Table 2.
Summary of included studies
| Reference | Jadad score | N | Age (median range) or (mean±SD) | Tumor type | Chemotherapy treatment | Nutritional status at inclusion | % patients (at risk of) malnutrition | Interventiona | Control | Duration |
|---|---|---|---|---|---|---|---|---|---|---|
| Elkort [36] | 1 | 47 | NR | Breast | 5-FU+Cytoxan+ methotrexate or l-PAM+5-FU | Well-nourished N=24 and moderately malnourished N=2, severely malnourished excluded (reported for N=26 completers) | 8 | High-energy ONS | Routine care | 12 months |
| Evans [29] | 1 | 180 | 59 (33–78) (CRC) and 61 (37–78) (NSCLC) | CRC- NSCLC | 5-FU+ methotrexate for CRC; vindesine+ cisplatin for NSCLC | Malnourished based on >5% BW loss: 39% (CRC) and 43% (NSCLC) | 39 (CRC) – 43 (NSCLC) | DC+high- energy ONS | Routine care | 12 weeks |
| Ovesen [39] | 3 | 137 | 58 (22–80) Ctr and 59 (29–80) Int | Lung ovary breast | Diverse | Half of patients had >5% BW loss in previous 3 mo | 50 | DC+ high-energy ONS if required | Routine care | 5 months |
| Breitkreutz [37] | 1 | 23 | 60.6±3.1 Ctr and 57.8±1.3 Int | GI | 5-FU and leucovorin | Inclusion criteria: moderate malnutrition, based on 3 out of 5 criteria (BW <90% of IBW or WL ≥10%/6 mo; triceps skinfold <90% of ideal; arm muscle circumference <90% of ideal; creatinine index <80% of ideal; serum albumin <35 g/l) | 100 | DC+ high-energy ONS | DC | 8 weeks |
| Baldwin [30] | 3 | 358 | 66.8 (24–88) | Mostly GI some NSCLC | Diverse single agents and combination- Palliative intent | Inclusion criterion: any weight loss in previous 3 mo. Mean % BW loss was 11.2±6.4 (GI) and 9.8±6 (lung) | 100 | DC and/or high- energy ONS | Routine care | 6 weeks |
| Bourdel- Marchasson [26] | 3 | 343 | 78±4.9 | Any | Diverse single agents and combination | Inclusion criterion: at risk of malnutrition according to MNA. MNA 20.4±2.1 (Ctr) and 20.1±2 (Int), Malnourished patients (MNA<17) were excluded. % BW loss was 8.6±7.9 (Ctr) and 8.9±6.6 (Int) | 100 | DC+high-energy ONS if required | Routine care | 3–6 months |
| Reference | Jadad score | N | Age (median range) or (mean± SD) | Tumor type | Chemo(radio)therapy treatment | Nutritional status at inclusion | % patients (at risk of) malnutrition | Interventionb | Control | Duration |
|---|---|---|---|---|---|---|---|---|---|---|
| Guarcello [31] | 2 | 46 | 68.7 (51–79) Ctr and 65.6 (43–79) Int | Lung stage IIIb–IV | Not reported | Inclusion criterion: malnutrition, BW loss >10% in previous 6 mo. % BW loss was 11.8 (4.3-18) (Ctr) and 12.9 (3.8-32.8) (Int) | 100 | High-protein, n-3 PUFA- enriched ONS | Isocaloric isonitrogeneous ONS | 8.5 weeks |
| Trabal [28] | 1 | 13 | 68.2±15.6 Ctr and 61.5±15.8 Int | CRC stage IV | FOLFOX or capecitabin | Two patients at risk of malnutrition, exclusion of severely malnourished patients (according to SGA scores). % BW loss was 3.1±3.3 (Ctr) and 8.1±6.9 (Int) | 15 | High-protein, n-3 PUFA- enriched ONS+DC | DC | 12 weeks |
| Van der Meij [27, 33] | 5 | 42 | 57.2±8.1 Ctr and 58.4±12 Int | NSCLC stage III | Cisplatin+ docetaxel or cisplatin +bevacizumab with concurrent thoracic radiotherapy | % BW loss in past mo: 1.5±4.7 (Ctr) and 0.3±2.4 (Int) 20% patients were considered malnourished based on BMI <18.5 and/or BW loss >5% in previous mo and/or BW loss >10% in previous 6 mo | 20 | High-protein, n-3 PUFA- enriched ONS | Isocaloric ONS | 5 weeks |
| Sanchez-Lara [34] | 3 | 92 | 61±12.4 Ctr and 58.8±14 Int | NSCLC stage III–IV | Paclitaxel+cisplatin/ carboplatin | % BW loss was 7.1±9 (Ctr) and 8.8±8 (Int) Malnutrition based on SGA: none (N=48), moderate (N=21), severe (N=23) | 48 | High-protein, n-3 PUFA- enriched ONS | Isocaloric diets | 6–8 weeks |
| Pastore [38] | 3 | 69 | 63.5±11.8 | GI–lung | Not reported | Malnutrition based on SGA: none (N=9), moderate (N=48), severe (N=12) | 87 | High-protein, n-3 PUFA- enriched ONS | Isocaloric ONS | 4 weeks |
a
Intervention nutritional goals are detailed in Table 3.
b
Intervention aims to provide about 590–600 kcal, 32–33 g protein and 2–2.2 g EPA per day.
CRC, colorectal cancer; Ctr, control group; DC, dietary counseling; 5-FU, 5-fluorouracil; FOLFOX, folinic acid, 5-fluorouracil and oxaliplatin; GI, gastrointestinal; (I)BW, (initial) body weight; Int, intervention group; l-PAM, Melphalan; MNA, mini nutritional assessment; mo, month; NSCLC, non-small-cell lung carcinoma; ONS, oral nutritional supplement; SGA, subjective global assessment.