Omega 3 (Eicosapentaenoic Acid and Others)

Omega 3 (Eicosapentaenoic Acid and Others)

PEP Topic 
Peripheral Neuropathy
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

Ghoreishi, Z., Esfahani, A., Djazayeri, A., Djalali, M., Golestan, B., Ayromlou, H., . . . Darabi, M. (2012). Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: A randomized double-blind placebo controlled trial. BMC Cancer, 12, 355.

doi: 10.1186/1471-2407-12-355
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Study Purpose:

Investigate omega 3 fatty acids in reducing the incidence and severity of paclitaxel-induced peripheral neuropathy

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to receive omega 3 fatty acid supplements at a dose of 640 mg three times daily, or an identical gelatin placebo capsule. All patients received the intervention throughout treatment and for one month after chemotherapy treatment. Patients were evaluated prior to chemotherapy and one month after completion of chemotherapy. Evaluations were done by a single neurologist.

Sample Characteristics:

  • N = 57           
  • MEAN AGE = 45.9
  • FEMALES = 100%
  • KEY DISEASE CHARACTERISTICS: All had breast cancer and were receiving four courses of 175 mg/m2 paclitaxel for positive node disease.

Setting:

  • SITE: Single site   
  • SETTING TYPE: Outpatient  
  • LOCATION: Iran

Phase of Care and Clinical Applications:

PHASE OF CARE: Active antitumor treatment

Study Design:

Double-blind, placebo-controlled, randomized trial

Measurement Instruments/Methods:

  • Total peripheral neuropathy score including sensory symptoms, pin sensibility, tendon reflexes, and nerve conduction studies of sural and peroneal nerves from scores for individual items of 0-4
  • Unilateral nerve conduction studies
  • Serum concentrations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)

Results:

70% of patients receiving omega 3 fatty acid supplements did not develop peripheral neuropathy, compared to 40% in the placebo group (odds ratio = 0.3, .95% CI = 0.10–0.88, p = .029). There was a non-significant trend toward lower severity of symptoms in those receiving omega 3 fatty acids. No significant differences existed between groups in individual nerve conduction study results. Significant differences did exist between groups in serum EPA and DHA concentrations (p < .005) with higher levels in the experimental group. No relationship existed between serum concentrations and peripheral neuropathy scores.

Conclusions:

Findings suggest that oral supplementation with omega 3 fatty acids may have a protective effect for development of peripheral neuropathy in patients receiving paclitaxel.

Limitations:

  • Small sample < 100
  • Measurement/methods were not well described.
  • Measurement validity/reliability was questionable.
  • Findings were not generalizable.
  • Study was underpowered by the authors’ report and calculations.
  • The specific grading of findings to calculate the peripheral neuropathy score is not well defined and is not a commonly used and validated scoring approach.
  • There was a limited timeframe of follow-up. 
  • Findings may not be applicable in patients receiving different neurotoxic drugs.

Nursing Implications:

Findings suggest a neuroprotective effect of omega 3 fatty acid supplementation. These are promising results, which warrant further research in well-powered studies and in the context of other types of neurotoxic chemotherapeutic agents.

Sanchez-Lara, K., Turcott, J.G., Juarez-Hernandez, E., Nunez-Valencia, C., Villanueva, G., Guevara, P., . . . Arrieta, O. (2014). Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: Randomised trial. Clinical Nutrition, 33, 1017–1023.

doi: 10.1016/j.clnu.2014.03.006
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Study Purpose:

To determine if a nutritional supplement taken by patients with advanced non-small cell lung cancer receiving paclitaxel with cisplantin/carboplatin chemotherapy can improve body composition, fatigue, health-related quality of life (HRQOL), and overall survival.

Intervention Characteristics/Basic Study Process:

The patients were randomized to isocaloric diet or isocaloric diet plus eicosapentaenoic-acid (EPA) supplement ProSure®.  Evaluations were conducted at baseline, after the first chemotherapy cycle, and after the second chemotherapy cycle.

Sample Characteristics:

  • N = 92  
  • AGE: 44-72 years
  • MALES: control group 23 (50%), intervention group 20 (43.5%); FEMALES: control group 23 (50%), intervention group 26 (56.5%)
  • KEY DISEASE CHARACTERISTICS: Stage IIIb and IV non-small cell lung cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Life expectancy greater than 12 weeks. All patients receiving chemotherapy with paclitaxel and cisplatin or carboplatin every three weeks for two cycles.

Setting:

  • SITE: Single site    
  • SETTING TYPE: Other    
  • LOCATION: Mexico

Phase of Care and Clinical Applications:

PHASE OF CARE: Active antitumor treatment

Study Design:

  • Randomized, controlled trial

Measurement Instruments/Methods:

  • Subject Global Assessment (SGA)
  • Bodystat Quadscan 4000 multifrequency
  • Food frequency questionnaire (FFQ)
  • Supplement intake diaries
  • Biochemical analysis
  • EORTC Quality of Life Core 30 Questionnaire (EORTC-QLQ-C30)
  • EORTC QLQ-LC13
  • Common Terminology Criteria for Adverse Events (CATCAE)

Results:

The ONS-EPA group exhibited significant differences in weight (p = 0.01) and lean body mass (p = 0.01). Significant improvement was also seen in calorie and protein intake (p <  0.001) when the nutritional supplement was included. The ONS-EPA group also exhibited significant improvement in inflammatory markers between time points (p = 0.02 to p = 0.05). In HRQOL, there was significant improvement in global health status between time points for the ONS-EPA group (p = 0.021). Differences were seen between groups in fatigue (p = 0.04), appetite loss (p = 0.05), and neuropathy (p = 0.05)

Conclusions:

In this study, ONS-EPA supplementation appears to be effective in improving nutritional status and decreasing side effects (appetite loss) in patients receiving chemotherapy for non-small cell lung cancer.

Limitations:

  • Small sample (less than 100)
  • Risk of bias (no blinding)
  • Findings not generalizable
  • Subject withdrawals of 10% or greater 
  • Only patients with non-small cell lung cancer were included.
  • There was a high rate of attrition in the control group (6 of 46) due to disease trajectory (worsening condition and death)

Nursing Implications:

More studies need to be done with EPA supplementation in this and other cancers.

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