BJ. Malnutrition and overall survival in older patients with cancer. Clin Nutr 2020; 40:966-977. [PMID: 32665101 DOI: 10.1016/j.clnu.2020.06.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 04/15/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS In this study, we assessed the prevalence of malnutrition and its association with overall survival among patients with cancer aged 65 years and older. METHODS In this retrospective cohort study, patients receiving cancer care underwent a comprehensive geriatric assessment (CGA). Malnutrition status was determined through the CGA. We used univariate and multivariable Cox regression survival analyses to assess the association between baseline malnutrition and survival. RESULTS A total of 454 patients with cancers were included in the analysis. The median age was 78 years and men and women were equally represented. Forty-two percent (n = 190) were malnourished at baseline, and 33% died during the follow-up (range 0.2-51.1 month). Univariate analysis showed that malnutrition increased the risk of all-cause mortality in older patients with cancer (HR, 1.49; 95% CI, 1.08-2.05; p = 0.01). In the multivariate Cox regression model, malnutrition increased the risk of all-cause mortality (HR, 1.87; 95% CI, 1.10-3.17; p = 0.02) in older patients with solid tumors. However, malnutrition did not increase the risk of all-cause mortality for hematologic malignancies. CONCLUSIONS In our study, we found that malnutrition was a risk factor for mortality in older cancer patients, especially in older patients with solid tumors. Prospective inter ventional studies are recommended.
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Affiliation(s)
- Xiaotao Zhang
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, USA; Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas, Health Science Center at Houston, USA
| | - Linda Pang
- General Internal Medicine, University of Texas, MD Anderson Cancer Center, USA
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas, Health Science Center at Houston, USA
| | - Ruosha Li
- Department of Biostatistics and Data Science, University of Texas, Health Science Center at Houston, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin Cancer Center, USA
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Garzón Herazo JR, Muñoz Velandia OM, Solano JC, Molina Pimienta L, Figueroa Lemus WJ. The nutrition risk index is associated with bacteremia within 30 days after autologous stem cell transplantation in patients with multiple myeloma. Transpl Infect Dis 2020; 22:e13302. [PMID: 32367601 DOI: 10.1111/tid.13302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess whether the nutrition risk index (NRI) is associated with the risk of bacteremia within the first days after autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). MATERIALS AND METHODS Retrospective cohort study of adult patients with MM taken to ASCT at the Hospital Universitario San Ignacio (Bogotá, Colombia) between 2005 and 2019. The outcome of interest was the incidence of bacteremia at 30 days. Multivariate analysis was used to identify whether the NRI was associated with bacteremia, controlling by different confounding variables. RESULTS One hundred and twenty-four patients with a median age of 58.5 years (IQR: 54-64) were included. 47.1% were in stage ISS III. 36.0% had moderate or severe malnourishment (NRI < 97.5). 11.2% presented bacteremia in the first 30 days after transplantation. In the univariate analysis, the NRI < 97.5 was associated with bacteremia (OR: 1.88; 95% CI: 1.30-2.72, P = .001); however, this association was not significant in the multivariate analysis, unlike the presence of mucositis (OR: 11.59; 95% CI: 1.9-68.3, <0.01), one or more previous lines of therapy (OR: 12.0; 95% CI: 2.1-67.4; P < .01), and duration of aplasia (OR: 1.70; 95% CI: 1.2-2.4, P < .01). CONCLUSIONS Patients with moderate or severe malnourishment have a higher incidence of bacteremia in the 30 days post-ASCT in patients with MM. Additional risk factors associated with bacteremia include the presence of mucositis, one or more previous lines of therapy, and the duration of aplasia.
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Affiliation(s)
- Javier Ricardo Garzón Herazo
- Department of Internal Medicine, Infectology Unit, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Oscar Mauricio Muñoz Velandia
- Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Julio Cesar Solano
- Department of Internal Medicine, Bone Marrow Transplantation Unit, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
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Mikkelsen S, Østergaard T, Zacher N, Holst M. Unintended weight loss in hematology outpatients - Work to do. Clin Nutr ESPEN 2020; 37:202-206. [PMID: 32359744 DOI: 10.1016/j.clnesp.2020.02.016] [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: 11/26/2019] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malnutrition frequently occurs in hematology diseases and may threaten the course of treatment and patient outcomes. While screening for nutritional risk is often done in hospitalized patients, it is rarely described in the outpatient setting. Hematology patients are often followed in outpatient settings before hospitalization and for a longer time after. AIMS The primary aim of this study was to investigate the prevalence of nutritional risk measured by unintended weight loss within three months and reduced food intake within one week among patients in a hematology outpatient clinic. The second purpose was to investigate the two variables as a quick initial screening tool. METHODS All patients visiting the outpatient clinic within one week were invited to participate in this study, designed as a questionnaire-based cross-sectional study, consisting of nine questions. Descriptive statistical analyses, chi2 test and simple logistic regression analyses were performed. RESULTS Of the 219 included patients, 23.7% had an unintended weight loss of mean 13.7% of body weight within the last three months and 13.2% had eaten less than usual within the past week. Patients who had significantly increased odds for unintended weight loss were >80 years of age [CI95%: 1274; 6084], patients visiting for examinations [CI95%: 1.105; 7.227], patients visiting for treatment [CI95%: 1.383; 6598] and patients visiting as part of a course of investigations [CI95%: 1.112; 34.184] as well as patients who had eaten less [CI95%: 2.731; 14.224]. Patients visiting the outpatient clinic for examination had significantly increased odds of having eaten less [CI95%: 1.783; 14.629]. CONCLUSIONS Based on the statistical analyses, almost one fourth of the patients had a significant unintended weight loss, about 15% had reduced food intake and only 7.8% had both unintended weight loss and reduced food intake. These results indicate that unintended weight loss can be used as a quick screening tool to identify and detect patients at risk of malnutrition and that guidelines should be drawn up for managing patients at nutritional risk in hematology outpatient clinics.
