Table 3.
Summary of studies included in review of incorporation of nutrition interventions as a component of cancer therapy
| Study, Year | Design, Sample Size | Population, Country | Cancer Dx, Cancer Tx | Nutrition Status | Nutrition Intervention(s) | Early or Late Intervention(s), Duration | Outcomes of Nutrition Intervention(s) |
|---|---|---|---|---|---|---|---|
| Bourdel-Marchasson, 2014 [30] | RCT 341 |
Older adults (70+ years) France |
Lymphoma or carcinoma CT |
At risk for malnutrition | Counseling + ONS if needed (intervention group) vs. standard care | Early 3-6 months |
↑ Energy intake *ᶲ No difference in weight loss ᶲ No difference in hospitalizations ᶲ No difference in response to cancer treatment ᶲ ↓ Complications (infections) *ᶲ No difference in mortality ᶲ |
| Cereda, 2018 [31] | RCT 159 |
Any adults (18+ years) Italy |
Head and neck cancer RT or RT plus systemic tx |
Any nutrition status | Counseling + ONS (intervention group) vs. counseling only | Early Throughout RT, at 1 month and 3-month follow-up visits after end of RT |
↓ Weight loss *ᶲ ↑ Energy intake *ᶲ ↑ Protein intake *ᶲ ↑ Handgrip strength ᶲ ↑ QoL *ᶲ ↑ Treatment tolerance ᶲ |
| Kim, 2019 [32] | RCT 34 |
Any adults (20+ years) Korea |
Pancreatic and bile duct cancers CT |
Patients with a BMI > 30 kg/m2 were excluded | Counseling + ONS (intervention group) vs. counseling only | Early for 61.8% of participants (initiated study participation in first cycle of CT) 8 weeks |
↑ Nutrition status (measured by PG-SGA) *ᶣ No difference in weight loss ᶲᶣ No difference in skeletal muscle mass ᶲᶣ No difference in FFM ᶲᶣ↑ Fat mass *ᶲᶣ ↑ Energy intake *ᶣ ↑ Protein intake *ᶣ ↑ QoL (fatigue symptoms) ᶣ |
| Meng, 2019 [28] | Prospective cohort study 78 |
Adults 18–70 years China |
Nasopharyngeal carcinoma CRT |
Any nutrition status | Early nutrition intervention (intervention group) vs. late nutrition intervention Intervention for both groups was ONS + EN or PN if needed |
Early for participants in the nutrition intervention group; late nutrition intervention group did not receive nutrition support until nutrition-related side effects from treatment developed Nutrition intervention lasted until 3 months after CRT |
↓ Weight loss *ᶲ ↓ BMI change *ᶲ ↑ Treatment tolerance (lower incidence of mucositis) *ᶲ ↓ Treatment breaks (>3 days) *ᶲ ↓ Treatment delays for toxicity *ᶲ ↓ Unplanned hospitalizations *ᶲ |
| Paccagnella, 2010 [29] | Retrospective cohort study 66 |
Any adults (18+ years) Italy | Head and neck cancer CRT |
Any nutrition status | Individualized counseling + ONS/EN if needed (intervention group) vs. standard care | Early Nutrition intervention lasted until 6 months after CRT |
↓ Weight loss *ᶲ ↑ Treatment tolerance *ᶲ ↓ Treatment delays *ᶲ ↓ Unplanned hospitalizations *ᶲ |
| Poulsen, 2014 [33] | RCT 61 |
Any adults (18+ years) Denmark |
GI gynecologic, or esophageal cancer CT and/or RT |
Any nutrition status | Counseling + ONS-EPA if desired (intervention group) vs. standard care | Early Between 5–12 weeks, follow-up performed 3 months after treatment |
↓ Weight loss *ᶲ ↑ Energy intake *ᶲ ↑ Protein intake *ᶲ No difference in change in FFM ᶲ No difference in change in fat mass ᶲ No difference in QoL ᶲ |
| Ravasco, 2012 [34] | RCT 111 |
Any adults (18+ years) Portugal |
Colorectal cancer RT followed by surgery + CT |
Any nutrition status | Nutrition counseling and education using regular foods (group 1) vs. ONS + usual diet (group 2) vs. usual diet only (group 3) |
Early 1.5 months |
