• Assessment
    Is there a relationship between nutritional intake (protein and kcals) to reduce symptoms and the reduction of symptoms associated with radiation therapy for elderly patients with breast or lung cancer?
    • Conclusion

      One (1) prospective longitudinal study (neutral quality rating ), evaluated 45 elderly lung and breast cancer patients receiving radiotherapy to describe the effect of specific variables, including nutritional intake and adequacy of nutritional intake, on weight and functional status. The researchers concluded that elderly lung and breast cancer patients experienced a significant weight loss at midpoint and end of radiation therapy, and that the percentage of calories contributed by protein significantly impacted weight status, with higher protein intake associated with improved weight status (p=0.02 at beginning of therapy, 15.4% mean total calories from protein; p=0.004 at approximately 3 weeks therapy, 16.7% mean total calories from protein; p=0.01 at conclusion of treatment, 18.1% mean total calories from protein).  There was no significant relationship between protein intake and weight status at 3 months post-treatment.  Protein intake was significantly associated to Karnofsky Performance Score at 3 weeks' therapy (p=0.03) and 3 months post-therapy (p=0.01).  No relationship was found between social support and weight status.  Further research is needed to determine the nutritional requirements of elderly lung and breast cancer patients receiving radiation therapy.

    • 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
       
  • Intervention
    Is there a relationship between the use of medical food supplements to improve nutritional intake (protein, kcals) and the reduction of symptoms associated with radiation therapy for patients with head and neck cancer?
    • Conclusion

      Two (2) RCTs (one positive quality, one neutral quality) found that MFS for patients with head and neck cancer undergoing radiation therapy may be helpful in preventing treatment interruptions, in reducing the number of mucosal reactions during therapy, and in minimizing weight loss.  In the positive quality study, 5 out of 12 control patients had to suspend treatment due to Grade III treatment toxicities. No intervention patient experienced Grade III toxicities, and none required suspension of treatment.  The other study found that supplement calories did not displace food calories in MFS patients, but added to total nutrient intake.  The neutral quality study was limited by compliance issues; no supplemented patient consumed the recommended volume of MFS, and only 7 out of 23 intervention patients consumed at least 80%.  The researchers concluded that all patients in this population should be considered for nutrition intervention.  Further research is needed to determine the appropriate use of MFS during radiation therapy for patients with head and neck cancer.

    • Grade: II
      • 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
       
    Is there a relationship between nutrition intervention by a dietitian to improve nutritional intake (protein and kcals) and the reduction of side effects associated with radiation therapy for head and neck cancer patients?
    • Conclusion

      Three positive quality studies and one neutral study found routine, nutrition intervention is beneficial and may prevent nutritional deterioration, improve calorie and protein intake, maintain anthropometric measurements and improve QOL in patients receiving radiation therapy for head and neck cancers. 

      One RCT found patients who received regular nutrition counseling from an RD based on the American Dietetic Association MNT protocol for cancer (radiation oncology) lost significantly less weight and FFM than controls.  Another RCT found nutrition counseling improves outcomes for patients with counseling having an equal or greater benefit than supplementation; and that at 3 months post-treatment, only counseling significantly impacted patient outcomes.  The prospective nonrandomized trial found that intensive nutrition intervention, including instruction to maintain caloric intake of 40 kcals/kg body weight, provided beneficial effects for head and neck cancer patients by minimizing weight loss, preserving FFM, and promoting maintenance of nutrition parameters. A two-group comparison showed that increased interaction or visits by a RD help decrease post-surgery and post-radiation therapy weight loss in patients with squamous cell cancer of the oral cavity.

      Further research is needed to determine the frequency, duration and optimal length of nutrition intervention for improved treatment-related outcomes and survival.

    • Grade: II
      • 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
       
    Is there a relationship between enteral nutrition to improve nutrition intake (protein and kcals) and the reduction of side effects associated with outpatient radiation therapy for head and neck cancer patients?
    • Conclusion

      Two positive quality RCTs found that head and neck cancer patients receiving radiation therapy may benefit from EN.  Energy and protein goals for patients in the RCTs were 40 kcals/kg and 1.0 - 1.5 g/kg body weight, respectively.  The researchers found that oral nutrition alone may not be adequate to maintain nutritional status during radiation therapy, and that EN may be required to meet nutrition goals.  Outpatient EN resulted in improvement or maintenance of weight status and increased mean calorie and protein intake when compared with controls.  The researchers concluded that maintenance of nutritional status by EN during radiation therapy may improve tolerance of therapy to promote better outcomes.  Further research is needed to determine the role of EN in improving nutritional intake in head and neck cancer patients.

    • Grade: II
      • 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
       
    Is there a relationship between parenteral nutrition to improve nutritional intake (protein, kcals) and the reduction of symptoms associated with pelvic radiation therapy for cancer?
    • Conclusion

      Two studies (2 retrospective reviews, quality ratings neutral) investigated the relationship between home PN to improve protein and calorie intake and reduction of symptoms associated with radiation-induced enteritis.  One study found that long-term outcomes, including total weaning from parenteral nutrition (p = 0.01) and survival (p = 0.0231), appear to be improved in patients treated for intestinal failure initially with bowel rest and home PN, rather than surgery.  In this study, patients' protein needs were provided at 1.0 - 1.2 g/kg, and energy needs were calculated by the Harris-Benedict formula.  The other study found that the most common complication related to home parenteral nutrition for radiation-induced enteritis was catheter-related infections (mean 1.56 days/100 days/patient).  The researchers found that home parenteral nutrition may be of benefit to patients with chronic radiation enteritis and intestinal failure.  These were descriptive studies only.  Further research is needed to determine the appropriate role of parenteral nutrition in treating patients with radiation-induced enteritis.

       

       

    • 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
       
  • Basic Research
    Is there a relationship between nutrition intervention to improve nutritional intake (protein and kcals) to reduce symptoms and the reduction of symptoms associated with pelvic radiation therapy for colorectal cancer patients?
    • Conclusion

      One positive quality RCT found that a group of patients who received dietary counseling plus regular diet during radiation therapy for colorectal cancer experienced significantly less nutritional decline (P< 0.02), significantly fewer toxicity symptoms (P < 0.01), and improvement in 6 of 6 function scores, when compared to groups receiving MFS or no nutrition intervention.  The researchers concluded that individualized dietary counseling, focusing on consumption of regular foods, is the most effective way to improve nutritional intake, nutritional status, and QOL during radiation therapy for colorectal cancer. 

      Further research into the role of nutrition intervention in radiation therapy for patients with colorectal cancer is needed.

    • 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
       
    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