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Affiliation(s)
- Sabina Mikkelsen
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Trine Østergaard
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Nina Zacher
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Mette Holst
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
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Marx W, McCarthy A, Marshall S, Crichton M, Molassiotis A, Ried K, Bird R, Lohning A, Isenring E. Supplemental prophylactic intervention for chemotherapy-induced nausea and emesis (SPICE) trial: Protocol for a multicentre double-blind placebo-controlled randomised trial. Nutr Diet 2020; 77:144-150. [PMID: 30033645 DOI: 10.1111/1747-0080.12446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/19/2018] [Accepted: 05/27/2018] [Indexed: 02/02/2023]
Abstract
AIM There is significant recent interest in the role of ginger root (Zingiber officinale) as an adjuvant therapy for chemotherapy-induced nausea. The supplemental prophylactic intervention for chemotherapy-induced nausea and emesis (SPICE) trial aims to assess the efficacy by reduced incidence and severity of chemotherapy-induced nausea and vomiting, and enhanced quality of life, safety and cost effectiveness of a standardised adjuvant ginger root supplement in adults undergoing single-day moderate-to-highly emetogenic chemotherapy. METHODS Multisite, double-blind, placebo-controlled randomised trial with two parallel arms and 1:1 allocation. The target sample size is n = 300. The intervention comprises four capsules of ginger root (totalling 60 mg of active gingerols/day), commencing the day of chemotherapy and continuing for five days during chemotherapy cycles 1 to 3. The primary outcome is chemotherapy-induced nausea-related quality of life. Secondary outcomes include nutrition status; anticipatory, acute and delayed nausea and vomiting; fatigue; depression and anxiety; global quality of life; health service use and costs; adverse events; and adherence. RESULTS During the five-month recruitment period from October 2017 to April 2018 at site A only, a total of n = 33 participants (n = 18 female) have been enrolled in the SPICE trial. Recruitment is expected to commence at Site B in May 2018. CONCLUSIONS The trial is designed to meet research gaps and could provide evidence to recommend specific dosing regimens as an adjuvant for chemotherapy-induced nausea and vomiting prevention and management.
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Affiliation(s)
- Wolfgang Marx
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Alexandra McCarthy
- School of Nursing, University of Auckland, Auckland, New Zealand
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Skye Marshall
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Megan Crichton
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Bond Institute of Health and Sport, Gold Coast, Queensland, Australia
| | - Alex Molassiotis
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Karin Ried
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- National Institute of Integrative Medicine (NIIM), Melbourne, Victoria, Australia
| | - Robert Bird
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Anna Lohning
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting. J Acad Nutr Diet 2019; 120:1210-1215. [PMID: 31892501 DOI: 10.1016/j.jand.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 10/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening. OBJECTIVE The aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments. DESIGN/PARTICIPANTS A single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland. MAIN OUTCOME MEASUREMENTS The primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian. STATISTICAL ANALYSIS Concurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient. RESULTS The ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found. CONCLUSION Patient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.
