Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. A Comparison of Calorie and Protein Intake in Hospitalized Pediatric Oncology Patients Dining With a Caregiver Versus Patients Dining Alone: A Randomized, Prospective Clinical Trial Effects of a high-fat diet on body composition in cancer patients receiving chemotherapy: a randomized controlled study The effect of oral nutritional supplements on head and neck cancer. Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. The effect of nutritional supplements on food intake in patients undergoing radiotherapy. Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomised trial. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy.
OBJECTIVE Weight loss is common in patients with malignant tumors and it can adversely affect quality of life and survival . The aim of the present study was to investigate the effects of a nutritional intervention in cancer patients in an outpatient setting . METHODS Cancer out patients ( N = 58 ) who were classified as undernourished or at high risk for undernutrition by the Nutritional Risk Screening 2002 tool were r and omized into two groups . One group ( n = 30 ) received st and ardized individual nutritional therapy , including counseling by a dietitian , food fortification , and oral nutritional supplements if required . The second group ( n = 28 ) received st and ard care . The nutritional intervention lasted 3 mo . Dietary intake ( 3-d dietary record ) , nutritional status ( body weight ) , physical functioning ( performance status , h and -grip strength ) and quality of life ( European Organization for Research and Treatment of Cancer Quality of Life Question naire version 3.0 ) were assessed at baseline and after 6 wk and 3 mo . An additional follow-up assessment was carried out 3 mo post-intervention . RESULTS Nutritional intervention led to a significantly higher average energy and protein intake in the nutritional therapy group ( + 379 kcal ; 95 % confidence interval [ CI ] , 117 - 642 ; P = 0.007 , respectively ; + 10.4 g ; 95 % CI , 2.3 - 18.5 ; P = 0.016 ) . However , the increased dietary intake was not associated with improvements in nutritional status , physical functioning , or quality of life . CONCLUSIONS Individual nutritional counseling significantly and positively influenced energy and protein intake , but did not improve nutritional or physical outcome or quality of life . These results indicate that nutritional therapy alone is of limited efficacy in cancer patients whose nutritional status has already deteriorated BACKGROUND We aim ed to determine the effect of dietary counseling or oral supplements on outcome for patients with cancer , specifically , nutritional outcome , morbidity , and quality of life ( QOL )  , during and 3 months after radiotherapy . METHODS Seventy-five patients with head and neck cancer who were referred for radiotherapy ( RT ) were r and omized to the following groups : group 1 ( n = 25 ) , patients who received dietary counseling with regular foods ; group 2 ( n = 25 ) , patients who maintained usual diet plus supplements ; and group 3 ( n = 25 ) , patients who maintained intake ad lib .  Nutritional intake ( determined by diet history ) and status ( determined by Ottery 's Subjective Global Assessment ) , and QOL ( determined by the European Organization for the Research and Treatment of Cancer Quality of Life Question naire version 3.0 [ EORTC QLQ-C30 ] ) were evaluated at baseline , at the end of RT , and at 3 months . RESULTS Energy intake after RT increased in both groups 1 and 2 ( p < or = .05 ) . Protein intake also increased in both groups 1 and 2 ( p < or = .006 ) . Both energy and protein intake decreased significantly in group 3 ( p < .01 ) . At 3 months , group 1 maintained intakes , whereas groups 2 and 3 returned to or below baseline levels . After RT , > 90 % of patients experienced RT toxicity ; this was not significantly different between groups , with a trend for reduced symptomatology in group 1 versus group 2/group 3 ( p < .07 ) . At 3 months , the reduction of incidence/severity of grade 1 + 2 anorexia , nausea/vomiting , xerostomia , and dysgeusia was different : 90 % of the patients improved in group 1 versus 67 % in group 2 versus 51 % in group 3 ( p < .0001 ) . After RT , QOL function scores improved ( p < .003 ) proportionally with improved nutritional intake and status in group 1/group 2 ( p < .05 ) and worsened in group 3 ( p < .05 ) ; at 3 months , patients in group 1 maintained or improved overall QOL , whereas patients in groups 2 and 3 maintained or worsened overall QOL . CONCLUSIONS During RT , nutritional interventions