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.

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.

• 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.

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

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

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

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.

• 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.