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Crichton M, Marshall S, Marx W, McCarthy AL, Isenring E. Efficacy of Ginger (Zingiber officinale) in Ameliorating Chemotherapy-Induced Nausea and Vomiting and Chemotherapy-Related Outcomes: A Systematic Review Update and Meta-Analysis. J Acad Nutr Diet 2019; 119:2055-2068. [PMID: 31519467 DOI: 10.1016/j.jand.2019.06.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/03/2019] [Accepted: 06/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ginger has been proposed as an adjuvant treatment for chemotherapy-induced nausea and vomiting. OBJECTIVE The aim of this systematic review with meta-analyses is to evaluate, in adult cancer patients receiving chemotherapy, the effects of ginger supplementation dose and duration on the incidence, duration, and severity of chemotherapy-induced nausea and vomiting and outcomes related to chemotherapy-induced nausea and vomiting (eg, quality of life and fatigue), compared with placebo or standard antiemetic medication. METHOD Five electronic databases were searched from database inception to April 2018. The quality of evidence was appraised with the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluation level. Data were pooled using Revman software. RESULTS Eighteen articles were analyzed. The likelihood of acute vomiting was reduced by 60% with ginger supplementation ≤1 g/day for duration >3 days, compared with control groups (odds ratio 0.4, 95% CI 0.17 to 0.81; P=0.01; n=3 studies; n=3 interventions; n=301 participants; I2=20%; Grading of Recommendations, Assessment, Development, and Evaluation level: Moderate). The likelihood of fatigue was reduced by 80% with ginger supplementation of any dose for duration <3 days (odds ratio 0.2, 95% CI, 0.03 to 0.87; P=0.03; n=1 studies; n=2 interventions; n=219 participants; I2=0%; Grading of Recommendations, Assessment, Development, and Evaluation level: Low). No statistically significant association was found between ginger and likelihood of overall or delayed vomiting, likelihood or severity of nausea, or other outcomes related to chemotherapy-induced nausea and vomiting. CONCLUSIONS Ginger supplementation might benefit chemotherapy-induced vomiting as well as fatigue. Due to clinical heterogeneity, this systematic review update found no association between ginger and chemotherapy-induced nausea and other chemotherapy-induced nausea and vomiting-related outcomes. The results of this systematic review and meta-analysis provide a rationale for further research with stronger study designs, adequate sample sizes, standardized ginger products, and validated outcome measures to confirm efficacy of ginger supplementation and optimal dosing regimens.
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Lin T, Yang J, Hong X, Yang Z, Ge T, Wang M. Nutritional status in patients with advanced lung cancer undergoing chemotherapy: a prospective observational study. Nutr Cancer 2019; 72:1225-1230. [PMID: 31603353 DOI: 10.1080/01635581.2019.1675720] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose: The consequences of malnutrition include increased risk of many complications. The assessment and management of nutritional problems are essential in supportive care of patients undergoing therapy. The primary objective of the present study was to assess changes in the nutritional status in lung cancer patients who had undergone chemotherapy.Patients and methods: Preliminary and post-chemotherapy assessments of patients' nutritional status and medical characteristics were conducted using the Patient-Generated Subjective Global Assessment (PG-SGA) from July 2014 to May 2016 at Harbin Medical University Cancer Hospital. Four hundred sixty-five advanced lung cancer patients (51.8% men and 48.2% women with a mean (SD) age of 60.2 ± 9.8 years) participated in the present study. PG-SGA was assessed prior to the initiation of chemotherapy and after four cycles of chemotherapy.Results: We found that 11.4% of the patients were severely malnourished and 65.6% of the patients were moderately malnourished prior to chemotherapy. After chemotherapy, 52.9% of the patients were considered moderately malnourished, whereas 33.8% were severely malnourished. The nutritional status had deteriorated in the majority of patients. After chemotherapy, there was a rise in the prevalence of nutrition impact symptoms.Conclusions: A deteriorated nutritional status was the result of the side effects caused by chemotherapy in the patients of the present study. These findings highlight that more attention should be paid to improve the nutritional status in patients with advanced lung cancer undergoing chemotherapy, and proper nutrition education and nutritional support should be provided to these patients.
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Affiliation(s)
- Tie Lin
- Department of Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing Yang
- Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Xuan Hong
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - ZhaoYang Yang
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ting Ge
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Meng Wang
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, China
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Abstract
PURPOSE OF REVIEW Malnutrition is a common and under-recognized geriatric condition in older adults with cancer. This review describes the public health burden, malnutrition prevention, and the relationship among cancer cachexia, malnutrition, and sarcopenia. Finally, clinical practice recommendations on malnutrition and prevention are presented. RECENT FINDINGS Advanced age and cancer stage, frailty, dementia, major depression, functional impairment, and physical performance are important risk factors for malnutrition in older adults with cancer. The Mini Nutrition Assessment (MNA), Malnutrition Universal Screening Tool (MUST), and Patient Generated Subjective Global Assessment (PG-SGA) are the most commonly used assessment tools in older adults with cancer. In addition, malnutrition is independently associated with poor overall survival and quality of life, longer hospital stays, greater hospital cost, and hospital readmission. Comprehensive malnutrition prevention is required for improving the nutrition status among older adults with cancer.
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Jo HS, Park K, Jung SM. A scoping review of consumer needs for cancer information. PATIENT EDUCATION AND COUNSELING 2019; 102:1237-1250. [PMID: 30772114 DOI: 10.1016/j.pec.2019.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This study was a scoping review of research on cancer-related health information seeking and needs of patients, survivor, non-patients, and caregivers. METHODS This study used the COSI model to search for articles published from 2007 to 2017. RESULTS In total, 117 articles with titles and abstracts including the following terms were selected: cancer, health, information, seeking. Non-patients obtained information from the Internet, doctors, and media, whereas patients obtained information from doctors, the Internet, and media. Information needs were the highest for treatment, prognosis, and psychosocial support. Patients had the highest need for information on prognosis and treatment, whereas non-patients had the highest need for general cancer information, prevention, and cancer examination. Caregivers sought information about treatment, psychosocial support, and prevention. CONCLUSION This study revealed an increase in the number of research articles identifying cancer patients' information needs. Cancer patients rely on health professionals for information; thus, relevant materials are needed. Furthermore, not only medical but also psychosocial support information is needed. PRACTICE IMPLICATIONS There is a need for cancer information from health professionals, and thus for patient-centered training materials. Furthermore, a survey system to evaluate consumers' cancer information needs should be developed.
