Utilization of the PICO framework to improve searching PubMed for clinical questions Long-term follow-up of the potential benefits of early nutritional intervention in adults with upper gastrointestinal cancer: a pilot randomised trial Impact of enteral nutrition on postoperative immune function and nutritional status. Potential benefits of early nutritional intervention in adults with upper gastrointestinal cancer: a pilot randomised trial The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Management of Dysphagia in Esophageal Adenocarcinoma Patients Undergoing Neoadjuvant Chemotherapy: Can Invasive Tube Feeding be Avoided?
 Perioperative nutrition in malnourished surgical cancer patients - a prospective, randomized, controlled clinical trial. Evaluation of quality of life following placement of self-expanding plastic stents as a bridge to surgery in patients receiving neoadjuvant therapy for esophageal cancer. Failure of dietetic referral in patients with gastrointestinal cancer and weight loss. Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago‐gastric cancer: a longitudinal cohort study Effects of Preoperative Enteral Nutrition on Postoperative Recent Nutritional Status in Patients with Siewert II and III Adenocarcinoma of Esophagogastric Junction after Neoadjuvant Chemoradiotherapy
Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Purpose This study aim ed to evaluate the long-term survival of all patients who participated in a pilot r and omised trial of an early nutritional intervention for adults with upper gastrointestinal cancer . It also sought to identify factors that predicted patient mortality . Methods All participants ( n = 21 ) who were r and omised into the original study were followed for a maximum of 5 years and 2 months ( final follow-up April 2016 ) . The primary outcome measure was time from date of recruitment until date of death , ascertained by the Victorian Cancer Registry and /or Monash Health Scanned Medical Records . Secondary analyses were conducted to identify factors that adversely affected survival . Results At the end of the follow-up period , three patients were alive in the nutrition intervention group whilst only two patients were living from the st and ard care group . Visual evaluation of the Kaplan-Meier survival curves demonstrated a possible survival benefit from being exposed to the intervention between 6 months and 1.4 years post-recruitment , though this benefit dissipated soon after . The intervention was not associated with increased survival in univariate analyses , but was after adjustment for other factors found to adversely impact on survival ( adjusted hazard ratio 0.12 ( 95 % CI 0.02–0.72 ) p = 0.02 ) . These factors were being a smoker ( 14.2 ( 1.43 to 140.67 ) , p = 0.02 ) ; low baseline physical functioning ( 1.11 ( 1.01 to 1.21 ) , p = 0.03 ) ; high baseline fatigue ( 1.09 ( 1.02–1.16 ) , p = 0.007 ) ; and high baseline dyspnoea ( 1.08 ( 1.02–1.13 ) , p = 0.003 ) . Conclusion Early and intensive nutrition intervention may increase the survival of people with upper gastrointestinal cancer We studied the effects of enteral nutrition ( EN ) support initiated 1 week before surgery on postoperative nutritional status , immune function , and inflammatory response in gastric cancer patients . A total of 200 gastric cancer patients were r and omly divided into two groups : EN starting 1 week before surgery ( study group ) and EN starting early after surgery ( control group ) . The two groups received EN support , following different therapeutic schedules , until the 9th day after operation . In the patients , body weight , skinfold thickness , upper-arm circumference , white blood cell count , albumin , prealbumin , C-reactive protein , peripheral immunoglobulins ( IgA , IgG , and IgM ) , T lymphocyte subsets , interleukin-6 , and tumor necrosis factor-α were measured 10 days before and after surgery and on the first day after surgery . There was no statistically significant difference in the results of recovery time of passage of gas by anus , abdominal distension , stomachache , blood glucose , hepatic and renal functions , and electrolytes between the two groups of patients ( P > 0 . 05 ) . Adverse reactions occurred to both groups at 1 and 2 days after operation . Such conditions was improved after the intravenous drip rate was adjusted . The albumin and prealbumin levels of the patients in both groups decreased at 1 day after operation ( P < 0 . 05 ) . The levels rose when the research was finished ( P < 0 . 