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Recommendations Summary

ONC: Breast Cancer: Chemotherapy 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: Breast cancer: Determination of REE and Chemotherapy

    Use of indirect calorimetry to measure REE is more accurate than estimation in early stage and advanced metastatic breast cancer patients. If measurement of REE is not possible or not thought to be imperative, use the HBE to estimate calorie requirements. Limited evidence indicates that the mean estimated REE was comparable to measured REE in these populations. No research was available to compare HBE using individual error or to compare HBE with other predictive equations in these populations.

    Rating: Weak

    • Risks/Harms of Implementing This Recommendation

      • Anxiety may be caused by indirect calorimetry procedures employing a face mask or canopy.
      • In some individuals, estimation of REE with predictive equations will lead to under- or over-feeding.

    • 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 small neutral quality time series studies expressed the measured REE of breast cancer patients as a percentage of estimated REE as predicted by the HBE. In both studies, measured REE was comparable to estimated REE, 98.6 ±9.6% HBE in advanced stage patients (Harvie et al, 2004) and 100.5 ± 8.0% HBE in early stage patients (Harvie et al, 2005).
        • Harvie et al, 2004 found that average measured and estimated energy needs of patients with advanced metastatic breast cancer were comparable to those of healthy controls (within 5% of each other).
        • Harvie et al, 2005 reported the breast cancer patients' REE was significantly higher than that of healthy control subjects (100.5 ± 8.0% HBE vs. 94.5 ± 8.5% HBE respectively; P < 0.05).
      • Further research is needed to determine the effects of breast cancer and breast cancer treatment on patients' actual REE.

    • Recommendation Strength Rationale

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