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Affiliation(s)
- Heui Sug Jo
- Department of Health Policy and Management, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Keeho Park
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Su Mi Jung
- Department of Health Policy and Management, Kangwon National University College of Medicine, Chuncheon, South Korea.
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Song C, Cao J, Zhang F, Wang C, Guo Z, Lin Y, Shi Y, Hu W, Ba Y, Xu H, Li W, Shi H. Nutritional Risk Assessment by Scored Patient-Generated Subjective Global Assessment Associated with Demographic Characteristics in 23,904 Common Malignant Tumors Patients. Nutr Cancer 2019; 71:50-60. [PMID: 30741002 DOI: 10.1080/01635581.2019.1566478] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Malnutrition is a problem affecting tumor patients greatly. This study aims to investigate whether demographic characteristics are related to the malnutrition of cancer patients. Twenty-three thousand nine hundred and four (23,904) patients with 16 common malignant tumors were enrolled in the study. Patient Generated Subjective Global Assessment (PG-SGA) was used as a screening tool to assess the nutritional risk of patients and analysis of variance was used to compare PG-SGA scores of patients. Correlations between PG-SGA scores and demographic characteristics were evaluated by correlation analysis. We observed that 57.88% tumor patients had some degree of malnutrition (score ≥4) and only 20.61% were well-nourished (score 0-1). Screening scores were higher among older patients for most of the tumors. PG-SGA scores showed the significant difference between females and males in some tumors. In addition, the PG-SGA scores of some tumors were significantly different in various types of medical insurances, education levels, occupations, regions, and nationalities. Correlation analysis indicated the existence of associations between PG-SGA scores and demographic characteristics. Understanding the distribution of nutritional risk of tumor patients and the correlations between the PG-SGA scores and demographic characteristics could help identify subgroups who may benefit from targeted interventions to improve the effect of clinical treatment and the quality of life for oncology patients.
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Affiliation(s)
- Chunhua Song
- a Department of Epidemiology and Statistics, College of Public Health , Zhengzhou University , Zhengzhou , PR China
| | - Jingjing Cao
- b Department of Preventive Medicine , Heze Medical College , Heze , PR China
| | - Feng Zhang
- a Department of Epidemiology and Statistics, College of Public Health , Zhengzhou University , Zhengzhou , PR China.,c Department of Immunology , Basic Medical College, Huazhong University of Science and Technology , Wuhan , PR China
| | - Chang Wang
- d Cancer Center of the First Hospital of Jilin University , Changchun , PR China
| | - Zengqing Guo
- e Department of Medical Oncology , Fujian Cancer Hospital, Fujian Medical University Cancer Hospital , Fuzhou , PR China
| | - Yuan Lin
- f Department of Gastrointestinal Surgery , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , PR China
| | - Yingying Shi
- g Department of Surgery , The First Affiliated Hospital of SunYat-sen University , Guangzhou , PR China
| | - Wen Hu
- h Department of Clinical Nutrition , West China Hospital of Sichuan University , Chengdu , PR China
| | - Yi Ba
- i Department of Gastrointestinal Oncology , Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy , Tianjin , PR China
| | - Hongxia Xu
- j Department of Nutrition , Daping Hospital & Research Institute of Surgery, Third Military Medical University , Chongqing , PR China
| | - Wei Li
- d Cancer Center of the First Hospital of Jilin University , Changchun , PR China
| | - Hanping Shi
- k Department of Gastrointestinal Surgery/Clinical Nutrition , Beijing Shijitan Hospital, Capital Medical University , Beijing , PR China
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Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr 2018; 38:644-651. [PMID: 29789167 DOI: 10.1016/j.clnu.2018.04.007] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevention and management of malnutrition is increasingly recognised as a significant element of cancer care. By identifying and comparing cancer malnutrition in two large cross-sectional cancer populations, this study aims to provide a greater understanding of clinical characteristics and trajectories relating to cancer malnutrition. METHODS A multi-centre point prevalence study was conducted in Victoria, Australia at two time points (March 2012, May 2014). Adults with cancer receiving ambulatory chemotherapy, radiotherapy and multi-day inpatients were included. The presence of malnutrition was determined using Patient Generated-Subjective Global Assessment (PG-SGA). Demographic, clinical information and 30-day outcomes were collected. RESULTS The study included 1677 patients in 2012 (17 sites) and 1913 patients in 2014 (27 sites). Older age, ≥5% weight loss, hospital admission and metastatic disease were factors significantly associated with malnutrition. Patients with upper gastrointestinal, head and neck and lung cancers were more likely to be malnourished. Malnutrition was associated with infection and poor outcomes at 30-days. Malnutrition prevalence reduced from 31% in 2012 to 26% in 2014 (p = 0.002). This reflects a reduction in patients with malnutrition receiving ambulatory chemotherapy, those with upper gastrointestinal or colorectal cancers and those residing in regional areas. CONCLUSION The study has provided a comprehensive description of cancer malnutrition prevalence representative of all treatment settings, tumour types and stages of disease. This provides valuable insight into cancer malnutrition enabling oncology services to identify opportunities to embed identification and prevention strategies into models of care, resulting in improved patient outcomes and reduced health care costs.