05 ) . The prealbumin level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The IgG level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The two groups of inflammatory reaction indicators of the study group were lower than those of the control group at 10 days after operation ( P < 0 . 05 ) . This study indicates that appropriate preoperative EN support for gastric cancer patients can improve their postoperative nutritional status and immune function , can reduce inflammatory response , and is more conducive to the recovery of patients Purpose This study aim ed to test whether a very early nutrition intervention delivered over the telephone was feasible and could improve outcomes amongst patients with upper gastrointestinal cancer . Methods Participants with a histologically proven new diagnosis of primary oesophageal or stomach cancer and who were to undergo surgery and /or chemotherapy were r and omised to receive either st and ard nutrition care ( SC ) or early and intensive nutrition intervention ( NI ) over the telephone/face-to-face . Participants were followed for 6 months . The primary outcome was quality of life ( QoL ) , assessed using the European Organization for Research and Treatment of Cancer Global Quality of Life question naire C30 ( EORTC QLQ-C30 ) and the European Quality of Life Instrument ( EQ-5D ) tool ; secondary outcomes were nutritional status and survival . Results Twenty-one participants were recruited ( 11 SC and 10 NI ) . At baseline , the prevalence of malnutrition was 90 % . Compared with SC , the NI group had a significantly higher EORTC global QoL score at the first mid- study follow-up ( coefficient ( 95 % CI ) 21.0 ( 12.1 , 29.9 ) adjusted for baseline , p < 0.001 ) and at 26 weeks ( 28.4 ( 21.3 , 35.4 ) adjusted for baseline , p < 0.001 ) . Nutritional risk score was lower ( p < 0.001 ) , and loss of body weight attenuated ( p < 0.001 ) in the NI group compared with SC . Six deaths occurred during the study , five in the SC group and one in the NI group ( p = 0.06 ) . The mean time spent with a dietitian per contact was significantly less for the NI group compared with SC ( 16(3 ) vs 40(6 ) min per dietetic contact , p < 0.001 ) . Conclusions This pilot study has shown the potential of a novel telephone-based early and intensive dietetic model of care for newly diagnosed upper gastrointestinal cancer patients OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Abstract Background Neoadjuvant chemotherapy is an accepted st and ard for locally advanced esophagogastric junction adenocarcinoma . However , the dysphagia frequently associated with this condition may interfere with patient tolerance of this treatment . In many centers , invasive tube feeding , placed either endoscopically , radiographically , or surgically , is used to address this issue , but it can cause significant morbidity . We sought to determine if an approach of goal -directed dietary counseling and appropriately timed neoadjuvant chemotherapy could obviate the need for invasive tube feeding . Methods Patients with locally advanced ( cT3 or N+ ) esophageal and esophagogastric junction adenocarcinoma undergoing neoadjuvant TCF [ Taxotere , cisplatin 5-fluorouracil ( 5-FU ) ] , ECF ( epirubicin , cisplatin , 5-FU ) , or FLOT ( docetaxel , oxaliplatin , leucovorin , and 5-FU ) at the McGill University Health Center from March 2007 to September 2012 were identified from a prospect i ve data base . All received individualized goal -directed dietary counseling , were monitored for signs/symptoms of malnutrition with serial ( baseline/presurgery ) body mass index , albumin , and completed serial symptom scores ( dysphagia ) , and quality -of-life question naires ( Functional Assessment in Cancer Therapy with the esophageal subset , FACT-E ) . We assessed the response of dysphagia and nutritional status to neoadjuvant chemotherapy and the need for invasive tube feeding . Results Of 130 patients undergoing neoadjuvant chemotherapy  , 78 had severe dysphagia ( defined as dysphagia score ≥2 on a 5-point Likert scale ) , most of whom received TCF ( 91 % ) . Overall dysphagia scores improved in 75 ( 96 % ) of 78 patients from a dysphagia score of 3 - 0 , most of which improved after the first cycle of therapy . This was associated with an increase in quality of life ( FACT-E scores 117 ± 23 to 140 ± 20 ) . With maintenance of weight ( 70 ± 22 to 69 ± 24 kg ) , body mass index ( 24.5 ± 8 to 23.9 ± 7 kg/m2 ) , and serum albumin ( 40 ± 5 to 37 ± 4 g/L ) . Only one patient required a stent , and none required jejunostomy or gastrostomy . Conclusions Appropriately