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Recommendations Summary

ONC: Non-Small Cell Lung Cancer: Chemotherapy and Determination of Resting Energy Expenditure 2007

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: Lung Cancer: Chemotherapy and Determination of REE

    Use of indirect calorimetry to measure REE is more accurate than estimation in patients with non-small cell lung cancer (NSLC) cancer undergoing chemotherapy. If measurement of REE is not possible or not thought to be imperative, use HBE to estimate calorie needs. However, limited evidence indicates that the HBE may underestimate energy needs by an average of 12-13%.

    Rating: Weak
    Imperative

    • Risks/Harms of Implementing This Recommendation

      • Some patients may experience anxiety associated with the indirect calorimetry measurement process.
      • Under- or over-feeding may result when energy needs are estimated rather than measured.

    • Conditions of Application

      • The studies reviewed for this recommendation only reviewed HBE as an energy estimating equation. See energy expenditure and energy assessment recommendations in the Critical Illness Guideline for information on other conditions. For more information on measuring vs. estimating RMR, see Determining Resting Metabolic Rate.
      • The AARC Clinical Practice Guidelines (1994) recommend that measurements may be indicated in patients with several conditions including:
        • Cancer with residual tumor
        • Extreme obesity
      • The AARC Clinical Practice Guidelines (1994) also provide recommendations for hazards and complications, limitations of the procedures and infection control.
      • Measures should be conducted by specialty-trained personnel who have documented and demonstrated proficiency to calibrate, operate and maintain the calorimeter and to recognize calorimeter values within the normal physiologic range.

    • Potential Costs Associated with Application

      • Cost of equipment, supplies and staff needs to be addressed in all indirect calorimetry measurements.

    • Recommendation Narrative

      • Two neutral quality time-series studies compared measured REE with estimated REE using the HBE before and after receipt of a course of chemotherapy and at the end of a course of chemotherapy in NSLC patients.  
        • Harvie et al, 2003 reported that the average measured REE was comparable to estimated, except in males prior to chemotherapy (measured REE was 113% of estimated).  
        • Harvie et al, 2005 (15/19 male subjects) found that average measured REE was 112% of the REE as estimated by HBE. 
      • Further research is needed to determine the energy needs of NSLC patients.

         

    • Recommendation Strength Rationale

      • Based on two neutral quality time-series studies, conclusion statement is a Grade III.