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van Veen MR, Winkels RM, Janssen SHM, Kampman E, Beijer S. Nutritional Information Provision to Cancer Patients and Their Relatives Can Promote Dietary Behavior Changes Independent of Nutritional Information Needs. Nutr Cancer 2018. [DOI: 10.1080/01635581.2018.1446092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Merel R. van Veen
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Renate M. Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Silvie H. M. Janssen
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Sandra Beijer
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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Borre M, Dam GA, Knudsen AW, Grønbaek H. Nutritional status and nutritional risk in patients with neuroendocrine tumors. Scand J Gastroenterol 2018; 53:284-292. [PMID: 29373941 DOI: 10.1080/00365521.2018.1430848] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Malnutrition is frequent among patients with malignancies and associated with impaired function, reduced quality of life and increased mortality. Few data are available in patients with neuroendocrine tumors (NET) on nutritional status, nutritional risk, and nutrition impact symptoms (NIS). We aimed to assess nutritional status (NS) and risk, level of function and associations with NIS in NET patients. METHODS In a cross-sectional study of NET patients, we measured body mass index (BMI) and handgrip strength (HGS) as markers of NS and muscle function assessed by HGS. The nutritional risk score (NRS) was determined by NRS-2002. NIS was assessed by the eating symptoms questionnaire (ESQ), and disease-related appetite questionnaire (DRAQ). RESULTS We included 186 patients (51% women), median age 66 years. We observed low BMI (<20.5 kg/m2) in 12%, low HGS in 25%, and impaired level of function in 43% of the patients. About 38% were at nutritional risk, more frequent in patients with residual disease (45% versus 29%, p < .05). Both low HGS, impaired level of function and being at nutritional risk were associated with the NIS: Nausea, vomiting, stomach ache and dry mouth (p < .05) whereas poor appetite and early satiety were only associated with being at nutritional risk and having impaired level of function (p < .05, all). CONCLUSIONS Almost 40% of NET patients were at nutritional risk; and 25% had impaired HGS associated with specific NIS that preclude food intake. We recommend that NET outpatients are screened with NRS-2002 and that HGS and NIS are determined if NET patients need nutritional therapy.
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Affiliation(s)
- Mette Borre
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital ENETS Centre of Excellence, Aarhus University Hospital , Aarhus , Denmark
| | - Gitte Aarøe Dam
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital ENETS Centre of Excellence, Aarhus University Hospital , Aarhus , Denmark
| | - Anne Wilkens Knudsen
- b Medical Division, and Medical Unit, Nutritional Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Henning Grønbaek
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital ENETS Centre of Excellence, Aarhus University Hospital , Aarhus , Denmark
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The relationship between nutritional status and handgrip strength in adult cancer patients: a cross-sectional study. Support Care Cancer 2018; 26:2441-2451. [DOI: 10.1007/s00520-018-4082-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/29/2018] [Indexed: 12/31/2022]
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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: 42] [Impact Index Per Article: 6.0] [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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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]
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Burhenn PS, McCarthy AL, Begue A, Nightingale G, Cheng K, Kenis C. Geriatric assessment in daily oncology practice for nurses and allied health care professionals: Opinion paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG). J Geriatr Oncol 2016; 7:315-24. [DOI: 10.1016/j.jgo.2016.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/19/2016] [Accepted: 02/10/2016] [Indexed: 12/14/2022]
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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.
