Oncology

ONC: Colorectal Cancer (2006-2007)

Colorectal Cancer and Nutrition:

• • Nutrition Intervention with Radiation Therapy
  • Nutrition Support and Surgery

• Intervention
  Is there a relationship between the use of preoperative nutrition support to improve nutritional intake (protein, kcals) and the reduction of adverse outcomes associated with surgery for gastric and colorectal cancer patients?

  • Conclusion

    One positive quality RCT found that parenteral or enteral preoperative nutrition support, provided for at least 10 days prior to surgery, and using standard PN and EN formulas, resulted in a small benefit for nutritionally depleted patients receiving surgical treatment for gastric and colorectal cancer when compared to nutritionally depleted patients receiving immediate surgery with no preoperative nutrition support.  Benefits of nutrition support included a decreased rate of sepsis (P <0.05) and intra-abdominal abscess formation (P< 0.05).  The benefit obtained increased with the degree of nutritional depletion.  The researchers found no increased morbidity related to nutrition support.  Total stay in PN and EN groups was not significantly longer than the control group, despite longer pre-operative stays in the nutrition support groups.  The researchers concluded that only patients with severe nutritional depletion, defined as weight loss > 10% prior to surgery, should receive nutritional support prior to surgery for gastric or colorectal 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.
  • Evidence Summary: Pre-operative Nutrition Support (Pro/Kcals): Adverse Outcomes for Gastric and Colorectal Cancer
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Von Meyenfeldt MF, Meijerink WJHJ, Rouflart MMJ, Builmaassen MTHJ, Soeters PB.  Perioperative nutritional support: a randomized clinical trial.  Clinical Nutrition (1992) 11: 180-186.
  • Search Plan and Results: Protein and Symptoms/Complications: Preoperative 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.
  • Evidence Summary: Nutritional Intervention in Patients with Colorectal Cancer Undergoing Pelvic Radiation Therapy: Nutritional Intake (Protein and Calories)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ravasco P, Monteiro-Grillo I, Vidal P, Camilo M. Dietary counseling improves patient outcomes: A prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncology. 2005; 23: 1,431-1,438.
  • Search Plan and Results: Radiation therapy: Diet Changes, Protein, Nutritional Intake, EN, Dietitian Involvement 2006