Oral nutritional supplements, physical activity, and sarcopenia in cancer

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

BACKGROUND AND AIMS

Nutritional support after hospital discharge was found to enhance the nutritional condition of patients after cancer surgery. However, the effect of such support on long-term clinical outcomes is controversial. We thus investigated the effect of nutritional support after hospital discharge on long-term clinical outcomes in patients after gastric cancer surgery.

METHODS

This was a secondary analysis on individuals at nutritional risk who underwent gastric cancer surgery and were included in a randomized controlled trial. The intervention group received oral nutritional supplements combined with dietary advice, and the control group received dietary advice alone. The long-term mortality (primary outcome) and other clinical outcomes were compared between the groups.

RESULTS

In total, 321 patients were included in this analysis, with a median follow-up duration of 60.5 months. According to the Nutritional Risk Screening 2002 (NRS 2002), the presence of nutritional risk was found to be a significant predictor of death. This association remained independent even after adjusting for age, sex, comorbidity, and American Joint Committee on Cancer stage. The adjusted hazard ratio for mortality increased by 1.30 (95% confidence interval [CI] 1.05-1.60, P = 0.016) for each additional point rise in NRS. During the follow-up, a total of 64 individuals (39.5%) in the intervention group and 81 patients (50.9%) in the control group died. Consequently, the adjusted hazard ratio for mortality between the two groups was 0.69 (95% CI 0.50-0.96, P = 0.026). The results of interaction tests did not yield statistically significant variations in fatality rates across the age, sex, comorbidity, NRS, and American Joint Committee on Cancer stage subgroups. Nutritional support after hospital discharge significantly improved handgrip strength (adjusted coefficient 5.05, 95% CI 3.01-7.08, P = 0.000) in addition to other functional outcomes.

CONCLUSIONS

Nutritional support after hospital discharge reduced long-term mortality and improved handgrip strength among patients at nutritional risk after gastric cancer surgery. The current investigation provides evidence for the recommendation of nutritional support, for post-surgery patients after hospital discharge, in cancer management guidelines.

Study of the significance of the combination of the fibrinogen-albumin ratio and sarcopenia in predicting the prognosis of laryngeal cancer patients undergoing radical surgery

OBJECTIVE

This study aims to investigate how the impact of preoperative sarcopenia and inflammatory markers for laryngeal cancer patients and develop a new scoring system to predict their prognosis.

MATERIALS AND METHODS

Patients who underwent laryngectomy for laryngeal cancer (LC) from December 2015 to December 2020 at the Second Affiliated Hospital of Fujian Medical University were included. Independent prognostic factors were determined using univariate and multivariate analyses. A new scoring system (SFAR) was established based on FAR and preoperative sarcopenia, and statistically analyzed.

RESULTS

198 cases included in this study that met the admission criteria. Multivariate analysis shown that preoperative sarcopenia, pTNM stage, and FAR were independent prognostic factors for laryngeal cancer. Based on these three indicators, we developed the SFAR scoring system. Multivariate analysis showed that SFAR was an independent predictor of laryngeal cancer (p < 0.001). SFAR was then incorporated into a prognostic model that included T-stage and N-stage, and a column-line graph was generated to accurately predict its survival.

CONCLUSION

Systemic inflammation and sarcopenia are significantly associated with postoperative prognosis in laryngeal cancer. A new scoring system (SFAR) had implications for improving the prognosis of patients undergoing surgery for laryngeal cancer.

The effect of preoperative supplementary parenteral nutrition on nutrition and inflammation in gastric cancer patients

OBJECTIVES

Supplemental parenteral nutrition (SPN) is recommended to add when enteral nutrition alone is not sufficient. This research aims to evaluate the effect of preoperative SPN in patients with gastric cancer.

METHODS

A total of 180 patients with gastric cancer were divided into three groups (60 patients per group) according to different nutritional support scheme. The primary endpoint was the changes in nutrition and inflammatory, while the secondary endpoint included the changes in prognosis.

RESULTS

Compared with the control group, there were significant differences in nutrition and inflammation related indicators in the oral nutrition supplement (ONS) group and the SPN + ONS group (P < 0.05). Compared with the ONS group, the SPN + ONS group showed significant differences in the above indicators (P < 0.05). However, no significant changes were observed in the incidence of complications, the postoperative exhaust time, and the hospitalization time.

CONCLUSIONS

Preoperative SPN had a positive effect on nutrition and inflammation of gastric cancer patients undergoing surgery, but had no significant effect on their prognosis.

Cancer history and physical function in patients with cardiovascular disease

Both cancer and cardiovascular disease (CVD) cause skeletal muscle mass loss, thereby increasing the likelihood of a poor prognosis. We investigated the association between cancer history and physical function and their combined association with prognosis in patients with CVD. We retrospectively reviewed 3,796 patients with CVD (median age: 70 years; interquartile range [IQR]: 61-77 years) who had undergone physical function tests (gait speed and 6-minute walk distance [6MWD]) at discharge. We performed multiple linear regression analyses to assess potential associations between cancer history and physical function. Moreover, Kaplan-Meier curves and Cox regression analyses were used to evaluate prognostic associations in four groups of patients categorized by the absence or presence of cancer history and of high or low physical function. Multiple regression analyses showed that cancer history was significantly and independently associated with a lower gait speed and 6MWD performance. A total of 610 deaths occurred during the follow-up period (median: 3.1 years; IQR: 1.4-5.4 years). The coexistence of low physical function and cancer history in patients with CVD was associated with a significantly higher mortality risk, even after adjusting for covariates (cancer history/low gait speed, hazard ratio [HR]: 1.93, P < 0.001; and cancer history/low 6MWD, HR: 1.61, P = 0.002). Cancer history is associated with low physical function in patients with CVD, and the combination of both factors is associated with a poor prognosis.