timed neoadjuvant chemotherapy with a highly effective regimen rapidly restores normal swallowing , maintains nutritional status , and obviates the need for invasive tube feeding in patients with significant dysphagia from esophageal adenocarcinoma BACKGROUND & AIMS Malnourished surgical patients are supposed to benefit from perioperative nutrition . It is unclear , however , whether enteral intervention really surpasses the parenteral one , and whether the modification of st and ard formula matters . The aim of the study was to evaluate the clinical value of the route and type of perioperative nutritional support . METHODS A group of 167 malnourished patients ( 91 M , 76 F , mean age 61.4 years ) operated between June 2001 and December 2008 was r and omly assigned during postoperative period to four groups according to nutritional intervention : enteral and parenteral , st and ard or immunomodulating . All patients received parenteral nutrition before surgery for 14 days , which provided homogenous groups for the postoperative evaluation . The trial was design ed to test the hypothesis that enteral nutrition and /or immunonutrition can reduce the incidence of postoperative complications . RESULTS The incidence of individual complications was comparable among all four groups ( p > 0.05 ) . Infectious complications occurred in 23 of 84 patients with st and ard diets and in 20 of 83 patients receiving immunomodulatory formula ( odds ratio 0.84 ; 95 % CI 0.42 to 1.69 ) . There were no significant differences in infectious complications ' ratio in patients receiving enteral ( 24/84 patients ) and parenteral formulas ( 19/83 patients ) . Neither immunomodulating formulas nor enteral feeding significantly affected the length of hospitalization , overall morbidity and mortality rates . CONCLUSIONS Results demonstrated that postoperative nutritional intervention generates comparable results regardless of the route and formula used and that preoperative intervention is of the utmost importance . The study was registered in the Clinical Trials Data base - number : NCT 00558155 PURPOSE To determine whether self-exp and ing plastic stent ( SEPS ) placement significantly improves quality of life and maintains optimal nutrition while allowing full-dose neoadjuvant therapy ( NAT ) in patients with esophageal cancer . PATIENTS AND METHODS A prospect i ve , dual-institution , single-arm , phase II ( http:// Clinical Trials.gov : NCT00727376 ) evaluation of esophageal cancer patients undergoing NAT prior to resection . All patients had a self-exp and ing polymer stent placed prior to NAT . The European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 , Functional Assessment of Cancer Therapy-Anorexia , and Functional Assessment of Cancer Therapy-General surveys were administered prior to stenting , within 1 week post-stent placement , and at the completion of neoadjuvant therapy . RESULTS Fifty-two patients were enrolled ; 3 ( 5.8 % ) had stent migrations requiring replacement . There were no instances of esophageal erosion or perforation . All patients received some form of neoadjuvant therapy . Thirty-six ( 69 % ) received chemoradiation ; 34 ( 93 % ) of these patients received the planned dose of chemotherapy , and 27 ( 75 % ) received the full planned dose of radiotherapy . There were 16 ( 31 % ) patients receiving chemotherapy alone ; 12 ( 74 % ) of patients in the  chemotherapy-alone  group completed the planned dose of therapy . CONCLUSION Placement of SEPS appears to provide significant improvement in quality of life related to dysphagia and eating restriction in patients with esophageal cancer undergoing neoadjuvant therapy . Consideration of SEPS instead of percutaneous feeding tube should be initiated as a first line in dysphagia palliation and NAT nutritional support This study examined whether staff working within a cancer centre treating patients with gastrointestinal malignancy routinely identified individuals from out patients for referral to a dietitian . A nutrition screening tool is employed only for in-patient admissions . Height , current and usual weight were recorded prospect ively in all patients referred for consideration of treatment .  