Effects of magnesium supplementation in testicular cancer patients receiving cis-platin: a randomised trial. Self-reported quality of life in users and nonusers of dietary supplements in cancer Improved protein kinetics and albumin synthesis by branched chain amino acid‐enriched total parenteral nutrition in cancer cachexia: A prospective randomized crossover trial Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients. Reduced postoperative infections with an immune-enhancing nutritional supplement. Changes of Terminal Cancer Patients' Health-related Quality of Life after High Dose Vitamin C Administration Dietary omega‐3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN) - a randomized multicentre trial Reversal of cancer-related wasting using oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine. Branched chain amino acids as the protein component of parenteral nutrition in cancer cachexia A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. EFFECT OF PARENTERAL GLUTAMINE PEPTIDE SUPPLEMENTS ON MUSCLE GLUTAMINE LOSS AND NITROGEN BALANCE AFTER MAJOR SURGERY Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. A randomized, double-blind, placebo-controlled trial of a β-hydroxyl β-methyl butyrate, glutamine, and arginine mixture for the treatment of cancer cachexia (RTOG 0122) Perioperative arginine-supplemented nutrition in malnourished patients with head and neck cancer improves long-term survival. Omega-3 fatty acid-, micronutrient-, and probiotic-enriched nutrition helps body weight stabilization in head and neck cancer cachexia. EFFECTS OF STANDARD AND/OR GLUTAMINE DIPEPTIDE AND/OR OMEGA-3 FATTY ASCID-SUPPLEMENTED PARENTERAL NUTRITION ON NEUTROPHIL FUNCTIONS, INTERLEUKIN-8 LEVEL AND LENGTH OF STAY--A DOUBLE BLIND,CONTROLLED, RANDOMISED STUDY. Branched-chain amino acid-supplemented nutritional support after gastrectomy for gastric cancer with special reference to plasma amino acid profiles. Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: a phase I/II study. Nutritional approach in malnourished surgical patients: a prospective randomized study.
The concentration of magnesium in serum has been shown to fall to potentially dangerously low levels after several courses of treatment with cis-diamminedichloroplatinum II ( cis-platin ) . The aims of this study were to examine the effects of magnesium supplementation on predicted outcome of treatment , rate of response to treatment and toxicity of treatment .  Sixteen patients with testicular cancer were studied in detail over a 14 month period . One patient with an ovarian dysgerminoma was also included in the study . Eight patients were r and omised to receive magnesium supplements both intravenous and oral ; nine did not . The non-supplemented group showed significantly greater renal tubular damage as assessed by urine N-acetyl-B-D-glucosaminidase ( NAG ) . There was a trend towards a reduction in treatment delays due to neutropenic episodes in the supplemented group , and serum magnesium concentrations remained significantly higher . Neither group showed differences in tumour growth rates or outcome . These results show that magnesium supplements are of considerable benefit and show no harmful effects in patients receiving cis-platin treatment . It is is suggested that magnesium supplements should be a routine part of the treatment regime , and that these should comprise both i.v . supplements during treatment and oral supplements between courses Goals of workTo describe the Quality of Life ( QoL ) characteristics of users of dietary supplements vs nonusers . Patients and methods A survey of 225 cancer patients presenting for treatment at Cancer Treatment Centers of America was completed between November 2001 and October 2003 . A vali date d instrument assessed the use of 56 dietary supplements in the past month . Two vali date d question naires assessed QoL. Mean QoL scores were compared between the users and nonusers using univariate and multivariate linear regression . Results Of 225 patients , 91 ( 40 % ) were males and 134 ( 60 % ) females . Sixty seven ( 30 % ) had breast cancer , 40 ( 18 % ) colorectal cancer , and 32 ( 14 % ) lung cancer . One hundred sixty four ( 73 % ) had used dietary supplements in the past month , while 61 ( 27 % ) had not . Mean European Organization for Research Treatment of Cancer QoL scores were significantly better among the users for physical and emotional function