Survival outcomes and prognostic nutritional index in very elderly small-cell lung cancer patients: importance of active treatment and nutritional support

Nutritional Intervention for the Elderly during Chemotherapy: A Systematic Review

This study aims to review existing literature on the effect of oral nutritional supplements (ONSs) during chemotherapy in older cancer patients. Electronic databases were searched for relevant studies up to March 2024. The risk of bias in the included studies was evaluated using the Cochrane tool. Eligible studies included randomized, prospective, and retrospective studies evaluating the effect of ONSs in elderly (median age > 65 years) cancer patients during chemotherapy. Data regarding chemotherapy adherence, toxicity, overall survival, and nutritional status were extracted. A total of ten studies, involving 1123 patients, were included. A meta-analysis of the results was not conducted due to the scarcity and heterogeneity of results. Some ONSs were associated with reduced incidence of chemotherapy side-effects, particularly oral mucositis, and improved nutritional status. There was limited or no evidence regarding the impact of ONSs on chemotherapy adherence or overall survival. Various types of ONS were investigated, including multimodal intervention with tailored nutritional counseling, whey protein supplements, amino acids supplements (including immune nutrition supplements), and fish oil omega-3-enriched supplements. ONSs showed promise in reducing chemotherapy side-effects and improving nutritional status in older cancer patients, but further studies are needed to explore their efficacy on chemotherapy adherence and overall survival. Future research should consider both chronological age and frailty criteria, account for dietary habits, and use specific nutritional assessment like Bioelectrical Impedance Analysis.

Prognostic Role of Pretreatment Prognostic Nutritional Index in Advanced Lung Cancer Patients Receiving First-Line Immunotherapy: A Meta-Analysis

The aim of this study was to further explore the association between pretreatment prognostic nutritional index (PNI) and survival among advanced lung cancer patients who received the first-line immunotherapy based on current relevant studies. Several databases were searched up to July 17, 2023. Progression-free survival (PFS) and overall survival (OS) were primary outcomes and the hazard ratios (HRs) with 95% confidence intervals (CIs) were combined. Subgroup analysis based on the pathological type [non-small cell lung cancer (NSCLC) vs small cell lung cancer (SCLC)] and combination of other therapies (yes vs no) were performed. Ten studies with 1291 patients were included eventually. The pooled results demonstrated that higher pretreatment PNI was significantly related to improved PFS (HR=0.62, 95% CI: 0.48-0.80, P＜0.001) and OS (HR=0.52, 95% CI: 0.37-0.73, P＜0.001). Subgroup analysis revealed that the predictive role of pretreatment PNI for PFS (HR=0.61, 95% CI: 0.45-0.81, P=0.001) and OS (HR=0.52, 95% CI: 0.35-0.77, P=0.001) was only observed among NSCLC patients and the combination of other therapies did not cause an impact on the prognostic role of PNI in lung cancer. Pretreatment PNI was significantly associated with prognosis in advanced NSCLC receiving first-line immunotherapy and patients with a lower pretreatment PNI had poorer survival.