Influence of age on problems experienced by patients with lung cancer undergoing radiation therapy. A strategy to use soft data effectively in randomized controlled clinical trials. The effect of oral nutritional supplements on head and neck cancer. A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. Controlled studies of nutritional intake in patients with malignant disease undergoing treatment. Different quantities of two commercial liquid diets consumed by weight-losing cancer patients. Dietary intake, nutritional status and well-being of cancer patients: a prospective study. Megestrol acetate therapy for anorexia and weight loss in children with malignant solid tumours Impact of nutritional status on DRG length of stay. Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. The effect of nutritional supplements on food intake in patients undergoing radiotherapy. Supportive use of megestrol acetate in patients with head and neck cancer during radio(chemo)therapy.
The purpose of this prospect i ve , longitudinal study was to determine if patients with lung cancer who are 65 years of age or older experience problems differently than do patients younger than age 65 during and following radiation treatment .  The moderator and outcome variables selected for study were recognized attendant problems that may develop during lung cancer treatment and that may influence the treatment regimen and response . No statistically significant differences were found between patients age 65 or older and those younger than age 65 on caloric intake , adequacy of energy intake , total radiation dose , concurrent illnesses , and social support at any of four data - collection periods . Similarly , there were no significant differences on weight , body mass index , and multidimensional functional status . The relationship between the social support subscales and functional status measures for the 65-or-older group suggested that those subjects with lower social support perceived themselves to have better functional status . There was no relationship between social support and two functional status measures for the under-65 group . The significant relationships between social support and the overall health rating were in opposite directions for the two age groups . The results suggest that chronologic age alone may not be a sufficient criterion to determine therapeutic regimen or to suggest that unique problems may result Soft data are defined as measures having substantial intrasubject variability due to errors of measurement or to the inconsistency of subjects ' responses . Such data are often important measures of response in r and omized clinical trials . In this context , we show that using an intensive design and the slope of response on time as the outcome measure ( a ) maximizes sample retention and ( b ) decreases within-group variability , thus ( c ) maximizing the power of test procedures without requiring increased sample sizes Fifty ambulatory patients with head and neck cancer treated by definitive radiation therapy at the Fox Chase Cancer Center were prospect ively studied to determine the effect of oral nutritional supplements on both nutritional status and treatment response . Nutritional supplements maintained serum albumin during and post treatment . Nutritional supplements were shown to increase total protein and total calorie intake rather than displace these nutrients in usual food intake . Equal weight loss occurred in both the supplemented and non-supplemented groups during the observation period of 6 months , with the same or greater amount of weight loss registered 10 weeks after the start of treatment . Food supplements did not affect treatment response or complications , nor did they offer any survival advantage One hundred ninety-two patients with previously untreated metastatic cancer ( 102 non-small-cell lung cancer [ NSCLC ] ; 90 colorectal cancer ) were r and omized to receive either ad lib nutritional intake ( control group ) or specific nutritional intervention during a 12-week study period when chemotherapy was administered . Those patients r and omized to nutritional interventions were counselled to take oral nutrients with caloric intake equal to 1.7 to 1.95 times their basal energy expenditure , depending on their pretreatment nutritional status ( " st and ard " group ) . An augmented group was counselled to have a caloric intake equivalent to that of the st and ard group but with 25 % of calories provided as protein and additional supplements of zinc and magnesium . Counselling increased caloric intake in both tumor types but reduced weight loss in the short term only for lung cancer patients . Ninety-three NSCLC patients were evaluable for tumor response to vindesine and cisplatin . Overall , only 20.4 % of the patients responded , and there were no significant differences in response rates , median time to progression , or overall duration of survival between the nutrition intervention groups and the control group . The