scales and fatigue , nausea , appetite loss , and constipation symptom scales adjusting for tumor site . In the stratified analysis , lung cancer patients did not show any statistically significant differences in QoL scores between the users and nonusers . Colorectal cancer patients demonstrated statistically significant differences in constipation symptom , with dietary supplement users having better QoL. Breast cancer patients demonstrated statistically significant differences in several QoL scale scores between users and nonusers . Conclusions Contrary to some of the previously published research , this study , conducted at a community hospital comprehensive cancer center that combines alternative treatment approaches with conventional cancer care , found better self-reported QoL among the users of dietary supplements , as compared to nonusers . The next step in this research is to prospect ively evaluate the patterns of changing QoL in relation to dietary supplement use across the entire duration of cancer diagnosis and treatment A prospect i ve r and omized crossover trial was conducted to determine the effect of a branched chain amino acid (BCAA)‐enriched solution on whole body leucine kinetics and fractional rates of albumin synthesis in patients with intra‐abdominal metastatic adenocarcinoma . Ten malnourished cancer patients were provided isonitrogenous amounts of both a conventional total parenteral nutrition ( TPN ) formula containing 19 % BCAA and a BCAA‐enriched TPN formula containing 50 % of the amino acids as BCAA in a r and om order . Whole body protein turnover was determined by a 10 hour continuous infusion of leucine14C . Increased whole body leucine flux ( 68 ± 5 ųumols/kg BW/hr versus 145 ± 11 ; mean ± SEM ; P 0.001 ) and oxidation ( 13 ± 2 ųmols/kg BW/hr to 46 ± 5 ; P 0.001 ) were determined on the BCAA‐enriched TPN . Increased whole body protein synthesis ( 2.2 ± 0.2 g protein/kg BW/day versus 3.9 ± 0.3 ; P 0.005 ) and leucine balance ( 2.5 ± 0.4 g leucine/d versus 6.5 ± 0.6 ; P 0.001 ) were also observed in patients receiving the BCAA‐enriched TPN  solution . Leucine release from protein breakdown was not statistically elevated ( 1.65 ± 0.18 g protein/kg BW/d versus 2.48 ± 0.40 ; P > 0.05 ) but , incorporation of leucine 14C into plasma albumin was significantly elevated ( 2.37 ± 0.23 ųumols/g/hr to 4.21 ± 0.33 ; P 0.001 ) when the patients received BCAA‐enriched TPN . Despite the better leucine balance , the improvement in the 24‐hour urinary nitrogen balance was not statistically significant ( 6.6 ± 3.9 g protein/d versus 11.4 ± 2.9 ; control versus BCAA‐enriched ; P=0.15 ) . BCAA‐enriched formulas  improve whole body leucine kinetics , fractional rates of albumin synthesis , and leucine balance , and thus may favorably influence protein metabolism in cancer cachexia . Cancer 58:147–157 , 1986 BACKGROUND Malnourished head and neck cancer patients are at increased risk of postoperative complications . OBJECTIVE We studied the effect of perioperative , arginine-supplemented nutritional support on nutritional status , immune status , postoperative outcome , and survival in severely malnourished ( weight loss > 10 % of body weight ) head and neck cancer patients undergoing major surgery . DESIGN Forty-nine patients were r and omly assigned to receive 1 ) no preoperative and st and ard postoperative tube feeding , 2 ) st and ard preoperative and postoperative tube feeding , or 3 ) arginine-supplemented preoperative and postoperative tube feeding . RESULTS Patients in both prefed groups received approximately 9 d of preoperative tube feeding , result ing in energy intakes of 110 % and 113 % of calculated needs ( compared with 79 % in the control group ; P = 0.007 ) . Compared with no preoperative feeding , preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes . Major postoperative complications occurred in 53 % , 47 % , and 59 % of patients in study groups 1 , 2 , and 3 ( NS ) . A trend was seen toward better survival in the arginine-supplemented group ( P = 0.15 ) . Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes ( P = 0.05 ) and higher endotoxin-induced cytokine production ( P = 0.010 for tumor necrosis factor alpha and P = 0.042 for interleukin 6 ) at the start of the study than did patients who died . CONCLUSIONS Nine days of preoperative tube feeding , with or without arginine , did not significantly improve nutritional status , reduce the surgery-induced immune suppression , or affect clinical outcome in severely malnourished head and neck cancer patients . Patients supplemented with arginine-enriched nutrition tended to live longer . Some markers of immune function may distinguish patients with good or bad prognoses OBJECTIVES /HYPOTHESIS Malnutrition is a significant risk factor for postoperative infections in patients undergoing oncologic surgery . This study was undertaken to determine if perioperative nutritional supplementation with an immune-enhancing formula is superior to st and ard formula in the prevention of postoperative infectious complications . STUDY DESIGN This was a prospect i ve , r and omized , double-blind trial comparing perioperative nutritional supplementation with Impact and st and ard nutritional formulas . METHODS Following stratification , 136 patients undergoing oncologic head and neck surgery were r and omly assigned to one of four treatment groups : preoperative/postoperative Impact , postoperative Impact , preoperative/postoperative st and ard formula , and postoperative st and ard formula . Outcome measures included laboratory evaluations of nutritional status , infectious and wound healing complications , and duration of hospitalization . Statistical analysis was performed using chi2 or two-tailed Fisher Exact Tests , when appropriate . RESULTS Intent-to-treat ( P = .02 ) and actual therapy ( P = .04 ) analyses revealed a significant decrease in the incidence of postoperative infectious complications ( all sites ) in patients who received Impact . There was no significant difference in wound healing problems or duration of hospitalization . Postoperative measures of nutrition status demonstrated a higher serum albumin ( P = .05 ) in patients who received Impact compared with st and ard formula . CONCLUSIONS Compared with st and ard formula , perioperative nutritional supplementation with Impact significantly reduced the incidence of infectious complications . The length of hospitalization was significantly prolonged in patients with postoperative infections , suggesting potential cost savings with the use of immune-enhancing formulas such as Impact Over the years there has been a great deal of controversy on the effect of vitamin C on cancer . To investigate the effects of vitamin C on cancer patients '  health-related quality of life , we prospect ively studied 39 terminal cancer patients . All patients were given an intravenous administration of 10 g vitamin C twice with a 3-day interval and an oral intake of 4 g vitamin C daily for a week . And then we investigated demographic data and assessed changes in patients ' quality of life after administration of vitamin C.  Quality of life was assessed with EORTC QLQ-C30 . In the global health/ quality of life scale , health score improved from 36±18 to 55±16 after administration of vitamin C ( p=0.001 ) . In functional scale , the patients reported significantly higher scores for physical , role , emotional , and cognitive function after administration of vitamin C ( p<0.05 ) . In symptom scale , the patients reported significantly lower scores for fatigue , nausea/vomiting , pain , and appetite loss after administration of vitamin C ( p<0.005 ) . The other function and symptom scales were not significantly changed after administration of vitamin C. In terminal cancer patients  , the quality of life is as important as cure . Although there is still controversy regarding anticancer effects of vitamin C , the use of vitamin C is considered a safe and effective therapy to improve the quality of life of terminal cancer patients The aim of the current prospect i ve , r and omized control study was to investigate the effect of dietary omega‐3 polyunsaturated fatty acids plus vitamin E on the immune status and survival of well‐nourished and malnourished patients with generalized malignancy Background Cachexia , a > 10 % loss of body-weight , is one factor determining the poor prognosis of pancreatic cancer . Deficiency of L-Carnitine has been proposed to cause cancer cachexia . Findings We screened 152 and enrolled 72 patients suffering from advanced pancreatic cancer in a prospect i ve , multi-centre , placebo-controlled , r and omized and double-blinded trial to receive oral L-Carnitine ( 4 g ) or placebo for 12 weeks . At entry patients reported a mean weight loss of 12 ± 2,5 ( SEM ) kg . During treatment body-mass-index