The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer

Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.

Development and validation of risk prediction model for sarcopenia in patients with colorectal cancer

Objectives

Sarcopenia is associated with a poor prognosis in patients with colorectal cancer. However, the clinical factors that lead to colorectal cancer patients with sarcopenia are still unclear. The objective of this study is to develop and validate a nomogram for predicting the occurrence of sarcopenia and to provide healthcare professionals with a reliable tool for early identification of high-risk patients with colorectal cancer associated sarcopenia.

Methods

A total of 359 patients diagnosed with colorectal cancer from July 2021 to May 2022 were included. All patients were randomly divided into a training (n = 287) cohort and a validation cohort (n = 72) at the ratio of 80/20. Univariate and multivariate logistic analysis were performed to evaluate the factors associated with sarcopenia. The diagnostic nomogram of sarcopenia in patients with colorectal cancer was constructed in the training cohort and validated in the validation cohort. Various evaluation metrics were employed to assess the performance of the developed nomogram, including the ROC curve, calibration curve, and Hosmer-Lemeshow test.

Results

Smoking history, drinking history, diabetes, TNM stage, nutritional status, and physical activity were included in the nomogram for the prediction of sarcopenia. The diagnostic nomograms demonstrated excellent discrimination, with AUC values of 0.971 and 0.922 in the training and validation cohorts, respectively. Moreover, the calibration performance of the nomogram is also excellent, as evidenced by the Hosmer-Lemeshow test result of 0.886.

Conclusions

The nomogram consisting of preoperative factors was able to successfully predict the occurrence of sarcopenia in colorectal cancer patients, aiding in the early identification of high-risk patients and facilitating timely implementation of appropriate intervention measures.

Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses

Background

Sarcopenia (SP) is defined as the quantitative and functional impairment of skeletal muscles. SP is commonly related to older age and is frequent in patients with cancer. To provide an overview of SP in patients treated with radiotherapy (RT) and to evaluate the current evidence, we analyzed the available systematic reviews and meta-analyses.

Methods

Reviews were identified using PubMed, Scopus, and Cochrane library databases, without date restriction. Only systematic reviews and meta-analyses on the prognostic impact of SP and on any treatments aimed at reducing SP effect, in patients undergoing RT, were included in this review. The analyses not separately reporting the results in patients treated with RT were excluded. The quality assessment was performed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews).

Results

From the 84 papers identified, five reviews met the inclusion criteria with four reports mainly including non-randomized trials. Three reviews on the effect of SP showed a significantly negative impact on overall survival in patients undergoing RT and/or chemoradiation for H&N cancers (HR: 1.63-2.07). Two reviews on interventional studies showed the possibility of 1) improving physical functions through nutritional and physical interventions and 2) avoiding muscle wasting by means of sufficient protein intake. The quality assessment of the included review showed that two and three analyses are classifiable as having low and moderate overall confidence rating, respectively.

Conclusions

The analyzed reviews uniformly confirmed the negative impact of SP in patients with H&N tumors undergoing RT and the possibility of improving muscle mass and function through nutritional and physical interventions. These results justify further research on this topic based on a more uniform SP definition and on a complete evaluation of the potentially confounding parameters.

Swimming Attenuates Muscle Wasting and Mediates Multiple Signaling Pathways and Metabolites in CT-26 Bearing Mice

Objectives: To investigate the effects of swimming on cancer induced muscle wasting and explore its underlying mechanism in CT-26 bearing mice.

Methods: BALB/c mice (n = 16) injected with CT-26 cells were divided into two groups, including Tumor group (n = 8) and Swimming group (n = 8). Another 8 un-injected mice were set as Control group. Mice in Swimming group were subjected to physical training for swimming twice per day for 30 min intervals and 6 days per week for a total of 4 weeks. The tumor volume was monitored every 3 days and tumor weight was measured at the end of experiment. The changes of muscle function, pathological and cell apoptosis of quadriceps muscles were further assessed, and its underlying mechanisms were further explored using multiple biological technologies.

Results: Swimming obviously alleviated tumor volume and weight in CT-26 bearing mice. Moreover, swimming attenuated the decrease of muscle tension, autonomic activities, and increase of muscle atrophy, pathological ultrastructure, as well as cell apoptosis of quadriceps muscles in CT-26 bearing mice. Furthermore, swimming significantly down-regulated the protein expression of NF-κB, p-NF-κB, TNF-α, IL-1β, IL-6 and Bax, while up-regulated the expression of Bcl-2. Further differential expressed metabolites (DEMs) analysis identified a total of 76 (in anion mode) and 330 (in cationic mode) DEMs in quadriceps muscles of CT-26 bearing mice after swimming, including taurochenodeoxycholic acid, taurocholic acid, ascorbic acid and eicosapentaenoic acid.

Conclusion: Swimming attenuates tumor growth and muscle wasting, and by suppressing the activation of NF-κB signaling pathway mediated inflammation, reducing the level of Bax medicated cell apoptosis, as well as modulating multiple metabolites might be the importantly underlying mechanisms.