• Intervention
    Can lean body mass in advanced cancer patients can be altered by fatty acids?
    • Conclusion
      Three studies (two positive quality RCTs, one neutral quality time series) evaluated the impact of omega-3 fatty acid supplementation on LBM in advanced cancer. One study (positive quality RCT) comparing an omega-3 fatty acid enriched liquid nutritional supplement which provided a mean dose of 1.6g EPA daily to an arginine enriched liquid nutritional supplement in weight stable patients, found an increase in triceps skinfold (p<0.05) and arm circumference (p<0.0.5) at 3 months, but no increase in fat-free mass as determined by BIA. A second study positive quality RCT), comparing fish oil supplements at a mean dose of 1.8g EPA/day to placebo found no change in LBM, as measured by BIA, with omega-3 fatty acid supplementation.  The third study (neutral qualty time series) utilized a complicated dietary and pharmacologic intervention which included an omega-3 fatty acid enriched liquid nutritional supplement which provided a mean dose of 2.2g EPA daily, indicated an increase in LBM, as measured by BIA, at 8 weeks (p=0.045) and 12 weeks (p=0.023). It is hard to identify which component of this intervention produced this effect.  Further research is needed to clarify these results.
    • 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: Catabolic Process: Fatty Acids 2006
       
    Can pro-inflammatory markers in cancer patients be altered by fatty acids?
    • Conclusion
      Three studies (two positive rated RCTs, one neutral rated time series and one negative rated time series) evaluated serum cytokine concentrations in patients with advanced cancer and ongoing weight loss with conflicting results. Two studies (negative rated time series, neutral rated time series) found decrease in serum IL-6, one found no change (positive rated RCT) and one found increases (positive rated RCT). Two studies found no change in serum TNF (negative rated time series, positive rated RCT), one found decreases (neutral rated time series) and one found increases (positive rated RCT). Two studies (negative rated time series, positive rated RCT) looked at IL-1 and found no significant change. One study (negative rated time series) looked at PIF and found a significant fall in the number of patients with detectable urine PIF at three weeks. Multiple doses of fish oil were used in these studies and three of the studies used fish oil in conjunction with other interventions. More research is needed to clarify these results.
    • 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: Catabolic Process: Fatty Acids 2006
       
    Is there a relationship between a patient’s intake of probiotics to reduce symptoms and the reduction of symptoms associated with cancer in all cancer patients?
    • Conclusion

      There is no evidence available that directly supports or refutes the relationship between a patient’s intake of probiotics to reduce symptoms and the reduction of symptoms associated with cancer in all cancer patients.

    • Grade: V
      • 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: Probiotics and Symptoms/Complications 2004
       
    Is there a relationship between the consumption of an EPA-containing nutritional supplement and prescribed appetite stimulant to the reduction of weight loss associated with varied cancer patients?
    • Conclusion

      Two (2) studies (1 large, multicenter, + quality RCT and 1 small, non-randomized neutral quality trial) had differing results on the effectiveness of an EPA-containing nutritional supplement (2 cans for 2.2 gm EPA/day) and appetite stimulant in reducing weight loss after four weeks of supplementation. The large, RCT did not find that the EPA-containing nutritional supplement group had any impact on weight status. A placebo-controlled trial should be completed.

    • 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: EPA/Omega 3 Fatty Acids and Symptoms/Complications 2005
       
    Is there a relationship between the intake of glutamine to reduce symptoms and the reduction of symptoms associated with cancer pateints?
    • Conclusion
      There is no evidence available that directly supports or refutes that the use of oral, enteral or parenteral glutamine will reduce symptoms associated with cancer.
    • Grade: V
      • 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 use of EPA as a fish oil supplement to the reduction of weight loss in patients associated with advanced cancers?
    • Conclusion

      Five (5) studies had mixed results as to the use of EPA as fish oil supplement and the reduction of weight loss. Three (3) studies (2 + RCTs, 1 – non-randomized trial) found that EPA as fish oil supplement did not have an effect on weight status. Two (2) other studies (1 + before and after study and 1 + RCT) did find EPA as a fish oil supplement to be successful in stabilizing weight in advanced cancer patients. 4/5 studies (2 from each group) are limited by small sample size. In addition, dosing of EPA and length of supplementation was not consistent in these studies. Further trials 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: EPA/Omega 3 Fatty Acids and Symptoms/Complications 2005
       
    Is there evidence that the catabolic process occuring in Stage IV cancer patients can be altered by amino acids?
    • Conclusion

      One positive quality RCT evaluated treatment with a formula containing HMB, L-glutamine and L-arginine in Stage IV cancer patients.  At 4 weeks, weight changes were not significant in the treatment group. At 12 weeks, weight gain of the treatment group from baseline (2.27+1.17 kg) was significant (p<.05).  Intent to treat analysis at 24 weeks, at which point only 9 patients completed the protocol, showed a trend toward a significant increase in FFM and weight.  More research 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: Catabolic Process: Amino Acids 2006