• Intervention
    Is there a relationship between a patient's intake of spicy foods and the impact on the degree of oral mucositis in chemotherapy patients?
    • Conclusion

      One study of weak design suggests that there is a positive relationship between the intake of spicy foods and the degree of oral mucositis and oral symptom scores in chemotherapy patients. Initial evidence is presented that spicy foods should be avoided prior to and during mucositis-causing cancer treatment. More research with stronger study design and greater heterogeniety of patient populations is needed to evaluate the effect of the consumption of spicy foods before and during mucositis-causing chemotherapy.

    • 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: Food Acidity and Food Seasoning and Symptoms/Complications 2005
       
    Is there a relationship between supplementation of antioxidant vitamin E, which may interact with cisplatin-based chemotherapy and tolerance of cisplatin-based chemotherapy to decrease neurotoxicity in cancer patients?
    • Conclusion

      Results of one randomized controlled trial of neutral quality, found that vitamin E supplementation (300 mg/day from the first day of chemotherapy and continued for three months after the suspension of treatment) significantly protects against cisplatin-induced peripheral neurotoxicity and reduces the incidence and intensity of neuropathic signs and symptoms. Vitamin E supplementation had no significant effect on either clinical response or systemic toxicities.  Larger RCTs are required to validate 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 C, E and selenium and an interaction with cisplatin-based chemotherapy protocols and tolerance of chemotherapy treatment in patients with varying types of cancers?
    • Conclusion

      Results of two reports, one of neutral and one of negative quality from one RCT found with supplementation with 2,000 mg vitamin C (L-ascorbic acid), 800 mg of vitamin E (dl-a-tocopherol-acetate) and 200 mcg selenium (sodium selenite) had no effect on cisplatin-based chemotherapy toxicity.  Caution must be taken when interpreting these results because in both studies, patient compliance with the milky beverages containing supplements was poor and sample sizes were small.  Further RCTs are required to validate 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 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 the antioxidant selenium, which may interact with cisplatin-based chemotherapy, and tolerance of cisplatin-based chemotherapy treatment in patients with a varying cancer types?
    • Conclusion

      Two studies of positive quality, one PRCT and one prospective, randomized, controlled, crossover study assessed the role of selenium related to cisplatin toxicity in female patients treated for ovarian cancer and various tumors, respectively. Both studies found selenium supplementation reduced bone marrow suppression. Investigators also found reduced nephrotoxicity, activation of selenium-dependent enzymes glutathione peroxidase and malondialdehyde and a reduction in side effects caused by chemotherapy. These studies indicate that there may be beneficial effects associated with the ingestion of supplemental selenium during chemotherapy.  Both studies were conducted in geographic areas with low selenium levels in the food supply and neither study reported baseline serum selenium levels.  One study reported baseline selenium levels of 70.4 ± 22 nanograms/ml and the other article did not report baseline serum selenium levels.  Further research is needed to confirm these findings in varying cancers and to determine the optimal dosage of selenium as a chemoprotector of cisplatin-based chemotherapy.

      Note:  According to the DRI for Vitamin C, Vitamin E, Selenium and Carotenoids, 7-9 (mcg/dL (70-90 nanograms/ml is considered the minimum level of plasma selenium required for selenoprotein synthesis.

       

    • 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 the intake of hot (temperature) foods and the degree of oral mucositis in patient's undergoing mucositis-causing chemotherapy?
    • Conclusion

      One weakly designed study suggests that there is a positive relationship between the intake of hot (temperature) foods and the degree of oral mucositis in patients undergoing mucositis-causing chemotherapy. Further research with better study design 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: Food Temperature and Symptoms/Complications 2005
       
    Is there a relationship between the intake of oral glutamine to improve tolerance and support recovery from chemotherapy and the reduction of diarrhea associated with treatment of cancer patients?
    • Conclusion

      Three (3) RCT’s (all + quality) found mixed results (one positive, two no difference) on the ability of oral glutamine to reduce chemotherapy induced diarrhea. All studies used FU-based chemotherapy, but varied in cancer sites, chemotherapy dosing and dosage and administration of oral glutamine. Further studies with consistent oral glutamine supplementation and greater heterogeneity of cancer sites need to be completed.

    • 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: Glutamine and Symptoms/Complications 2005
       
    Is there a relationship between the intake of oral glutamine to improve tolerance and support recovery from chemotherapy and the reduction of mucositis or stomatitis associated with treatment of cancer patients?
    • Conclusion

      Five strong studies did not find glutamine to be effective. One (1) metaanalysis (5 studies and 343 patients) and 4 RCTs (including one crossover design), all with + quality rating and adequate sample sizes, did not find oral glutamine to be effective in preventing or reducing chemotherapy-induced oral mucositis/stomatitis. It should be noted that the studies used varying glutamine doses and administration schedules and included various cancer sites, but were primarily completed in FU-based chemotherapy. A non-randomized, neutral quality trial, found oral glutamine to be effective, but this study is limited by small sample size and study design.

       

    • Grade: I
      • 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 parenteral glutamine to improve tolerance and support recovery from chemotherapy and the reduction of mucositis associated with treatment in cancer pateints?
    • Conclusion

      Two studies had conflicting results on the benefit of parenteral glutamine for chemotherapy-induced mucositis/stomatitis. Both of these studies were limited by small sample size, one with poor study design, and differing glutamine dosing and administration. Larger studies with better study design are 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: Glutamine and Symptoms/Complications 2005