positively influenced outcomes , and counseling was of similar/higher benefit ; in the medium term , only counseling exerted a significant impact on patient outcomes Hospitalization and cancer therapy can contribute to decreased food intake in children and adolescents with cancer , making it a challenge to meet their nutritional needs . The affect of hospitalization and the eating environment for pediatric oncology patients has not been studied very well , and the effect of altering the social aspect of mealtime for hospitalized pediatric oncology patients has not been studied at all . The authors conducteda r and omized , prospect i ve clinical trial to determine if hospitalized pediatric oncology patients consume more protein and calories when eating with afamily member or when eating alone in their room at mealtime . All food and beverage intake was recorded for 3 consecutive days , and a food service satisfaction survey was completed on Day 3 . Food records were analyzed for calorie and protein intake , and surveys were analyzed for patient/parent satisfaction . The study was completed by 200 hospitalized patients and their parent/caregiver . Overall , neither calorie nor protein intake differed significantly between the two groups , but patient/parent satisfaction was significantly higher in the group of patients who dined with their caregiver . By using analysis of variance , the authors found that ideal body weight and years of sickness were significantly associated with calorie and protein intake Summary BACKGROUND : Patients with cancer are characterized by a profound impairment of glucose utilization , with lipids being the preferred metabolic fuel . In contrast , the energy needs of malignant tumors are almost entirely met by glucose . We therefore studied the effects of a high-fat diet , particularly on body composition . PATIENTS AND METHODS : Twenty-three moderately malnourished patients with gastrointestinal carcinomas were r and omized to receive either a conventional diet supplying 35 nonprotein kcal and 1.1 g of protein/kg per day ( group A , n = 11 ) or a fat-enriched artificial liquid diet ( 20 nonprotein kcal/kg per day ) plus normal meals ( group B , n = 12 ) for a period of eight weeks , i.e. , from the first to the third chemotherapy cycle . The fat content of the artificial diet was 66 % of the nonprotein calories . The day before the nutritional interventions , and again after four and eight weeks , body compartments were determined using bioelectrical impedance analysis , lymphocyte sub population s were quantified using flow cytometry , and some aspects of the quality of life were rated using four linear analog self- assessment ( LASA ) scales . The statistical calculations were done as an exploratory data analysis . RESULTS : The consumption of non-protein calories did not differ significantly between the two patient groups . An average weight gain in group B contrasted with an average weight loss in group A after four ( P < 0.01 ) and eight weeks ( P < 0.05 ) . Fat-free mass showed an intergroup difference in favor of group B after eight weeks ( P < 0.05 ) . Body cell mass was maintained throughout the study in group B , but declined significantly up to weeks 4 and 8 in group A ( intergroup difference : P < 0.05 and 0.01 , respectively ) . A decrease in the total lymphocyte count by 559 cells/μl occurred with the fat-enriched diet ( P < 0.05 ) . Several aspects of the quality of life were rated to be better in group B than in group A , although not all differences reached statistical significance . CONCLUSION : In patients with cancer , a high-fat diet may possibly support the maintenance of both body weight and body cell mass . However , monitoring the lymphocyte count is advisable . ZusammenfassungHINTERGRUND : Karzinompatienten sind durch eine erhebliche Beeinträchtigung der Glukoseutilisation gekennzeichnet , wobei Fette die bevorzugte Energiequelle darstellen . I m Gegensatz dazu decken maligne Tumoren ihren Energiebedarf fast völlig durch Glukose . Deshalb untersuchten wir Auswirkungen einer fettreichen Ernährung besonders auf die Körperzusammensetzung . PATIENTEN UND METHOD IK : 23 mäßig mangelernährte Patienten mit gastrointestinalen Karzinomen erhielten acht Wochen lang , nämlich vom ersten bis zum dritten Chemotherapiezyklus , r and omisiert entweder eine konventionelle Kost mit 35 Nichteiweißkalorien und 1,1 g Protein/kg je Tag ( Gruppe A , n = 11 ) oder eine mit Fett angereicherte künstliche Trinknahrung ( 20 Nichteiweißkalorien/kg je Tag ) mit zusätzlichen normalen Mahlzeiten ( Gruppe B , n = 12 ) . Der  Fettgehalt der Trinknahrung  