• Intervention
    Is there a relationship between a diet containing probiotics and improved tolerance and support for recovery from anticancer therapy and the reduction of radiation-related diarrhea in cancer patients?
    • Conclusion

      A lack of studies with strong research design [(-) rating in three studies], dissimilar products (each study used different probiotic strains, amounts, dosing), differing patient populations and stage of treatment makes it difficult to provide a straight-forward conclusion on the amount, timing, and type of probiotics needed to prevent/reduce diarrhea as a radiation-related side effect. Probiotics appear to be helpful, but more conclusive research is needed before this can be applied in the clinical setting.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Probiotics and Symptoms/Complications 2004
       
    Is there a relationship between a patient’s intake of probiotics to reduce symptoms and the reduction of symptoms associated with cancer in all cancer patients?
    • Conclusion

      There is no evidence available that directly supports or refutes the relationship between a patient’s intake of probiotics to reduce symptoms and the reduction of symptoms associated with cancer in all cancer patients.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Probiotics and Symptoms/Complications 2004
       
    Is there a relationship between supplementation of antioxidant vitamins E and C and acetylcysteine, which may interact with chemotherapy and radiotherapy protocols, and cancer patients tolerance of chemotherapy and radiotherapy treatment?
    • Conclusion

      In one RCT of neutral quality, antioxidant vitamin E (600 mg/day), vitamin C (1 gm/day, given only on days in which therapy was applied) and N-acetylcysteine (200mg/day, given only on days in which therapy was applied) offered a cardioprotective effect measured via left ventricular ejection fraction for patients undergoing chemotherapy and radiotherapy for neoplastic disease.  Further research is needed to confirm these findings.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Antioxidants and Chemotherapy 2006
       
    Is there a relationship between supplementation of antioxidant vitamins E and C, which may interact with radiotherapy treatment, tolerance of radiotherapy treatment and late-effects of radiotherapy treatment in patients with chronic radiation proctitis?
    • Conclusion

      Research does not support or refute the use of supplemental vitamins C and E to improve tolerance or late-effects of radiotherapy treatment in patients with chronic proctitis.  One small, negative quality, before-after time series study reported a reduction in bleeding, diarrhea, and fecal urgency beginning within six weeks of supplementation with 500 mg vitamin C and 400 IU vitamin (taken three times daily) and continued in a subset of patients still taking the supplements a year later.   Large, well-designed studies are needed to address the potential interaction of antioxidants with radiotherapy and treatment outcome.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Antioxidants and Radiation Therapy 2006
       
    Is there a relationship between the intake of oral glutamine to improve and support recovery from radiation therapy and the reduction of mucositis associated with treatment of cancer patients?
    • Conclusion

      There is no evidence available that directly supports or refutes that the use of oral glutamine can improve and support recovery from radiation therapy or can reduce mucositis associated with radiation therapy.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of oral glutamine to improve tolerance and support recovery from radiation therapy and the reduction of diarrhea associated with treatment of cancer patients?
    • Conclusion

      Oral glutamine is not effective in the prevention of radiation-induced diarrhea as found in one study, with adequate sample size and good study design. More studies are needed to clarify this relationship.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Glutamine and Symptoms/Complications 2005
       
  • Basic Research
    Is there a relationship between nutrition intervention to improve nutritional intake (protein and kcals) and reduce symptoms and the reduction of symptoms associated with radiation therapy for high-nutritional risk (head and neck, GI) and low-nutritional risk (breast, lung, brain, gallbladder, uterine) cancers?
    • Conclusion

      One (1) prospective before-and-after study (quality rating neutral) found that individualized nutrition counseling designed to increase nutrition intake, based on each patient's clinical condition and nutrition status, is able to overcome predicted nutrition deterioration associated with radiation therapy in high-risk cancer patients.  Patients were classified as high- or low-risk based on expected radiation-induced GI symptoms.  At both beginning and end of radiation therapy, high-risk patients were assessed as moderately or severely malnourished more often than the low-risk group (p< 0.02).  During the course of radiation therapy, low-risk patients' nutrition status and quality of life remained stable, while high-risk patients' nutrition status improved (energy intake increased, p = 0.03; protein intake increased, p = 0.08, ns).  For high-risk patients, improved quality of life was statistically correlated with increased nutrition intake (p = 0.001).  The patients, in a subjective evaluation, attributed their improved nutrient intake to nutrition counseling.  The researchers concluded that individualized nutrition intervention is a feasible way to increase nutrition intake, which is associated with better quality of life.  Because all patients in the study received dietary counseling, it is possible that the high-risk patients' improvements were due to other factors.   Further research is needed to determine the role of nutrition intervention in reducing symptoms associated with radiation therapy for various types of cancer.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Radiation therapy: Diet Changes, Protein, Nutritional Intake, EN, Dietitian Involvement 2006