First appointment with the dietitian , first hospital admission , demographic and clinical details were obtained from hospital records . Time from first appointment to referral to a dietitian was examined . Between September 2002 and March 2004 , 920 patients were included . Five hundred and seventeen patients had lost weight  , of whom 223 patients had lost between 5 % and 10 % and 294 patients had lost more than 10 % of their pre-morbid weight . Three hundred and twenty-seven patients ( 36 % ) were referred to dietitians . Twenty eight ( 9 % ) of referrals were made by staff in out patients . Two hundred and ninety-nine were referred during or after an inpatient admission but only 39 % of these occurred within the first seven days following admission . One third of patients with more than 10 % weight loss were not referred for  dietary assessment  , even following admission . The likelihood of referral was significantly associated with the degree of weight loss ( univariate analysis hazard ratio ( HR ) 1.75 , 95 % Confidence Interval ( CI ) 1.4 - 2.19 , multivariate HR 1.65 , 95 % CI 1.22 - 2.23 ) and was independent of factors such as performance status and clinical setting . Few patients were identified early in their treatment for referral to a dietitian . Since most chemotherapy is now given on an outpatient basis , patients are unlikely to be referred if they do not require admission . This study suggests that an out-patient dietetic screening tool is urgently required . Such screening is likely to result in considerable improvements to the clinical care of cancer patients with weight loss BACKGROUND Patients with oesophago-gastric ( OG ) cancer may be at risk of malnutrition , troublesome gastrointestinal symptoms ( GI ) and reduced dietary intake in view of the tumour location and multimodality curative treatment approach . Longitudinal research is lacking . The present study aim ed to assess ( i )  nutritional status  and how it evolved over the first year ; ( ii ) the association between nutritional status scores and GI symptom scores ; and ( iii ) the nutrient and food group intake pattern . METHODS This was a prospect i ve , observational study of patients with an OG lesion planned for radical treatment , with assessment at diagnosis , 3 months and 12 months after the start of treatment .  Nutritional assessment  was performed using the Patient-Generated Subjective Global Assessment , GI symptoms measured using the modified Gastrointestinal Symptom Rating Scale and dietary intake assessed using a semi-quantitative food frequency approach . RESULTS Eighty patients ( 61 males , 19 females ; aged 46 - 89 years ) were recruited . At baseline , 3 ( n = 68 ) and 12 months ( n = 57 ) , 61 % , 62 % and 60 % , respectively , were moderately/severely malnourished . Higher symptom burden was associated with poorer nutritional status at baseline ( r = 0.55 , P < 0.001 ) , 3 months ( r = 0.51 , P < 0.001 ) and 12 months ( r = 0.42 , P = 0.001 ) . At each respective time point , 37 % , 38 % and 42 % were meeting their estimated average requirement for energy . No change in mean ( SD ) intake of energy , fibre , nutrient and food groups was observed over time . CONCLUSIONS Patients with OG cancer have progressive weight loss , with malnutrition present over the majority of the 12-month study period . Optimising nutritional status and symptom management throughout the treatment pathway should be a clinical priority Abstract Objective : To study the effects of preoperative enteral nutrition ( EN ) on postoperative recent nutritional status ( PRNS ) in patients with Siewert II and III adenocarcinomas of esophagogastric junction ( AEG ) after neoadjuvant chemoradiotherapy ( NCRT ) . Methods : A total of 66 patients with resectable AEG ( Siewert II and III ) were r and omly divided into two groups . The trial group accepted oral nutrition supplementation ( ONS ) for 7 days before surgery while the control not . Results : Nutrition indexes were higher in trial group after surgery whereas the opposite was true for the diamine oxidase ( DAO ) and d-lactate ( P < 0.05 ) . The rate of malnutrition and nutritional risk became lower in trial group on the 8th day after surgery ( P < 0.05 ) . Injury levels of intestinal mucosa were more severe among control group . The recent prognosis was better in trial group . For patients with or without nutritional risks at admission , the PRNS and recent prognosis were improved by preoperative EN . Logistic regression analysis suggested that preoperative EN could be an independent protective factor of PRNS . Conclusions : Preoperative EN may improve the PRNS and recent prognosis of patients with Siewert II and III AEG after NCRT
BACKGROUND Malnutrition is highly prevalent in patients with Upper Gastrointestinal ( UGI ) cancer and is associated with poor outcomes .
However , there are no evidence -based guidelines for nutrition support specific to UGI cancer surgery .