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Recommendations Summary

ONC: Nutrition Substances and Chemotherapy-Induced Peripheral Neuropathy 2013

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    ONC: Nutrition Substances and Chemotherapy-Induced Peripheral Neuropathy

    If an adult oncology patient is at risk for or has chemotherapy-induced peripheral neuropathy (CIPN), the registered dietitian nutritionist (RDN) should advise the patient that the use of nutrition substances (vitamin E, calcium and magnesium infusions, acetyl-L-carnitine, glutamine, glutathione) may or may not be beneficial as a means of preventing or improving CIPN. Research indicates that these substances have had only limited success in preventing or improving CIPN in oncology patients receiving specific chemotherapeutic agents.

    Rating: Weak
    Conditional

    • Risks/Harms of Implementing This Recommendation

      As with all dietary supplements, there is a potential for interaction with treatment that is unknown.

    • Conditions of Application

      • This recommendation applies to adult oncology patients who are at risk for or have CIPN
      • Consider advance directives when planning nutrition intervention.

    • Potential Costs Associated with Application

      Additional costs may be incurred with use of nutrition substances.

    • Recommendation Narrative

      CIPN is a significant debilitating symptom directly related to the administration of neurotoxic chemotherapy for the treatment of cancer. The evidence summary below is based on research from searches completed through May 2008 and the ONS PEP Research Evidence Table for Peripheral Neuropathy with searches completed through June 2011.   

      • A total of 15 studies using Vitamin E (three studies), Calcium and Magnesium (four studies), acetyl-L-carnitine (two studies), glutamine (three studies) and glutathione (three studies) in various combinations with cisplatin, paclitaxel, oxaliplatin, 5-FU or leucovorin were reviewed. The effectiveness regarding use of these substances in the prevention or improvement of peripheral neuropathy from chemotherapy.
      • Weight of the Evidence Category: Effectiveness was not established.

    • Recommendation Strength Rationale

      The Academy of Nutrition and Dietetics (AND) and the Oncology Expert Work Group concur with the Oncology Nursing Society Putting Evidence Into Practice (ONS PEP) guideline on Evidence-Based Interventions for Chemotherapy-Induced Peripheral Neuropathy and approved the following equivalency scale: External Guideline EAL Equivalency Rating.

      • Evidence to support the recommendation on vitamin E, calcium and magnesium infusions, acetyl-L-carnitine, glutamine, and glutathione in preventing or improving CIPN: Effectiveness not established (EAL Rating Equivalent: Weak).

    • Minority Opinions

      None.