Hopeful
10-01-2010, 01:55 PM
Elsevier Global Medical News. 2010 Sept 24, S Freeman
BARCELONA (EGMN) - Malnutrition remains a significant problem in cancer treatment, with a study reporting that all of nearly 1,000 cancer patients evaluated in Spanish hospitals were malnourished, more than 70% of them at levels ranging from moderate to severe.
New data from Portugal suggest, however, that individualized nutritional counseling not only improves patients' nutritional status, but can also prolong their overall survival after they undergo radiotherapy.
Long-term follow-up (median, 6.5 years) of 111 colorectal cancer patients in a prospective trial revealed that the shortest survival (4.1 years) and highest mortality rate (30%) occurred in patients who were not given any nutritional intervention. Patients who were given high-protein liquid supplements had a median survival of 6.5 years and a mortality rate of 22%, but the longest survival (7.3 years) and lowest mortality (8%) were observed in patients who received personalized nutritional advice.
Both studies were presented at the biennial meeting of the European Society of Therapeutic Radiation and Oncology (ESTRO 29). "Malnutrition and its clinical consequences still remain as a major problem in our daily practice," despite the more active care of patients, said Dr. Albert Biete, who reported on the NUTRIDIS study from Spain.
The NUTRIDIS Study
The cross-sectional NUTRIDIS study aimed to assess the impact of malnutrition and its clinical consequences in patients treated for primary cancer. Data were collected from April 2006 to April 2007 on 1,069 patients who were treated within the radiation oncology, medical oncology, and palliative care departments of 40 Spanish hospitals.
Nutritional status was determined at study entry by a variety of measures, including laboratory tests and calculation of the body mass index. Patients' oncological treatments as well as nutritional and other drug support measures were recorded, and their effects on nutrition status assessed.
Nearly two-thirds (63.8%) of the 922 patients that could be evaluated were male; the median age of all patients was 63.8 years. During the preceding 6 months, patients lost a median of 10.1 kg, which was associated with a median decrease in weight of 8.7%. Fewer than half (45%) of patients had metastatic disease, and 49.1% had a performance status of 1.
All patients with cancer were found to have some level of malnutrition, with almost one-fifth (18.1%) being severely malnourished, 53.5% suffering from moderate malnutrition, and the remainder having 'light' malnutrition.
"We found a statistically significant relationship between the severity of malnutrition and the treatment response," said Dr. Biete of the radiation oncology department at the Hospital Clinic i Provincial de Barcelona.
He reported that malnutrition was associated with a host of complications, including weight loss (48.7%), asthenia (47.1%), anorexia (37.2%), hypoproteinemia (33.3%), anemia (32.2%), depression (13.7%), anxiety (9.5%), infections (8.8%), mucositis (8.8%), taste disorders (6.9%), delayed wound closure (6.5%), and impaired capability to concentrate (6.1%).
These complications significantly affected patients' ability to undertake their normal daily activities, said Dr. Biete. In a large percentage of patients, the received treatment had affected the nutritional status (64.1%), whereas malnutrition influenced the response to treatment in 43.1%, causing problems with completing treatment and delaying the end of treatment.
Dr. Biete noted that supportive nutritional measures were used in 60.8% of patients, and that megestrol acetate was the most commonly prescribed drug aimed at improving patients' appetite.
Personal Counseling More Effective
The Portuguese study presented by Dr. Paula Ravasco suggests, however, that nutritional counseling can be a far more effective means of improving patient outcomes than are nutritional supplements alone, at least in patients undergoing radiotherapy. In addition to improving overall survival, dietary counseling improved patients' quality of life to a greater extent than did protein supplements or no nutritional intervention.
Early and timely individualized nutritional intervention had a sustained effect on outcomes," said Dr. Ravasco, a clinical expert in nutrition at the University of Lisbon.
"What our data clearly demonstrate is that nutritional advice has to be individualized," she added in an interview.
Between 2000 and 2003, 111 patients undergoing radiotherapy for colorectal cancer were evenly randomized to dietary counseling, protein supplements, or what the investigators called ad libitum intake. Investigators reported previously that counseling and supplements improved outcomes during radiotherapy, but only counseling results in sustained benefits 3 months later (J. Clin. Oncol. 2005;23:1431-8).
Dr. Ravasco advised that evidence-based nutritional counseling should always be based on an initial assessment of patients' nutritional status and intake via a structured questionnaire. Patients' dietary preferences, habits, and intolerances need to be considered, along with their psychological status and whether they are likely to be cooperative or might need help to feed themselves. Identifying any symptoms or conditions (such as gastrointestinal, anorexia, or pain) that might interfere with nutritional support is also important before a diet is prescribed.
"We are entering a new era in cancer management," said Dr. Ravasco. Considering the clinical evidence now available, adjuvant nutritional intervention is an essential addition to the multidisciplinary care of patients with cancer, she added.
She and her associates are planning a larger, four-arm trial to look at the combined effects of nutritional counseling and supplements vs. counseling alone, supplements alone, and no intervention. This will initially involve patients with high-risk cancers, including colorectal, gastric, esophageal, and head and neck cancers, but could eventually be expanded to include patients with any solid tumor.
The NUTRIDIS study was supported by a grant from PRASFARMA SA in Barcelona. The randomized trial received a grant from Núcleo Regional do Sul da Liga Portuguesa contra o Cancro-Terry Fox Foundation. Dr. Biete and Dr. Ravasco reported no conflicts of interest.