betrug 66 % der Nichteiweißkalorien . Am Tag vor Beginn der Ernährungsbeh and lungen sowie nach vier und acht Wochen wurden die Körperkompartimente durch bioelektrische Impedanzanalyse , Lymphozytensub population en durchflusszytometrisch und einige Aspekte der Lebensqualität mit Hilfe von vier linearen analogen Selbstbeurteilungsskalen quantifiziert . Die Wahrscheinlichkeitsstatistik best and in einer explorativen Date nanalyse . ERGEBNISSE : Die Aufnahme von Nichteiweißkalorien war zwischen den Patientengruppen nicht signifikant unterschiedlich . Einer durchschnittlichen Gewichtszunahme in der Gruppe B st and nach vier ( P < 0,01 ) und acht Wochen ( P < 0,05 ) ein mittlerer Gewichtsverlust in der Gruppe A gegenüber . Die  fettfreie Körpermasse differierte nach acht Wochen zugunsten der Gruppe B ( P < 0,05 ) . Die Körperzellmasse blieb in der Gruppe B während der ganzen Studiendauer erhalten , nahm aber in der Gruppe A bis zur vierten und achten Woche jeweils signifikant ab ( Gruppenunterschied : P < 0,05 bzw . 0,01 ) . Während der fettreichen Ernährung fiel eine Verringerung der Lymphozytenzahl um 559 Zellen/μl auf ( P < 0,05 ) . Die Bewertung der Lebensqualität brachte in der Gruppe B unter mehreren Aspekten bessere Ergebnisse als in der Gruppe A ( P = 0,01–0,06 ) . SCHLUSSFOLGERUNG : Bei Karzinompatienten fördert eine fettreiche Ernährung möglicher Weise die Erhaltung des Körpergewichts und der Körperzellmasse . Allerdings sollte dabei die Lymphozytenzahl kontrolliert 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 BACKGROUND Weight loss in patients with cancer is common and associated with a poorer survival and quality of life . Benefits from nutritional interventions are unclear . The present study assessed the effect of dietary advice and /or oral nutritional supplements on survival , nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma . METHODS Participants were r and omly assigned to receive no intervention , dietary advice , a nutritional supplement or dietary advice plus supplement before the start of chemotherapy . Patients were followed for 1 year . Survival , nutritional status and quality of life were assessed . RESULTS In total , 256 men and 102 women ( median age , 66 years ; range 24 - 88 years ) with gastrointestinal ( n = 277 ) and lung ( n = 81 ) cancers were recruited . Median ( range ) follow-up was 6 ( 0 - 49 ) months . One-year survival was 38.6 % ( 95 % confidence interval 33.3 - 43.9 ) . No differences in survival , weight or quality of life between groups were seen . Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks , although this was independent of nutritional intervention . CONCLUSIONS Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life . Weight gain predicted a longer survival but occurred independently of nutritional intervention BACKGROUND & AIMS The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups ( DRG ) has never been studied in a multidisciplinary setting . This study aims to determine the prevalence of malnutrition in a tertiary hospital in Singapore and its impact on hospitalization outcomes and costs , controlling for DRG . METHODS This prospect i ve cohort study included a matched case control study . Subjective Global Assessment was used to assess the  nutritional status on admission of 818 adults .  Hospitalization outcomes over 3 years were adjusted for gender , age , ethnicity , and matched for DRG . RESULTS Malnourished patients ( 29 % ) had longer hospital stays ( 6.9±7.3 days vs. 4.6±5.6 days , p<0.001 ) and were more likely to be readmitted within 15 days ( adjusted relative risk=1.9 , 95 % CI 1.1 - 3.2 , p=0.025 ) . Within a DRG , the mean difference between actual cost of hospitalization and the average cost for malnourished patients was greater than well-nourished patients ( p=0.014 ) . Mortality was higher in malnourished patients at 1 year ( 34 % vs. 4.1 % ) , 2 years ( 42.6 % vs. 6.7 % ) and 3 years ( 48.5 % vs. 9.9 % ) ; p<0.001 for all . Overall , malnutrition was a significant predictor of mortality ( adjusted hazard ratio=4.4 , 95 % CI 3.3 - 6.0 , p<0.001 ) . CONCLUSIONS Malnutrition was evident in up to one third of the in patients and led to poor hospitalization outcomes and survival as well as increased costs of care , even after matching for DRG . Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed Twenty-three patients with head and neck cancer were r and omly allocated , regardless of pretreatment nutrition status , to receive either radiotherapy alone ( 12 patients ) or radiotherapy plus nutritional oral supplementation ( 11 patients ) with high-protein nutritional powder of balanced nutrient content ( Ensure ) .  