↑ Nutrition status (measured by PG-SGA; group 1) *ᶲ ↑ BMI (group 1) *ᶲ↑ Energy intake (group 1) *ᶲ ↑ Protein intake (group 1) *ᶲ ↑ Treatment tolerance (measured by late radiotherapy toxicity; group 1) *ᶲ ↑ QoL (group 1) *ᶲ ↓ Mortality (group 1) *ᶲ Results are from long-term follow-up (range = 4.9–8.2 years) and compared to groups 2 and 3 |
| Roca-Rodriguez, 2014 [35] | RCT 26 |
Adults 18–80 years Spain |
ENT cancer RT, and CT if needed |
Any nutrition status | ONS-EPA (intervention group) vs. isocaloric ONS | Late (14 days after start of RT) 76 days |
↓ BMI decline ᶲ |
| Sanchez-Lara, 2014 [36] | RCT 92 |
Adults 18–80 years Mexico |
Non-small cell lung cancer CT |
Any nutrition status | Diet plus ONS-EPA (intervention group) vs. isocaloric diet only Extra calories from ONS were subtracted from intervention group diet so both groups received an isocaloric diet |
Early 8+ weeks |
↓ Weight loss *ᶲ ↑ LBM *ᶲ ↑ Energy intake *ᶲᶣ ↑ Protein intake *ᶲᶣ ↑ QoL (increased global health status; ᶣ improved fatigue and loss of appetite ᶣᶲ) * ↑ Treatment tolerance (less nausea, vomiting, and neuropathy) *ᶲ No difference in tumor response rate ᶲ No difference in overall survival ᶲ↑ PFS ᶲ |
| Shirai, 2017 [37] | Retrospective cohort study 179 |
Adults 18–80 years Japan |
GI cancer CT |
>5% of pre-illness body weight | ONS-EPA (intervention group) vs. no additional nutritional treatment/placebo | Unknown 6 months |
↑ Skeletal muscle mass and LBM *ᶣ No difference in overall survival ᶲ ↑ Treatment tolerance for patients with mGPS of 1 or 2 who received ONS-EPA ᶲ ↑ Prognosis for patients with mGPS of 1 or 2 who received ONS-EPA *ᶲ |
| Trabal, 2010 [38] | RCT 13 |
Any adults (18+ years) Spain |
Colorectal cancer CT |
Excluded patients with severe malnutrition (based on PG-SGA or BMI < 16.5 or >30 kg/m2 Patients withdrawn if they developed malnutrition during the study |
Counseling + ONS-EPA (intervention group) vs. counseling only | Early 12 weeks |
↑ Weight *ᶲ ↑ Energy intake ᶲ ↑ Protein intake ᶲ ↑ QoL (improved fatigue, pain, physical function, social function) ᶲ ↑ Treatment tolerance ᶲ |
| van der Meij, 2010 [39] | RCT 40 |
Adults 18–80 years The Netherlands |
Non-small cell lung cancer CRT |
Any nutrition status | ONS-EPA (intervention group) vs. isocaloric ONS | Early 5 weeks |
↓ Weight loss *ᶲ ↓ Loss of FFM *ᶲ No difference in energy intake ᶲ No difference in protein intake ᶲ |
| van der Meij, 2012 [40] | RCT 40 |
Adults 18–80 years The Netherlands |
Non-small cell lung cancer CRT |
Any nutrition status | ONS-EPA (intervention group) vs. isocaloric ONS | Early 5 weeks |
↑ QoL (global health status, physical function, cognitive function, social function) *ᶲ ↑ Physical activity (during weeks 3 and 5) *ᶲ No difference in handgrip strength ᶲ ↑ Treatment tolerance (lower incidence of nausea/vomiting) *ᶲ No difference in treatment delays/dose reduction ᶲ No difference in unplanned hospital admissions ᶲ |
Key: ↑ increased/higher; ↓ decreased/lower; * statistically significant (p < 0.05); ᶲ compared to control group/standard of care; ᶣ compared to baselin. Abbreviations: BMI, body mass index; CRT, chemoradiotherapy; CT, chemotherapy; Dx, diagnosis; EPA, eicosapentaenoic acid; EN, enteral nutrition; ENT, ear, nose and throat; FFM, fat free mass; GI, gastrointestinal; LBM, lean body mass; mGPS, modified Glasgow Prognostic Score; ONS, oral nutrition supplement; ONS-EPA, oral nutrition supplement containing eicosapentaenoic acid; PFS, progression-free survival; PG-SGA, Patient Generated Subjective Global Assessment; PN, parenteral nutrition; QOL, quality of life; RCT, randomized controlled trial; RT, radiotherapy; Tx, treatment.