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Hogan D, Lan LTT, Diep DTN, Gallegos D, Collins PF. Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease. J Hum Nutr Diet 2016; 30:83-89. [DOI: 10.1111/jhn.12402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- D. Hogan
- Nutrition and Dietetics; School of Exercise and Nutrition Sciences; Faculty of Health; Queensland University of Technology; Kelvin Grove QLD Australia
| | - L. T. T. Lan
- Respiratory Care Center; University of Medicine and Pharmacy; Ho Chi Minh City Vietnam
| | | | - D. Gallegos
- Nutrition and Dietetics; School of Exercise and Nutrition Sciences; Faculty of Health; Queensland University of Technology; Kelvin Grove QLD Australia
| | - P. F. Collins
- Nutrition and Dietetics; School of Exercise and Nutrition Sciences; Faculty of Health; Queensland University of Technology; Kelvin Grove QLD Australia
- Department of Nutrition and Dietetics; Princess Alexandra Hospital; Woolloongabba QLD Australia
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Kim HS, Lee JY, Lim SH, Cho J, Kim SJ, Jang JH, Kim WS, Jung CW, Kim K. Patient-Generated Subjective Global Assessment as a prognosis tool in patients with multiple myeloma. Nutrition 2016; 36:67-71. [PMID: 28336110 DOI: 10.1016/j.nut.2016.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/03/2016] [Accepted: 06/14/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Disease-related weight loss is relatively common in patients with newly diagnosed multiple myeloma (MM), but limited data exist regarding the effects of nutritional status on survival. The aim of this study was to assess the relationship between malnutrition (as measured by Patient-Generated Subjective Global Assessment [PG-SGA]) and clinical characteristics of patients with MM, and to investigate the association between the PG-SGA score before chemotherapy and overall survival in MM patients. METHODS Using the PG-SGA score, we retrospectively explored the effect of malnutrition on the survival of Asian patients with MM. RESULTS We divided 216 patients with MM into three groups based on their PG-SGA scores. Of these patients 23% (n = 50) had PG-SGA scores ≥9, indicating severe malnutrition requiring specialist nutrition intervention. Body mass index and serum hemoglobin were independently associated with PG-SGA scores (P < 0.05). The median survival time was not reached in nourished patients with PG-SGA scores of 0 to 3, 58.7 mo in moderately malnourished patients with PG-SGA scores of 4 to 8, and 35 mo in severely malnourished patients with PG-SGA scores ≥9 (P = 0.001). Multivariate analysis revealed that PG-SGA scores ≥9 compared with PG-SGA scores of 0 to 3 (hazard ratio [HR], 2.347; 95% confidence interval [CI], 1.271-4.334; P = 0.006), International Staging System (ISS) stage III compared with ISS stage I (HR, 2.360; 95% CI, 1.271-4.379; P = 0.007), and autologous stem cell transplantation (HR, 0.388; 95% CI, 0.248-0.606; P < 0.001) were associated with overall survival. CONCLUSIONS A higher PG-SGA score before chemotherapy was associated with reduced survival among patients with MM. Nutritional evaluation should be an integral part of the clinical assessment of MM patients, and the PG-SGA score would be an appropriate tool to evaluate nutritional status.
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Affiliation(s)
- Hae Su Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Division of Hematology-Oncology, Department of Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji Yun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hee Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaewon Cho
- Department of Dietetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Jang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul Won Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients. Support Care Cancer 2016; 24:3883-7. [DOI: 10.1007/s00520-016-3196-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/28/2016] [Indexed: 01/04/2023]
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van Veen MR, Beijer S, Adriaans AMA, Vogel-Boezeman J, Kampman E. Development of a Website Providing Evidence-Based Information About Nutrition and Cancer: Fighting Fiction and Supporting Facts Online. JMIR Res Protoc 2015; 4:e110. [PMID: 26350824 PMCID: PMC4704902 DOI: 10.2196/resprot.4757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 11/13/2022] Open
Abstract
Background Although widely available, the general public, cancer patients, and cancer survivors have difficulties accessing evidence-based information on nutrition and cancer. It is challenging to distinguish myths from facts, and sometimes conflicting information can be found in different places. The public and patients would benefit from evidence-based, correct, and clear information from an easily recognizable source. Objective The aim of this project is to make scientific information available for the general public, cancer patients, and cancer survivors through a website. The aim of this paper is to describe and evaluate the development of the website as well as related statistics 1st year after its launch. Methods To develop the initial content for the website, the website was filled with answers to frequently asked questions provided by cancer organizations and the Dutch Dietetic Oncology Group, and by responding to various fiction and facts published in the media. The website was organized into 3 parts, namely, nutrition before (prevention), during, and after cancer therapy; an opportunity for visitors to submit specific questions regarding nutrition and cancer was included. The website was pretested by patients, health care professionals, and communication experts. After launching the website, visitors’ questions were answered by nutritional scientists and dieticians with evidence- or eminence-based information on nutrition and cancer. Once the website was live, question categories and website statistics were recorded. Results Before launch, the key areas for improvement, such as navigation, categorization, and missing information, were identified and adjusted. In the 1st year after the launch, 90,111 individuals visited the website, and 404 questions were submitted on nutrition and cancer. Most of the questions were on cancer prevention and nutrition during the treatment of cancer. Conclusions The website provides access to evidence- and eminence-based information on nutrition and cancer. As can be concluded from the number of visitors and the number of questions submitted to the website, the website fills a gap.