increased by 3,4 ± 1,4 % under L-Carnitine and decreased ( −1,5 ± 1,4 % ) in controls ( p < 0,05 ) . Moreover , nutritional status ( body cell mass , body fat ) and quality -of-life parameters improved under L-Carnitine . There was a trend towards an increased overall survival in the L-Carnitine group ( median 519 ± 50 d versus 399 ± 43 d , not significant ) and towards a reduced hospital-stay ( 36 ± 4d versus 41 ± 9d , n.s . ) . Conclusion While these data are preliminary and need confirmation they indicate that patients with pancreatic cancer may have a clinical ly relevant benefit from the inexpensive and well tolerated oral supplementation of L-Carnitine BACKGROUND Cancer-related cachexia is caused by a diverse combination of accelerated protein breakdown and slowed protein synthesis . The hypothesis proposed in this study is that supplementation of specific nutrients known to positively support protein synthesis and reduce protein breakdown will reverse the cachexia process in advanced cancer patients . METHODS Patients with solid tumors who had demonstrated a weight loss of at least 5 % were considered for the study . Patients were r and omly assigned in a double-blind fashion to either an isonitrogenous control mixture of nonessential amino acids or an experimental treatment containing beta-hydroxy-beta-methylbutyrate ( 3 g/d ) , L-arginine ( 14 g/d ) , and L-glutamine ( 14 g/d [ HMB/Arg/Gln ] ) . The primary outcomes measured were the change in body mass and fat-free mass ( FFM ) , which were assessed at 0 , 4 , 8 , 12 , 16 , 20 , and 24 weeks . RESULTS Thirty-two patients ( 14 control , 18 HMB/Arg/Gln ) were evaluated at the 4-week visit . The patients supplemented with HMB/Arg/Gln gained 0.95 + /- 0.66 kg of body mass in 4 weeks , whereas control subjects lost 0.26 + /- 0.78 kg during the same time period . This gain was the result of a significant increase in FFM in the HMB/Arg/Gln-supplemented group ( 1.12 + /- 0.68 kg ) , whereas the subjects supplemented with the control lost 1.34 + /- 0.78 kg of FFM ( P = 0.02 ) . The response to 24-weeks of supplementation was evaluated by an intent-to-treat statistical analysis . The effect of HMB/Arg/Gln on FFM increase was maintained over the 24 weeks ( 1.60 + /- 0.98 kg ; quadratic contrast over time , P < 0.05 ) . There was no negative effect of treatment on the incidence of adverse effects or quality of life measures . CONCLUSIONS The mixture of HMB/Arg/Gln was effective in increasing FFM of advanced ( stage IV ) cancer . The exact reasons for this improvement will require further investigation , but could be attributed to the observed effects of HMB on slowing rates of protein breakdown , with improvements in protein synthesis observed with arginine and glutamine A prospect i ve r and omized trial was conducted to determine the effects of branched chain amino acids ( BCAA ) as the protein component of total parenteral nutrition ( TPN ) on protein kinetics in patients with intra‐abdominal adenocarcinoma . Nine malnourished patients were given both conventional TPN containing 19 per cent BCAA ( AA ) and isocaloric , isonitrogenous TPN containing 50 per cent BCAA ( BCAA‐TPN ) , in r and om order . Both [13C]leucine and [14C]tyrosine were employed as tracers to avoid the potential bias due to the different amino acid composition of the two TPN solutions . With BCAA‐TPN , leucine and tyrosine flux increased significantly from ( mean ± s.d . ) 158·0 ± 37·2 to 243·5 ± 75·8 μmol kg−1 h−1 ( P < 0·025 ) and from 35·0 ± 8·4 to 42·6 ± 11·0 μmol kg−1 h−1 ( P < 0·05 ) respectively . Leucine oxidation was significantly higher on BCAA‐TPN ( 24·1 ± 6·3 on AA versus 68·3 ± 37·1 μmol kg−1 h−1 , P < 0·025 ) while tyrosine oxidation was significantly lower ( 3·7 ± 1·8 μmol kg−1 h−1 on AA versus 2·5 ± 2·0 μmol kg−1 h−1 on BCAA‐TPN , P < 0·05 ) . Whole body protein synthesis and breakdown was significantly higher on BCAA‐TPN by the tyrosine tracer ( 31·3 ± 7·3 on AA versus 40·1 ± 9·3 μmol kg−1 h−1 , P < 0·025 and 33·0 ± 8·4 on AA versus 41·3 ± 11·1 μmol kg−1 h−1 , P < 0·05 ) respectively . Using the leucine tracers both synthesis and breakdown were increased , but not significantly , from 133·8 ± 40·0 to 175·3 ± 65·1 μmol kg−1 h−1 and from 127·9 ± 33·6 to 167·7 ± 71·2 μmol kg−1 h−1 respectively . The fractional albumin synthetic rate increased significantly on BCAA‐TPN from 4·3 ± 2·9 on AA to 8·0 ± 5·1 per cent per day ( P < 0·05 ) . The reduction in tyrosine oxidation , suggesting improved protein utilization , coupled with an increase in protein and albumin synthesis , strongly support a positive benefit from BCAA‐TPN in cancer cachexia BACKGROUND & AIMS Perioperative nutrition with specialized enteral diets improves outcome when compared with st and ard formulas . A post-hoc analysis suggested preoperative administration as the most important period . Thus , we design ed a study to underst and prospect ively whether preoperative supplementation could be as efficacious as the perioperative approach and superior to a conventional treatment ( no artificial nutrition ) in reducing postoperative infections and length of hospital stay . METHODS A total of 305 patients with preoperative weight loss < 10 % and cancer of the gastrointestinal tract were r and omized to receive the following : ( 1 ) oral supplementation for 5 days before surgery with 1 L/day of a formula enriched with arginine , omega-3 fatty acids , and RNA , with no nutritional support given after surgery ( preoperative group , n = 102 ) ; ( 2 ) the same preoperative treatment plus postoperative jejunal infusion with the same enriched formula ( perioperative group , n = 101 ) ; and ( 3 ) no artificial nutrition before and after surgery ( conventional group ; n = 102 ) . RESULTS The 3 groups were comparable for all baseline and surgical characteristics . Intention-to-treat analysis showed a 13.7 % incidence of postoperative infections in the preoperative group , 15.8 % in the perioperative group , and 30.4 % in the conventional group ( P = 0.006 vs. preoperative ; P = 0.02 vs. perioperative ) . Length of hospital stay was 11.6 + /- 4.7 days in the preoperative group , 12.2 + /- 4.1 days in the perioperative group , and 14.0 + /- 7.7 days in the conventional group ( P = 0.008 vs. preoperative and P = 0.03 vs. perioperative ) . CONCLUSIONS Preoperative supplementation is as effective as perioperative administration in improving outcome . Both strategies seem superior to the conventional approach Twelve patients admitted for elective resection of carcinoma of colon or rectum were allocated at r and om to experimental and control groups ( six in each ) and received a total parenteral nutrition regimen providing 230 mg N/kg and 166 KJ/kg daily over the first 5 postoperative days . In the experimental group the parenteral fluid was supplemented with a synthetic glutamine-containing dipeptide , L-alanyl-L-glutamine ( 54 mg peptide-N/kg per day ) and the control group received corresponding amounts of alanine-N and glycine-N. On each postoperative day nitrogen balance was better in the experimental group ; mean daily nitrogen balance with alanyl-glutamine was -1.5 ( SE 0.4 ) g N/day and with the control solution -3.6 ( 0.2 ) g N/day . The cumulative nitrogen balances on the fifth postoperative day were -7.1 ( 2.2 ) and -18.1 ( 1.7 ) g N , respectively . With the peptide-containing solution  intramuscular glutamine concentration remained close to the preoperative value whereas with the control solution it decreased from 19.7 ( SE 0.9 ) to 12.0 ( 0.6 ) mmol/l intracellular water PURPOSE A phase III , r and omized study was carried out to establish the most effective and safest treatment to improve the primary endpoints of cancer cachexia-lean body mass ( LBM ) , resting energy expenditure ( REE ) , and fatigue- and relevant secondary endpoints : appetite , quality of life , grip strength , Glasgow Prognostic Score ( GPS ) and proinflammatory cytokines . PATIENTS AND METHODS Three hundred thirty-two assessable patients with cancer-related anorexia/cachexia syndrome were r and omly assigned to one of five treatment arms : arm 1 , medroxyprogesterone ( 500 mg/day ) or megestrol acetate ( 320 mg/day ) ; arm 2 , oral supplementation with eicosapentaenoic acid ; arm 3 , L-carnitine ( 4 g/day ) ; arm 4 , thalidomide ( 200 mg/day ) ; and arm 5 , a combination of the above . Treatment duration was 4 months . RESULTS Analysis of variance showed a significant difference between treatment arms . A post hoc analysis showed the superiority of arm 5 over the others for all primary endpoints . An analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) significantly increased in arm 5 . REE decreased significantly and fatigue improved significantly in arm 5 . Appetite increased significantly in arm 5 ; interleukin (IL)-6 decreased significantly in arm 5 and