tumor response rate to time-sequenced 5-fluorouracil ( 5-FU ) and methotrexate in the 81 evaluable patients with colorectal cancer was only 14.8 % , and no significant differences in tumor response rates were noted between the three groups . Furthermore , the median time to progression and overall duration of survival were not different for the control , st and ard , and augmented groups . Nutritional interventions using dietary counselling had no impact on the percent of planned chemotherapy dose administered , the degree of toxicity experienced by patients , or the frequency of treatment delays . A multivariate prognostic factor analysis demonstrated that for lung cancer , the percent of weight loss , serum albumin concentration , and presence of liver metastases were significant ( P less than .05 ) and independent prognostic variables for survival duration . For colorectal cancer , serum albumin , alkaline phosphatase , lactic dehydrogenase ( LDH ) levels , and percent targeted caloric intake ( TCI ) were significant independent predictors of survival duration Ninety-seven patients with cancer , undergoing radiation treatment , were studied . Forty-two were given special dietary counseling and supplements of Sustagen or Isocal ;  42 controls  received no special advice or supplements .  Thirteen patients were excluded because of poor prognoses and the ethical need for food supplements . Nutrient intake of all groups was assessed by 3-d diet records in household measures in the first and the last week of treatment . Intake was significantly higher in the adjunctive than the control group . The excluded group , despite supplementation , had intakes similar to the control group . No difference was observed between the control and adjunctive groups in clinical status at the end of treatment or in long-term outcome Twenty ambulatory , weight-losing patients with advanced cancer of the lung , breast , or ovary were r and omized to supplement their diet for 2 months with either of two commercial complete liquid diets , one containing intact milk proteins and the other partially hydrolyzed soy proteins . Both products were prescribed as sip feeds in addition to normal food . The patients consumed more of the hydrolysate-containing product than of that with intact ( milk ) protein . The difference was significant and was maintained during both months of the study . An increase in total energy and protein was obtained in both groups , but was significant only with the hydrolysate product . At the end of the study there was no group difference in measures of nutritional status , but weight loss was halted in both groups Changes in dietary intake , nutritional status , body composition and well-being were studied in 108 cancer patients over a period of 20 weeks . The patients , constituting a group of elderly women with uterine cancer , a group of elderly men with urological cancer and a group of male and female patients of various ages with malignant lymphoma , were prospect ively followed during and after aggressive treatment given with curative intent . Detailed information on the dietary intake was measured by a dietary history and cross-check method covering the 2 months prior to the onset of therapy and a 48-hr dietary record which was applied seven times during the observation period . The nutritional status was monitored by anthropometric measurements and laboratory assays in blood and urine . The patient 's well-being was assessed by the use of st and ard performance scales by the observers and the application of patient 's question naires concerning complaints , ability to self-care , mobility and daily activities . The main results are described here , indicating that : ( 1 ) most patients studied had a more than adequate diet during the 2 months preceding cancer therapy when compared to the Dutch Recommended Dietary Allowances ; ( 2 ) the impact on dietary intake and nutritional status was relatively minor and generally transient ; and ( 3 ) the treatment course was accompanied by distinct changes of well-being associated with , but not necessarily result ing from or leading to , changes of dietary intake Background : Malnutrition is very frequent in childhood cancer . Its main cause is inadequate intake for energy dem and s owing to lack of appetite . Megestrol acetate is a synthetic progestin that has been used for reversing anorexia in adult cancer A prospect i ve audit of 100 admissions to a general medical unit was performed to determine the relationship of the initial nutritional status of the patients to the actual length of stay and hospital charges . These data then were compared with the allowed length of stay and estimated reimbursement under the prospect i ve payment system of diagnosis-related groups ( DRGs ) . Forty-five percent of the malnourished patients were hospitalized longer than that allowed under DRGs , compared to 30 % for normal patients and 37 % in the borderline group . The average length of stay was 15.6 + /- 2.2 days