Dobrila-Dintinjana, R., Trivanovic, D., Zelic, M., Radic, M., Dintinjana, M., Petranovic, D., . . . Matijasic, N. (2013). Nutritional support in patients with colorectal cancer during chemotherapy: Does it work? Hepato-Gastroenterology, 60, 475–480. 

DOI Link

Study Purpose

To determine if dietary counseling, oral nutrition, and megestrol acetate affect nutritional status and survival in patients with advanced cancer

Intervention Characteristics/Basic Study Process

Consecutive patients were given nutritional counseling, 400 mg per day megestrol, oral supplements of 600 kcal per day, and a product containing eicosapentaenoic acid with an additional 600 kcal. Prospective patients were then compared to historical controls when nutritional supplements were not available in the country. Patients were followed for up to 24 weeks.

Sample Characteristics

  • N = 628
  • MEDIAN AGE = 67.5 years (SD = 2.7 years)
  • MALES: 56.3%, FEMALES: 43.7%
  • KEY DISEASE CHARACTERISTICS: Colorectal cancer; about 2/3 had metastatic disease

Setting

  • SITE: Single-site  
  • SETTING TYPE: Outpatient  
  • LOCATION: Croatia

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care

Study Design

Prospective and observational with a historical control comparison

Measurement Instruments/Methods

  • Body weight
  • Eastern Comparative Oncology Group (ECOG) Performance Status
  • Appetite loss scale

Results

This study reports a higher prevalence of diarrhea and water retention in patients receiving nutritional intervention. It reports a lower prevalence of loss of appetite at 12 weeks in those given the intervention compared to historical controls (p = .0046) and improvement of appetite by 12 weeks in the intervention group (p = .0046). Survival curve analysis showed improved survival among those who received the intervention (p = .022)

Conclusions

Oral dietary supplements and nutritional counseling may benefit patients with advanced colorectal cancer.

Limitations

  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Measurement/methods not well described
  • Other limitations/explanation: Method of measurement for appetite not described; megestrol acetate has been shown to improve appetite, so it is not clear what effect the other components of the intervention had on appetite.

Nursing Implications

Dietary counseling and provision of oral nutritional supplements may be of benefit to patients.