Table 3.
Fasting results
| Reference (author, year) | Design | Population (no. of participants, cancer site, treatment) | Intervention (DR intervention, corresponding cancer treatment) | Feasibility | Tolerance | Treatment effect |
|---|---|---|---|---|---|---|
| De Groot 2013 and 2015, Netherlands [38, 39] | Pilot RCT |
13 (7 IG, 6 CG) IG: Median age 51y (range 47-64y) CG: Median age 52y (range 44-69y) Stage 2–3 breast cancer |
48 h fast (24 h before until 24 h after start of chemotherapy) 3 weekly (neo) adjuvant TAC-chemotherapy |
15% withdrawal | NR |
↑ median blood glucose (mmol/L); IG: 5.2 to 6.8 (p = 0.042), CG: 4.8 to 7.0 (p = 0.043) ↓ mean IGF-1 (nmol/L) of 17% in IG (23.7 to 19.6, p = 0.012), ↔ CG ↔ median insulin (mU/L) in IG, ↑ in CG group: 2.0 to 16.0 (p = 0.043) ↔ TSH (mU/L) in IG: 1.49 to 0.42, ↓ in CG: 1.38 to 0.61 (p = 0.034) ↔ in IGF-BP3 or FT4 ↑ erythrocytes in IG (Day 7: p = 0.007, 95% CI 0.106–0.638; Day 21: p = 0.002, 95% CI 0.121–0.506) ↑ thrombocytes in IG (p = 0.00007, 95% CI 38.7–104) at day 7 ↔ leukocytes or neutrophils ↔ self-report side effects |
| Dorff, 2016 and Quinn, 2013, USA [40] | Dose escalation |
20 Median age 61y (range 31–75y) Any cancer |
3 cohorts fasted before chemotherapy for 24, 48 and 72 h (divided as 48 pre-chemo and 24 post-chemo) Platinum based chemotherapy |
Adherence: 24 h fast: 67%, 48 h fast: 83%, 72 h fast 57% |
Grade 1/2 fatigue, headache, dizziness, hypoglycaemia, weight loss, hyponatremia and hypotension No grade 3/4 fasting-related toxicities 5% failed to regain 25% of weight lost |
↓ IGF1. 24 h fast: Cycle 1: − 30% (− 12 to − 44%) Cycle 2: − 31% (− 45% to − 13%) 48 h fast: Cycle 1: − 33% (− 45% to − 18%) Cycle 2: − 20% (− 37 to 1%) 72 h fast: Cycle 1: − 8% (− 24 to 13%) Cycle 2: 16% (− 5 to − 42%) ↔ glucose ↓ mean insulin. 24 h fast: − 56%. 48 h fast: − 27%. 72 h fast: − 42% at 48 h (data at 72 h NR) ↓ DNA damage in 48 h and 72 h, but not 24 h fast ↓ nausea. 24 h fast: 100%, 48 h fast: 87%, 72 h fast: 43% (p = 0.019) ↓ vomiting. 24 h fast: 83%, 48 h fast: 43%, 72 h fast: 0% (p = 0.003) ↔ neutropenia. 24 h fast: 67%, 48 h fast: 14%, 72 h fast: 29% (p = 0.17) |
| Mas, 2017, France [41] | Qualitative |
15 Age NR Breast cancer |
Self-administered fast concurrent to chemotherapy |
Main motivation to limit chemotherapy side effects Effect of fasting on tumour was not a motivation (patients felt cancer-free following surgery) Offered a chance for ppts to take an active role in treatment |
13% reported AEs which stopped them fasting | Fasting was a positive experience that reduced the side effects of chemotherapy and reinforced self-esteem |
| Safdie, 2009 and [42], USA [43] | Case series |
10 Median age 61y (range 44-78y) Breast (n = 4), prostate (n = 2), ovarian (n = 1), uterine (n = 1), lung (n = 1), oesophageal (n = 1) cancer |
Self-administered fast ranging from 48 to 140 h prior to and/or 5–56 h following chemotherapy | NR |
Low grade dizziness, hunger, and headaches reported No grade 3/4 toxicities Weight loss recovered in “most” patients |
↓ in fatigue (p < 0.001), weakness (p < 0.00193) and GI side effects (absent) in 46 reported cycles with fasting compared with 18 ad-libitum cycles |
↑ = increase/higher
↓ = reduction/lower
↔ = no change/no difference
Where absolute figures were provided, %s have been calculated to aid comparison
Abbreviations: AEs Adverse Events, CG Control Group, CHO Carbohydrate, DR Dietary Restriction, FT4 thyroxine, GI, gastrointestinal, IG Intervention Group, IGF Insulin-like Growth Factor, IGFBP Insulin-like Growth Factor Binding Protein, NR Not Reported, RCT Randomised Controlled Trial, SAEs Serious Adverse Events, TSH Thyroid Stimulating Hormone