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Isenring E, Elia M. Which screening method is appropriate for older cancer patients at risk for malnutrition? Nutrition 2015; 31:594-7. [DOI: 10.1016/j.nut.2014.12.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/29/2014] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
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Wagland R, Richardson A, Armes J, Hankins M, Lennan E, Griffiths P. Treatment-related problems experienced by cancer patients undergoing chemotherapy: a scoping review. Eur J Cancer Care (Engl) 2014; 24:605-17. [DOI: 10.1111/ecc.12246] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- R. Wagland
- Faculty of Health Sciences, Highfield; University of Southampton; Southampton UK
| | - A. Richardson
- Faculty of Health Science, Southampton General Hospital; University of Southampton & University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - J. Armes
- Florence Nightingale School of Nursing & Midwifery King's College London; London UK
| | - M. Hankins
- Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences; University of Southampton; Southampton UK
| | - E. Lennan
- University Hospital Southampton; Southampton UK
| | - P. Griffiths
- Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences, Highfield; University of Southampton; Southampton UK
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Marx W, McCarthy AL, Ried K, Vitetta L, McKavanagh D, Thomson D, Sali A, Isenring L. Can ginger ameliorate chemotherapy-induced nausea? Protocol of a randomized double blind, placebo-controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:134. [PMID: 24712653 PMCID: PMC3984021 DOI: 10.1186/1472-6882-14-134] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/14/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preliminary research shows ginger may be an effective adjuvant treatment for chemotherapy-induced nausea and vomiting but significant limitations need to be addressed before recommendations for clinical practice can be made. METHODS/DESIGN In a double-blinded randomised-controlled trial, chemotherapy-naïve patients will be randomly allocated to receive either 1.2 g of a standardised ginger extract or placebo per day. The study medication will be administrated as an adjuvant treatment to standard anti-emetic therapy and will be divided into four capsules per day, to be consumed approximately every 4 hours (300 mg per capsule administered q.i.d) for five days during the first three cycles of chemotherapy. Acute, delayed, and anticipatory symptoms of nausea and vomiting will be assessed over this time frame using a valid and reliable questionnaire, with nausea symptoms being the primary outcome. Quality of life, nutritional status, adverse effects, patient adherence, cancer-related fatigue, and CINV-specific prognostic factors will also be assessed. DISCUSSION Previous trials in this area have noted limitations. These include the inconsistent use of standardized ginger formulations and valid questionnaires, lack of control for anticipatory nausea and prognostic factors that may influence individual CINV response, and the use of suboptimal dosing regimens. This trial is the first to address these issues by incorporating multiple unique additions to the study design including controlling for CINV-specific prognostic factors by recruiting only chemotherapy-naïve patients, implementing a dosing schedule consistent with the pharmacokinetics of oral ginger supplements, and independently analysing ginger supplements before and after recruitment to ensure potency. Our trial will also be the first to assess the effect of ginger supplementation on cancer-related fatigue and nutritional status. Chemotherapy-induced nausea and vomiting are distressing symptoms experienced by oncology patients; this trial will address the significant limitations within the current literature and in doing so, will investigate the effect of ginger supplementation as an adjuvant treatment in modulating nausea and vomiting symptoms. TRIAL REGISTRATION ANZCTR.org.au Identifier: ACTRN12613000120774.
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Affiliation(s)
- Wolfgang Marx
- Centre of Dietetics Research, University of Queensland, St Lucia, Brisbane, QLD, Australia
- National Institute of Integrative Medicine, Melbourne, VIC, Australia
- Health Sciences & Medicine, Bond University, Brisbane, QLD, Australia
| | - Alexandra L McCarthy
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karin Ried
- National Institute of Integrative Medicine, Melbourne, VIC, Australia
| | - Luis Vitetta
- School of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Medlab, Sydney, NSW, Australia
| | - Daniel McKavanagh
- Oncology & Haematology Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Damien Thomson
- PAH Oncology & Haematology Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Avni Sali
- National Institute of Integrative Medicine, Melbourne, VIC, Australia
| | - Liz Isenring
- Centre of Dietetics Research, University of Queensland, St Lucia, Brisbane, QLD, Australia
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Health Sciences & Medicine, Bond University, Brisbane, QLD, Australia
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Zekri J, Morganti J, Rizvi A, Sadiq BB, Kerr I, Aslam M. Novel simple and practical nutritional screening tool for cancer inpatients: a pilot study. Support Care Cancer 2014; 22:1401-8. [DOI: 10.1007/s00520-013-2100-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 12/11/2013] [Indexed: 01/16/2023]
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Ferreira D, Guimarães TG, Marcadenti A. Acceptance of hospital diets and nutritional status among inpatients with cancer. EINSTEIN-SAO PAULO 2013; 11:41-6. [PMID: 23579742 PMCID: PMC4872966 DOI: 10.1590/s1679-45082013000100008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 11/12/2012] [Indexed: 11/22/2022] Open
Abstract
Objective: To verify acceptance of hospital diets as to the nutritional status among patients admitted to the Oncology/Hematology Unit of a tertiary care hospital. Methods: A cross-sectional study conducted among 100 patients, aged ≥18 years, of both genders. Body mass index and subjective global nutritional evaluation by patients were used to detect the nutritional status. The rest-ingestion index was used to evaluate diet acceptance, and the reasons for non-acceptance were identified by means of a questionnaire. Data were expressed in means and standard deviation, or medians and percentages. Comparisons were made using the Student's t test, Wilcoxon Mann-Whitney test, and Pearson's χ2 test. Results: A total of 59% of patients were males, and mean age was 51.6±13.5 years. According to the global subjective nutritional evaluation done by the patients themselves, 33% of the participants were considered malnourished and the body mass index detected 6.3% of malnutrition. The main symptoms reported were lack of appetite, xerostomia (dry mouth), constipation, dysgeusia, odor-related nausea, and early satiety. The rest-ingestion index was approximately 37% and significantly greater among the malnourished relative to the well-nourished (58.8 versus 46.4%; p=0.04). The primary reasons reported for non-acceptance of the diet offered were lack of flavor, monotonous preparations, large quantities offered, lack of appetite, and inappropriate temperature of the meal. Conclusion: A high the rest-ingestion index was seen among the patients with cancer, especially those who were malnourished according to the global nutritional evaluation produced by the patient.
