Oral nutritional interventions involve the provision of dietary advice or education with or without dietary modification or nutritional supplements. Nutritional supplements included in this type of intervention are those involving general protein-calorie supplements and multiple combinations of vitamins, minerals, and other compounds. Specific herbal supplements and some highly specific supplements such as carnitine and individual vitamins are considered as separate interventions.
Baldwin, C., Spiro, A., Ahern, R., & Emery, P.W. (2012). Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis. Journal of the National Cancer Institute, 104, 371–385.
STUDY PURPOSE: To examine the effect of oral nutritional interventions on outcomes among patients with cancer
Analysis indicates that oral nutritional interventions were associated with significant improvement in dyspnea and appetite symptom scales. It is unclear what the specific impacts of dietary counseling versus oral nutritional supplements were on these outcomes.
Nutritional interventions such as dietary counseling and oral nutritional supplementation may be helpful in managing symptoms of dyspnea and anorexia in patients cancer. Evidence does not provide strong support due to variability in timing of interventions, the exact nature of the interventions, actual nutritional status of patients included, and the timing of outcome data measurement. Nutritional interventions such as dietary counseling and oral nutritional supplement are low-risk interventions that may be helpful for some patients. Well-designed research and reporting in this area would be helpful to guide practice.
Cerchietti, L. C., Navigante, A. H., Peluffo, G. D., Diament, M. J., Stillitani, I., Klein, S. A., & Cabalar, M. E. (2004). Effects of celecoxib, medroxyprogesterone, and dietary intervention on systemic syndromes in patients with advanced lung adenocarcinoma: a pilot study. Journal of Pain and Symptom Management, 27, 85–95.
Systemic-immune metabolic syndrome (SIMS) implies dysregulation of psychoneuroimmunoendocrine homeostasis, resulting in cachexia, anorexia, chronic nausea, early satiety, fatigue, tumor fever, cognitive changes, and superinfections (i.e., increased cytokines may increase cachexia-anorexia syndrome [CAS] and mediate anorexia).
The study included 15 adult outpatients with stage IIIb or IV lung adenocarcinoma.
Patients were included if they
The study was conducted in a community outpatient setting in Argentina.
The study used a pilot, open-label, uncontrolled convenience sample design.
Weekly measurements included
Cost of medications, polymeric diet, and cost of cytokine measurements should be considered.
Jensen, M. B., & Hessov, I. (1997). Randomization to nutritional intervention at home did not improve postoperative function, fatigue or well-being. British Journal of Surgery, 84, 113–118.
Postoperative fatigue and deterioration in functional capacity have been correlated with postoperative weight loss. Nutritional support to enhance the regain of weight may be beneficial to convalescence.
Patients received soy protein supplements and dietician home visits and traveled five times during the 180 days in the postoperative period after discharge.
The study included 32 patients undergoing elective colorectal surgery; 22 (69%) had cancer.
The study was conducted in a community setting in Denmark.
Patients were undergoing the active treatment, postoperative phase of care.
This was a randomized trial with a usual care comparison group; patients and investigators were not blinded to treatment assignment.
The intervention group consumed significantly more protein than the control group. The intervention group slowly gained weight (p = 0.005) and body mass (p = 0.002) compared to the control group. Both groups had comparable scores for fatigue, functional status, and disability at discharge, 160 days, and the conclusion of the evaluation period.
Mantovani, G., Macciò, A., Madeddu, C., Gramignano, G., Lusso, M. R., Serpe, R., . . . Deiana, L. (2006). A phase II study with antioxidants, both in the diet and supplemented, pharmaconutritional support, progestagen, and anti-cyclooxygenase-2 showing efficacy and safety in patients with cancer-related anorexia/cachexia and oxidative stress. Cancer Epidemiology, Biomarkers and Prevention, 15, 1030–1034.
The integrated treatment consisted of the following components:
Patient outcomes were assessed at baseline and one, two, and four months.
Not identified
Patients were undergoing the active treatment phase of care.
This was an open, early-phase II study.
Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF)
Compared to baseline scores, fatigue outcomes improved at two months (p = 0.22) and more so at four months (p = 0.004). No correlation existed between changes in fatigue and changes in any other variable studied.
Mantovani, G., Macciò, A., Madeddu, C., Gramignano, G., Serpe, R., Massa, E., . . . Floris, C. (2008). Randomized phase III clinical trial of five different arms of treatment for patients with cancer cachexia: interim results. Nutrition, 24, 305–313.
All patients received basic treatment with polyphenols (300 mg/day) from alimentary sources (e.g., onions, apples, oranges, red wine, and green tea) or supplementary tablets. Patients also received antioxidant agents (a-lipoic acid and carbocisteine), as well as vitamins A, C, and E, orally. All patients then were randomized to one of the following five treatment arm interventions:
The planned treatment duration was four months. Patient outcomes were evaluated at 4, 8, 16, and 24 weeks.
Policlinico Universitario and Ospedale Oncologico Regionale, Cagliari, Italy
The study was a randomized, phase II, two-center clinical trial with five treatment arms.
Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF)
When comparing baseline and posttreatment measures, statistically significant improvements in fatigue outcomes were observed in the L-carnitine treatment arm (p = 0.039) and the MPA/MA plus pharmacologic nutritional support, L-carnitine, and thalidomide arm (p = 0.015). Fatigue worsened significantly in patients receiving EPA-enriched oral supplementation treatment (p = 0.051).
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.
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.
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.
PHASE OF CARE: Active antitumor treatment
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)
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.
More studies need to be done with EPA supplementation in this and other cancers.