arm 4 ; GPS and Eastern Cooperative Oncology Group performance status ( ECOG PS ) score decreased significantly in arm 5 , arm 4 , and arm 3 . Toxicity was quite negligible , and was comparable between arms . CONCLUSION The most effective treatment in terms of all three primary efficacy endpoints and the secondary endpoints appetite , IL-6 , GPS , and ECOG PS score was the combination regimen that included all selected agents Purpose Cancer cachexia is a common problem among advanced cancer patients . A mixture of β-hydroxyl β-methyl butyrate , glutamine , and arginine ( HMB/Arg/Gln ) previously showed activity for increasing lean body mass ( LBM ) among patients with cancer cachexia . Therefore a phase III trial was implemented to confirm this activity . Material s and methods Four hundred seventy-two advanced cancer patients with between 2 % and 10 % weight loss were r and omized to a mixture of β-hydroxyl β-methyl butyrate , glutamine , and arginine or an isonitrogenous , isocaloric control mixture taken twice a day for 8 weeks  . Lean body mass was estimated by bioimpedance and skin-fold measurements . Body plethysmography was used when available . Weight , the Schwartz Fatigue Scale , and the Spitzer Quality of Life Scale were also measured . Results Only 37 % of the patients completed protocol treatment . The majority of the patient loss was because of patient preference ( 45 % of enrolled patients ) . However , loss of power was not an issue because of the planned large target sample size . Based on an intention to treat analysis , there was no statistically significant difference in the 8-week lean body mass between the two arms . The secondary endpoints were also not significantly different between the arms . Based on the results of the area under the curve ( AUC ) analysis , patients receiving HMB/Arg/Gln had a strong trend higher LBM throughout the study as measured by both bioimpedance ( p = 0.08 ) and skin-fold measurements ( p = 0.08 ) . Among the subset of patients receiving concurrent chemotherapy , there were again no significant differences in the endpoints . The secondary endpoints were also not significantly different between the arms . Conclusion This trial was unable to adequately test the ability of β-hydroxy β-methylbutyrate , glutamine , and arginine to reverse or prevent lean body mass wasting among cancer patients . Possible contributing factors beyond the efficacy of the intervention were the inability of patients to complete an 8-week course of treatment and return in a timely fashion for follow-up assessment , and because the patients may have only had weight loss possible not related to cachexia , but other causes of weight loss , such as decreased appetite . However , there was a strong trend towards an increased body mass among patients taking the Juven ® compound using the secondary endpoint of AUC BACKGROUND Plasma arginine concentrations are lower in patients with cancer , which indicates that arginine metabolism may be disturbed in these patients . Arginine supplementation has been associated with positive effects on antitumor mechanisms and has been shown to reduce tumor growth and to prolong survival . Furthermore , the prognosis of patients with head and neck cancer remains disappointing . Insufficient intake frequently leads to malnutrition , which contributes to high morbidity and mortality rates . OBJECTIVE The aim of this study was to assess the long-term effects of perioperative arginine supplementation in severely malnourished patients with head and neck cancer . DESIGN In this double-blind , r and omized , controlled trial , we r and omly assigned 32 severely malnourished patients with head and neck cancer to receive 1 ) st and ard perioperative enteral nutrition ( n = 15 ) or 2 ) arginine-supplemented perioperative enteral nutrition ( n = 17 ) . The primary outcome was long-term ( ≥10 y ) survival . Secondary outcomes included the long-term appearance of locoregional recurrence , distant metastases , and second primary tumors . RESULTS No significant differences in baseline characteristics were observed between groups . The group receiving arginine-enriched nutrition had a significantly better overall survival ( P = 0.019 ) and better disease-specific survival ( P = 0.022 ) . Furthermore , the arginine-supplemented group had a significantly better locoregional recurrence-free survival ( P = 0.027 ) . No significant difference