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Affiliation(s)
- Daiane Ferreira
- Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
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Malihi Z, Kandiah M, Chan YM, Hosseinzadeh M, Sohanaki Azad M, Zarif Yeganeh M. Nutritional status and quality of life in patients with acute leukaemia prior to and after induction chemotherapy in three hospitals in Tehran, Iran: a prospective study. J Hum Nutr Diet 2013; 26 Suppl 1:123-31. [DOI: 10.1111/jhn.12043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Z. Malihi
- Alumni Centre; Academic Division; Universiti Putra Malaysia; Serdang Malaysia
| | - M. Kandiah
- Department of Food Science and Nutrition; Faculty of Applied Sciences; UCSI University; Kuala Lumpur Malaysia
| | - Y. M. Chan
- Faculty of Medicine and Health Sciences; Institute of Gerontology; University of Putra Malaysia; Serdang Malaysia
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Marx WM, Teleni L, McCarthy AL, Vitetta L, McKavanagh D, Thomson D, Isenring E. Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review. Nutr Rev 2013; 71:245-54. [PMID: 23550785 DOI: 10.1111/nure.12016] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of cytotoxic treatment. It continues to affect a significant proportion of patients despite the widespread use of antiemetic medication. In traditional medicine, ginger (Zingiber officinale) has been used to prevent and treat nausea in many cultures for thousands of years. However, its use has not been confirmed in the chemotherapy context. To determine the potential use of ginger as a prophylactic or treatment for CINV, a systematic literature review was conducted. Reviewed studies comprised randomized controlled trials or crossover trials that investigated the anti-CINV effect of ginger as the sole independent variable in chemotherapy patients. Seven studies met the inclusion criteria. All studies were assessed on methodological quality and their limitations were identified. Studies were mixed in their support of ginger as an anti-CINV treatment in patients receiving chemotherapy, with three demonstrating a positive effect, two in favor but with caveats, and two showing no effect on measures of CINV. Future studies are required to address the limitations identified before clinical use can be recommended.
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Affiliation(s)
- Wolfgang M Marx
- Centre for Dietetic Research, University of Queensland, Brisbane, Queensland 4072, Australia.
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Bozzetti F, Mariani L, Lo Vullo S, Amerio ML, Biffi R, Caccialanza R, Capuano G, Correja I, Cozzaglio L, Di Leo A, Di Cosmo L, Finocchiaro C, Gavazzi C, Giannoni A, Magnanini P, Mantovani G, Pellegrini M, Rovera GM, Rovera L, Sandri G, Tinivella M, Vigevani E. The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer 2012; 20:1919-28. [PMID: 22314972 PMCID: PMC3390688 DOI: 10.1007/s00520-012-1387-x] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 01/15/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE There is little information about the nutritional status of cancer outpatients because the practice of nutritional screening is rarely performed. This study aims to define the pattern of scores of nutritional risk in 1,453 outpatients and factors associated with a high nutrition risk score, to facilitate the identification of such patients by the oncologists. METHODS We prospectively screened the nutritional status of cancer outpatients according to the NRS-2002 score which combines indicators of malnutrition and of severity of the disease (1-3 points, respectively). A score ≥ 3 indicates "nutritional risk". The association of the nutritional scores with some patient/tumour/therapy-related variables was investigated through univariable and multivariable linear regression models. RESULTS Thirty-two percent of outpatients were at nutritional risk. Primary tumour site, Eastern Cooperative Oncology Group score and presence of anorexia or fatigue were significantly associated with the nutrition risk score. Depending on the combination of these variables, it was possible to estimate different probabilities of nutritional risk. CONCLUSIONS The frequency of a relevant nutritional risk was higher than expected considering the favourably selected population. The nutritional risk was associated with common clinical variables which are usually recorded in the charts and could easily alert the oncologist on the need of a further nutritional assessment or a nutritional support.
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Affiliation(s)
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian 1, 20133 Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | | | | | | | - Isabel Correja
- University Hospital, Belo Horizonte, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Lidia Rovera
- ASO Ordine Mauriziano Istituto di Ricerca e Cura del Cancro, Candiolo, Italy
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Davidson W, Teleni L, Muller J, Ferguson M, McCarthy AL, Vick J, Isenring E. Malnutrition and Chemotherapy-Induced Nausea and Vomiting: Implications for Practice. Oncol Nurs Forum 2012; 39:E340-5. [PMID: 22750904 DOI: 10.1188/12.onf.e340-e345] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Wendy Davidson
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia.
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Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gupta D, Vashi PG, Lammersfeld CA, Braun DP. Role of Nutritional Status in Predicting the Length of Stay in Cancer: A Systematic Review of the Epidemiological Literature. ANNALS OF NUTRITION AND METABOLISM 2011; 59:96-106. [DOI: 10.1159/000332914] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 09/06/2011] [Indexed: 12/16/2022]
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