in the malnourished group compared to approximately 10 days in the other two groups ( p less than 0.01 ) . Although the estimated base DRG reimbursement was similar in all three groups ( $ 4352-$5124 ) , the actual hospital charges were significantly greater in the malnourished ( $ 16,691 + /- 4389 ) and borderline ( $ 14,118 + /- 4962 ) groups compared to normals ( $ 7692 + /- 687 ) , ( p less than 0.01 ) . The DRG system will have an adverse financial impact in the care of malnourished patients . It is suggested that early recognition of malnutrition and aggressive treatment may lead to a decrease in the length of stay and cost deficit incurred by malnourished patients PURPOSE This study examined the effect of frequent nutritional counseling on oral intake , body weight , response rate , survival , and quality of life in patients with cancer of the lung ( small-cell ) , ovary , or breast undergoing cyclic chemotherapy . PATIENTS AND METHODS Of 105 assessable patients , 57 were r and omized to receive nutritional counseling , and 48 to receive no nutritional counseling and consumption of an ad lib oral intake .  The intervention group was counseled to achieve a daily energy and protein intake according to recommended dietary allowances . Counseling was st and ardized and performed by a trained dietitian , and took place twice monthly during a 5-month period from start of chemotherapy . RESULTS Dietary counseling increased daily energy intake by approximately 1 MJ and protein intake by 10 g over the entire study period . There was no change in the control group . Counseling led to an insignificant increase in body weight , but triceps skinfold measurement increased significantly after 5 months . Response rate and overall survival did not differ between the groups . Quality of life measured by the Quality -of-Life index ( QL-index ) increased significantly in both groups , but did not differ between groups . CONCLUSION No clinical benefit could be demonstrated despite long-term and continuous improved food intake in cancer patients with solid tumors undergoing aggressive chemotherapy PURPOSE / OBJECTIVES To describe the effect of nutritional supplements on food intake in patients undergoing radiotherapy .  DESIGN Experimental prospect i ve . SAMPLE 40 newly diagnosed patients with cancer beginning external beam radiation therapy .  METHODS Weekly dietary counseling and recording of total daily dietary intake for three days a week for four weeks . One half of the subjects were r and omly assigned to ingest a liquid nutritional supplement between meals and at bedtime . MAIN RESEARCH VARIABLES Total daily protein and caloric intake , food-derived protein and caloric intake , and supplement-derived protein and caloric intake . FINDINGS Subjects ingesting nutritional supplements between meals significantly increased their total caloric and protein intake above that of controls and did not reduce their food-derived caloric or protein intake compared to controls . CONCLUSIONS Nutritional supplements can be used to increase total caloric and protein intake without causing a significant reduction in food intake . IMPLICATION S FOR NURSING PRACTICE In this patient sample , supplements were not substituted for food intake . Further research is needed to determine the effects of supplements on appetite in patients with advanced cancer To study the supportive effect of megestrol acetate during intensive combined modality treatment , a r and omised , double-blind , placebo-controlled study was performed in patients with head and neck cancer . The patients received either 160 mg of megestrol acetate daily or placebo during radio(chemo)therapy and for up to 6 weeks thereafter . The nutritional status as measured by anthropometric and biochemical parameters and the subjective quality of life were assessed prior to therapy , at weeks 1 , 4 and 6 of radiotherapy and 12 and 18 weeks from the start of therapy . 61 of 64 patients were evaluable . In the control group ( n = 30 ) , the nutritional parameters deteriorated during therapy and were fully restored during follow-up . By contrast , the patients treated with megestrol acetate ( n = 31 ) could maintain their baseline values . The difference between the groups was most pronounced in patients taking food per mouth ( weight loss during treatment : control group : 4.1 kg ; megestrol acetate group : 0.8 kg , P = 0.0004 ) , but was not significant in patients fed via percutaneous endoscopically guided gastrostomy ( PEG ) . Subjective quality of life remained constant in the megestrol acetate group while it decreased in the control group . However , differences were not statistically significant . Megestrol acetate prevents further deterioration of nutritional status during radio(chemo)therapy and may have an impact on subjective quality of life
PURPOSE / OBJECTIVES To evaluate and synthesize the evidence regarding cancer-related anorexia and cachexia symptom management and make recommendations for future directions .