• Intervention
    Is there a relationship between consumption of a fat-enriched diet to enhance nutritional intake to improve tolerance and support recovery from chemotherapy for gastrointestinal cancer, and improved tolerance of symptoms?
    • Conclusion

      One (1) small RTC (positive quality) of 23 patients with GI cancer were randomized to receive a conventional diet alone or a conventional diet plus a fat-enriched supplement.  The study found that the conventional diet (35 non-protein kcals/kg/day and 1.1 g protein/kg/day), plus a fat-enriched supplement (at least 15 non-protein kcals/kg/day with 66% of calories provided by fat), resulted in weight gain and maintenance of body cell mass when compared with controls (p < 0.05 and 0.01, respectively). The study group showed a decline in total lymphocyte count (p< 0.05). 

       

    • 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: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between intervention by a dietitian to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemoradiation therapy for esophageal cancer patients, and the reduction of complications associated with treatment?
    • Conclusion

      One retrospective chart review of neutral quality found that implementation of a standard nutrition pathway by a dietitian is associated with improved outcomes in esophageal cancer patients, including decreased weight loss (P<0.03), fewer unplanned hospital admissions during treatment (p<0.04), shorter LOS during unplanned hospital admissions (P< 0.002), and improved tolerance of treatment as assessed by completion of the prescribed treatment course (P< 0.003) and percent desired radiation received (P< 0.004).  The researchers recommended that all esophageal cancer patients planning chemoradiation treatment receive a proactive nutrition assessment by a trained oncology dietitian on initial presentation, and that all patients receive appropriate nutrition support by a multidisciplinary team.

    • 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: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between enteral nutrition to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemoradiation therapy for esophageal cancer patients, and the reduction of complications associated with treatment?
    • Conclusion

      One prospective, non-randomized controlled trial of positive quality found that EN for severely dysphagic esophageal cancer patients, providing 37 kcals/kg/day and 2.0 g protein/kg/day, delivered for 34 days, resulted in weight maintenance (p = 0.01) and unchanged total protein/albumin status (p = 0.01) when compared to patients without dysphagia who received a standard, ad libitum diet during chemoradiation therapy for esophageal cancer.  There were no significant differences between groups in terms of tolerance of therapy, response to therapy, suitability for radical resection, or median survival time. 

       

    • 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: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between parenteral nutrition to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemoradiation therapy for esophageal cancer patients, and the reduction of complications associated with treatment?
    • Conclusion

      One neutral quality retrospective review found that patients who received PN during CRT for esophageal cancer, at 30-35 kcals/kg/day and 1.0 - 1.5 g protein/kg/day, during the treatment period (21 - 28 days), were able to tolerate higher doses of 5-fluorouracil (p=0.02), cisplatin (p = 0.05), and interferon alpha 2b (p = 0.05) and a greater percentage of total radiation dose than a comparison group which received no PN support.  The PN group experienced significant decreases in weight (p = 0.04) during treatment.  There were no significant differences between the groups in CRT toxicities, CRT-related deaths, post-surgical complications, total hospital stay, total days in the ICU, treatment response, or mortality.  Patients receiving PN were more likely to receive scheduled CRT compared to patients who did not receive PN.  However, it did not result in improved effectiveness of this treatment regimen in esophageal cancer patients. 

    • 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: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between nutrition intervention to enhance intake (protein, kcals) to improve tolerance and support recovery from intensive chemotherapy for small cell lung cancer patients, and the reduction of complications associated with treatment?
    • Conclusion

      One two-group comparison study of neutral quality found that nutrition intervention by an RD to improve nutrition intake in patients receiving intensive chemotherapy for small cell lung cancer resulted in improved weight status (p < 0.01) and improved QOL (p < 0.001), but did not have a significant impact on either nutrition intake, nutritional status, or treatment outcome.  The average calorie and protein intake of the study period group (SPG) at initiation of the study was low at 20-25 kcal/kg/day, and 40% of SPG patients had a protein intake < 40 g/day.  Protein intake improved in the SPG group during the study period to an average 50 – 80 g/day per patient; no patient reached the desired level of 95-105 g/day.  Sixty four percent (64%) of patients used MFS at some point during treatment, and the researchers postulated that MFS use probably increased the average kcal and protein values. The study was limited by the use of historical controls.

    • 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: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between nutritional intake (protein, kcals) to improve tolerance and support recovery from biochemotherapy for melanoma patients, and the reduction of complications associated with treatment?
    • Conclusion

      One (1) small comparative, descriptive study (neutral quality) of 25 patients (19 on treatment and 6 off treatment) studied the relationship of fatigue to kcal and protein intake in patients receiving biochemotherapy for melanoma.  No association between dietary intake and fatigue was observed. 

    • 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: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between intervention by a dietitian to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemotherapy for acute leukemia, and the reduction of complications associated with treatment?
    • Conclusion

      One small RCT of neutral quality of 29 hospitalized patients found that nutritional care by an RD resulted in positive nutrition outcomes for patients receiving chemotherapy for acute lymphocytic and nonlymphocytic leukemia. Daily contact for assessment, education and motivation by an RD was effective in increasing body weight in the intervention group earlier and more often than in the control group (33.8% vs. 13.2%; 48.7% vs. 18.3% depending on treatment protocol).  The researchers found that nutrition intake was highly correlated with body weight status.  Mean daily energy intake of 23.3 ± 11.4 kcals/kg/day was associated with weight loss; 30.9 ± 13.1 kcals/kg/day was associated with stable weight; and 39.3 ± 12.2 kcals/kg/day was associated with weight gain (P < 0.0001).  A significant correlation was found between nutritional intake and tumor-therapy side effects (e.g., anorexia and fatigue) (P-values <0.01).

    • 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: Protein and Symptoms/Complications: Chemotherapy 2006