in the occurrence of distant metastases or occurrence of a second primary tumor was observed between the groups . CONCLUSION Perioperative arginine-enriched enteral nutrition significantly improved the long-term overall survival and long-term disease-specific survival in malnourished patients with head and neck cancer OBJECTIVE To evaluate whether an oral nutritional supplement enriched with omega-3 fatty acids , micronutrients , and probiotics affected body weight ( BW ) changes , serum albumin and prealbumin levels in patients with head and neck cancer ( HNC ) cachexia . STUDY DESIGN Sixty-eight HNC patients were r and omly assigned to receive either an Ethanwell/Ethanzyme ( EE ) regimen enriched with omega-3 fatty acids , micronutrients , and probiotics , or control ( Isocal ) for a 3-month period . Analysis of covariance was used to examine the association between BW change and variables . RESULTS Patients with body mass index ( BMI ) < 19 and those receiving the EE regimen consumed fewer daily calories but showed significantly increased BW and maintained higher serum albumin and prealbumin levels than other patients ( P<.05 ) . Their BW changes were significantly associated with changes in serum albumin and prealbumin levels . CONCLUSIONS EE regimen improved BW as well as serum albumin and prealbumin levels in HNC patients with BMI < 19 BACKGROUND AND AIMS Protein calorie malnutrition for cancer patients is related with altered cellular and humoral immunity . St and ard TPN and glutamine and lipid emulsion with omega 3 fatty acids were given to colorectal cancer patients and the effects of these to neutrophil functions and IL-8 levels are compared . METHODS Consecutive 36 patients with colorectal cancer diagnosed with endoscopic biopsy and with malnutrition determined by subjective global assessment were enrolled to study . The patients are r and omly divided into four groups . St and ard TPN to control group , TPN with glutamine solution to S-D group , TPN with omega 3 fatty acid solution to S-O group and TPN with omega 3 fatty acids solution and glutamine to S-D-O group were given for seven days after the operation . At the preoperative , postoperative first day and 7th day , neutrophil phagocytosis index , neutrophil adhesivity index and IL-8 levels were determined . RESULTS In all groups compared to control group neutrophil phagocytosis index were increased significantly ( p<0.05 ) . The most increasing was in group 3 . There was n't significant difference between groups about postoperative first day neutrophil adhesiveness index ( p>0.05 ) . At the 7th day the neutrophil adhesivity index for study groups were increased compared with control group , but there was no significant differences between groups . There was no significant difference between groups for IL-8 levels . CONCLUSIONS As a result of the study , altered cellular immunity in colorectal cancer patients with malnutrition can be corrected with omega 3 fatty acid emulsions and glutamine added to TPN so the ratio of morbidity and mortality can be decreased Preoperative plasma aminograms constructed for 63 patients expected to undergo gastrectomy for gastric cancer at different stages showed markedly lower concentrations of many plasma amino acids in the Stage IV and recurrent cases . The amino acid levels were inversely proportional to tumor size . On the other h and , preoperative arteriovenous differences in free amino acid levels were positive in Stage I cancer but negative in Stage IV cancer , indicating that intake of amino acids by the skeletal muscles exceeded the outflow in Stage I , whereas there was a net loss of amino acids from the skeletal muscles in advanced cancer . The amount of amino acids actually lost from the skeletal muscles after muscular loading in Stage I cancer also surpassed that in Stage IV cancer . Administration of TPN solution supplemented with 31 % branched-chain amino acids ( BCAA ) might favorably influence muscle protein metabolism in gastric cancer patients by inhibiting protein degradation and promoting synthesis , as treatment was more effective than 21 % BCAA-enriched TPN Carnitine deficiency is among the many metabolic disturbances that may contribute to fatigue in patients with cancer . Administration of exogenous L-carnitine may hold promise as a treatment for this common symptom . Little is known about L-carnitine  safety , tolerability , and dose-response