Hopeful
BARCELONA (EGMN) - Malnutrition remains a significant problem in cancer treatment, with a study reporting that all of nearly 1,000 cancer patients evaluated in Spanish hospitals were malnourished, more than 70% of them at levels ranging from moderate to severe.
New data from Portugal suggest, however, that individualized nutritional counseling not only improves patients' nutritional status, but can also prolong their overall survival after they undergo radiotherapy.
Long-term follow-up (median, 6.5 years) of 111 colorectal cancer patients in a prospective trial revealed that the shortest survival (4.1 years) and highest mortality rate (30%) occurred in patients who were not given any nutritional intervention. Patients who were given high-protein liquid supplements had a median survival of 6.5 years and a mortality rate of 22%, but the longest survival (7.3 years) and lowest mortality (8%) were observed in patients who received personalized nutritional advice.
Both studies were presented at the biennial meeting of the European Society of Therapeutic Radiation and Oncology (ESTRO 29). "Malnutrition and its clinical consequences still remain as a major problem in our daily practice," despite the more active care of patients, said Dr. Albert Biete, who reported on the NUTRIDIS study from Spain.
The NUTRIDIS Study
The cross-sectional NUTRIDIS study aimed to assess the impact of malnutrition and its clinical consequences in patients treated for primary cancer. Data were collected from April 2006 to April 2007 on 1,069 patients who were treated within the radiation oncology, medical oncology, and palliative care departments of 40 Spanish hospitals.
Nutritional status was determined at study entry by a variety of measures, including laboratory tests and calculation of the body mass index. Patients' oncological treatments as well as nutritional and other drug support measures were recorded, and their effects on nutrition status assessed.
Nearly two-thirds (63.8%) of the 922 patients that could be evaluated were male; the median age of all patients was 63.8 years. During the preceding 6 months, patients lost a median of 10.1 kg, which was associated with a median decrease in weight of 8.7%. Fewer than half (45%) of patients had metastatic disease, and 49.1% had a performance status of 1.
All patients with cancer were found to have some level of malnutrition, with almost one-fifth (18.1%) being severely malnourished, 53.5% suffering from moderate malnutrition, and the remainder having 'light' malnutrition.
"We found a statistically significant relationship between the severity of malnutrition and the treatment response," said Dr. Biete of the radiation oncology department at the Hospital Clinic i Provincial de Barcelona.
He reported that malnutrition was associated with a host of complications, including weight loss (48.7%), asthenia (47.1%), anorexia (37.2%), hypoproteinemia (33.3%), anemia (32.2%), depression (13.7%), anxiety (9.5%), infections (8.8%), mucositis (8.8%), taste disorders (6.9%), delayed wound closure (6.5%), and impaired capability to concentrate (6.1%).
These complications significantly affected patients' ability to undertake their normal daily activities, said Dr. Biete. In a large percentage of patients, the received treatment had affected the nutritional status (64.1%), whereas malnutrition influenced the response to treatment in 43.1%, causing problems with completing treatment and delaying the end of treatment.
Dr. Biete noted that supportive nutritional measures were used in 60.8% of patients, and that megestrol acetate was the most commonly prescribed drug aimed at improving patients' appetite.
Personal Counseling More Effective
The Portuguese study presented by Dr. Paula Ravasco suggests, however, that nutritional counseling can be a far more effective means of improving patient outcomes than are nutritional supplements alone, at least in patients undergoing radiotherapy. In addition to improving overall survival, dietary counseling improved patients' quality of life to a greater extent than did protein supplements or no nutritional intervention.
Early and timely individualized nutritional intervention had a sustained effect on outcomes," said Dr. Ravasco, a clinical expert in nutrition at the University of Lisbon.
"What our data clearly demonstrate is that nutritional advice has to be individualized," she added in an interview.
Between 2000 and 2003, 111 patients undergoing radiotherapy for colorectal cancer were evenly randomized to dietary counseling, protein supplements, or what the investigators called ad libitum intake. Investigators reported previously that counseling and supplements improved outcomes during radiotherapy, but only counseling results in sustained benefits 3 months later (J. Clin. Oncol. 2005;23:1431-8).
Dr. Ravasco advised that evidence-based nutritional counseling should always be based on an initial assessment of patients' nutritional status and intake via a structured questionnaire. Patients' dietary preferences, habits, and intolerances need to be considered, along with their psychological status and whether they are likely to be cooperative or might need help to feed themselves. Identifying any symptoms or conditions (such as gastrointestinal, anorexia, or pain) that might interfere with nutritional support is also important before a diet is prescribed.
"We are entering a new era in cancer management," said Dr. Ravasco. Considering the clinical evidence now available, adjuvant nutritional intervention is an essential addition to the multidisciplinary care of patients with cancer, she added.
She and her associates are planning a larger, four-arm trial to look at the combined effects of nutritional counseling and supplements vs. counseling alone, supplements alone, and no intervention. This will initially involve patients with high-risk cancers, including colorectal, gastric, esophageal, and head and neck cancers, but could eventually be expanded to include patients with any solid tumor.
The NUTRIDIS study was supported by a grant from PRASFARMA SA in Barcelona. The randomized trial received a grant from Núcleo Regional do Sul da Liga Portuguesa contra o Cancro-Terry Fox Foundation. Dr. Biete and Dr. Ravasco reported no conflicts of interest.
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