Omega 3 (Eicosapentaenoic Acid and Others)

Omega 3 (Eicosapentaenoic Acid and Others)

PEP Topic 
Fatigue
Description 

EPA is an essential omega-3 fatty acid, distinguished from other long-chain polyunsaturated fatty acids by its specific chemical configuration. Bluefish, swordfish, salmon, and mackerel are rich in EPA. EPA has been studied in anorexia, and omega-3 fatty acid supplementation has been evaluated for its effect in fatigue, peripheral neuropathy, and prevention of infection.

 

Effectiveness Not Established

Research Evidence Summaries

Bruera, E., Strasser, F., Palmer, J. L., Willey, J., Calder, K., Amyotte, G., & Baracos, V. (2003). Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. Journal of Clinical Oncology, 21, 129–134.

doi: 10.1200/JCO.2003.01.101
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Intervention Characteristics/Basic Study Process:

Patients were given a daily dose of up to 18 gel capsules, including

  • 1,000 mg of fish oil, 1,800 mg of eicosapentaenoic acid (EPA), 120 mg of docosahexaenoic acid (DHA), and 1 mg of Vitamin E.
  • Placebo was 1,000 mg of olive oil.

Sample Characteristics:

  • The sample was comprised of 91 adult patients with locally recurrent or metastatic cancer. Each arm had 30 patients.
  • Of the patients, 31% dropped out.
  • Patients were included if they had anorexia, weight loss more than 5% of their preillness weight, were able to intake orally, and had normal cognition.

Setting:

The study was conducted at a Canadian acute palliative care unit and the inpatient and outpatient units of a cancer center.

Study Design:

The study was a double-blind, placebo-controlled trial.

Measurement Instruments/Methods:

  • Tiredness visual analog scale (VAS), ranging from 1 to 10
  • Karnofsky Performance Status (KPS)

Results:

Patients could not take 18 large capsules every day; the mean was 12 per day, with five patients in each group dropping out.

A strong trend was observed toward improved appetite in both groups. With the fish oil group, a trend existed toward less tiredness, but no significant change existed with appetite, weight loss, or calories.

Side effects of fish oil capsules included belching and fish oil taste.

Limitations:

  • The study was of short duration.
  • A lack of symptom improvement was observed.
  • Capsules were not well tolerated.
  • Long-term compliance was doubtful.
  • Gastrointestinal symptoms occurred with fish oil and placebo, causing oily diarrhea and an inability to tolerate them in the esophagus or stomach.

Read, J. A., Beale, P. J., Volker, D. H., Smith, N., Childs, A., & Clarke, S. J. (2007). Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial. Supportive Care in Cancer, 15, 301–307.

doi: 10.1007/s00520-006-0153-3
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Intervention Characteristics/Basic Study Process:

An energy-dense oral nutritional supplement of eicosapentaenoic acid (EPA-ONS), an anti-inflammatory agent, was shown to reduce weight loss, increase lean body mass, and improve functional capacity and nutritional status in previous research. The EPA intervention instructed patients to consume two tetrapaks (480 mL) of EPA-ONS per day in addition to their regular diet for a total of nine weeks. Tetrapacks contained 16 g of protein, 1.09 g of EPA, and 0.46 g of docosahexaenoic acid (DHA). Chemotherapy commenced at week 4 and was repeated every two weeks. Patient outcomes were assessed at baseline, the end of week 3, and the end of week 9.

Sample Characteristics:

  • The study was comprised of 23 patients with advanced colorectal cancer (CRC) who had one prior chemotherapy regimen (median age = 61 years).
  • The majority of the patients was male (n = 15) and had received previous surgery and chemotherapy (n = 17). 
  • Patients were excluded if they had previously received irinotecan, had preexisting intestinal disease, psychiatric disorders, edema, dehydration, or were unable to orally intake medications. Patients who could not have a three-week delay in administering cytotoxic chemotherapy without impacting disease progression were also excluded.

Setting:

The study was conducted at the Royal Prince Alfred and Concord Hospitals in Sydney, Australia.

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

This was an open-label, phase II study.

Measurement Instruments/Methods:

Disease and treatment assessment (DATA) form

Results:

The EPA intervention resulted in a trend toward improvement during the full course of therapy for overall well-being (p = 0.05) and energy (p = 0.03). The quality of life measure for fatigue was maintained at the same mean score throughout the study.

Limitations:

  • The study had a small sample size.
  • The study lacked a neutral comparison group.

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