in patients with cancer . We conducted a Phase I/II open-label trial to assess the safety and tolerability of exogenous L-carnitine and clarify the safe dose range associated with symptom effects for future controlled trials . Adult patients with advanced cancer , carnitine deficiency ( free carnitine < 35 for males or < 25 microM/L for females , or acyl/free carnitine ratio > 0.4 ) , moderate to severe fatigue , and a Karnofsky Performance Status ( KPS ) score > or = 50 were entered by groups of at least three into a st and ard maximum tolerated dose design . Each successive group received a higher dose of L-carnitine ( 250 , 750 , 1250 , 1750 , 2250 , 2750 , 3000 mg/day , respectively ) , administered in two daily doses for 7 days . To compare symptom outcomes before and after supplementation , patients completed vali date d measures of fatigue ( Brief Fatigue Inventory [ BFI ] ) , depressed mood ( Center for Epidemiologic Studies Depression Scale [ CES-D ] ) , quality of sleep ( Epworth Sleeplessness Scale [ ESS ] ) , and KPS at baseline and 1 week later . Of the 38 patients screened for carnitine levels , 29 were deficient ( 76 % ) . Twenty-seven patients participated ( " intention to treat , ITT " ) ( 17 males , 10 females ) , and 21 completed the study ( " completers " ) ; 17 of these patients ( " responders , " mean+/-[SD ] age=57.9+/-15 ) had increased carnitine levels at the end of the supplementation period . The highest dose achieved was 3000 mg/day . No patient experienced significant side effects and no toxicities were noted . Analysis of all the patients accrued ( ITT , n=27 ) showed a total carnitine increase from 32.8+/-10 to 54.3+/-23 microM/L ( P<0.001 ) and free carnitine increase from 26.8+/-8 to 44.1+/-17 microM/L ( P<0.001 ) . BFI decreased significantly , from 66+/-12 to 39.7+/-26 ( P<0.001 ) ; ESS decreased from 12.9+/-12 to 9+/-6 ( P=0.001 ) ; and CES-D decreased from 29.2+/-12 to 19+/-12 ( P<0.001 ) . A separate analysis of the 17 " responders " showed a dose-response relationship for total- ( r=0.54 , P=0.03 ) , free-carnitine ( r=0.56 , P=0.02 ) levels , and fatigue ( BFI ) scores ( r=-0.61 , P=0.01 ) . These findings suggest that l-carnitine may be safely administered at doses up to 3000 mg/day and that positive effects may be more likely at relatively higher doses in this range . This study provides the basis for the design of future placebo-controlled studies of l-carnitine supplementation for cancer-related fatigue HYPOTHESIS Perioperative administration of a supplemented enteral formula may decrease postoperative morbidity . DESIGN R and omized clinical trial . SETTING Department of surgery at a university hospital . PATIENTS One hundred ninety-six registered malnourished patients ( weight loss > or = 10 % ) who were c and i date s for major elective surgery for malignancy of the gastrointestinal tract . INTERVENTION After r and omization ( n = 150 ) , one group received postoperative enteral feeding with a st and ard diet within 12 hours of surgery ( control group ; n = 50 ) . Another group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine , omega-3 fatty acids , and RNA ( preoperative group ; n = 50 ) . After surgery , patients were given the same st and ard enteral formula as the control group . A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet . After surgery , patients were given enteral feeding with the same enriched formula ( perioperative group ; n = 50 ) . MAIN OUTCOME MEASURES Postoperative complications and length of hospital stay . RESULTS The 3 groups were comparable for baseline demographics , biochemical markers , comorbidity factors , and surgical variables . The intent-to-treat analysis showed that the total number of patients with complications was 24 in the control group , 14 in the preoperative group , and 9 in the perioperative group ( P = .02 , control group vs perioperative group ) . Postoperative length of stay was significantly shorter in the preoperative ( 13.2 days ) and perioperative ( 12.0 days ) groups than in the control group ( 15.3 days ) ( P = .01 and P = .001 , respectively , vs the control group ) . CONCLUSION Perioperative immunonutrition seems to be the best approach to support malnourished patients with cancer
We provide a systematic review to support the European Palliative Care Research Collaboration development of clinical guidelines for cancer patients suffering from cachexia .