Nutrition status was assessed subjectively and objective ly for all patients before and at weekly intervals during the course of irradiation . All patients who received nutritional supplementation experienced an increase in body weight and in triceps skin-fold thickness , whereas 58 % of the other group had weight loss ( p = 0.001 ) . Irradiation had to be suspended in 5 of the 12 patients who received no nutritional support because of severe mucosal reaction and /or poor performance status . All patients who received nutritional supplementation during radiotherapy had their course of irradiation without interruption 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 BACKGROUND Nutritional interventions have shown increased energy intake but not improvement in health-related quality of life ( HRQL ) or prognosis in non small cell lung cancer ( NSCLC ) patients . Eicosapentaenoic acid has been proposed to have anti-inflammatory , anticachectic and antitumoural effects . OBJECTIVE To compare the effect of an oral EPA enriched supplement with an isocaloric diet on nutritional , clinical and inflammatory parameters and HRQL in advanced NSCLC patients . DESIGN Patients with advanced NSCLC were r and omized to receive diet plus oral nutritional supplement containing EPA ( ONS-EPA ) or only isocaloric diet ( C ) . All patients received paclitaxel and cisplatin/carboplatin treatment . Weight , body composition , dietary intake , inflammatory parameters and HRQL were assessed at baseline and after the first and second cycles of chemotherapy . Response to chemotherapy and survival were evaluated . RESULTS Ninety two patients were analysed ( 46 ONS-EPA,46 C ) . ONS-EPA group had significantly greater energy ( p < 0.001 ) and protein ( p < 0.001 ) intake compared with control . Compared with baseline , patients receiving the ONS-EPA gained 1.6 ± 5 kg of lean body mass ( LBM ) compared with a loss of -2.0 ± 6 kg in the control ( p = 0.01 ) . Fatigue , loss of appetite and neuropathy decreased in the ONS-EPA group ( p ≤ 0.05 ) . There was no difference in response rate or overall survival between groups . CONCLUSION Patients with NSCLC receiving ONS-EPA  significantly improves energy and protein intake , body composition . and decreased fatigue , loss of appetite and neuropathy . Registered with Clinical Trials.gov ( NCT01048970 ) PURPOSE To investigate the impact of dietary counseling or nutritional supplements on outcomes in cancer patients :  nutritional , morbidity , and quality of life ( QoL ) during and 3 months after  radiotherapy .  PATIENTS AND METHODS A total of 111 colorectal cancer out patients referred for radiotherapy , stratified by staging , were r and omly assigned : group 1 ( G1 ; n = 37 ) , dietary counseling ( regular foods ) ; group 2 ( G2 ; n = 37 ) , protein supplements ; and group 3 ( G3 ; n = 37 ) , ad libitum intake .  Nutritional intake ( diet history ) , status ( Ottery 's Subjective Global Assessment ) , and QoL ( European Organisation for Research and Treatment of Cancer Quality of Life Question naire version 3.0 ) were evaluated at baseline , at the end , and 3 months after radiotherapy . RESULTS At radiotherapy completion , energy intake increased in G1/G2 ( P < or = .04 ) , G1 more than G2 ( P = .001 ) , and decreased in G3 ( P < .01 ) . Protein intake increased in G1/G2 ( P < or = .007 ) , G1 less than G2 ( not significant ) , and decreased in G3 ( P < .01 ) . At 3 months , G1 maintained nutritional intake and G2/G3 returned to baseline . After radiotherapy and at 3 months , rates of anorexia , nausea , vomiting , and diarrhea were higher in G3 ( P < .05 ) . At radiotherapy completion , in G1 all QoL function scores improved proportionally to adequate intake or nutritional status ( P < .05 ) ; whereas in G2 only three of six function scores improved proportionally to protein intake ( P = .04 ) , and in G3 all scores worsened ( P < .05 ) . At 3 months , G1 patients maintained/improved function , symptoms , and single-item scores ( P < .02 ) ; in G2 , only few function and symptom scales improved ( P < .05 ) ; in G3 , QoL remained as poor as after radiotherapy . In G1/G2 , respectively , improvement/deterioration of QoL correlated with better or poorer intake or nutritional status ( P < .003 ) . CONCLUSION During radiotherapy , both interventions positively influenced outcomes ; dietary counseling was of similar or higher benefit , whereas even 3 months after RT , it was the only method to sustain a significant impact on patient outcomes
AIM An underst and ing of effective foodservice interventions on nutrition outcomes in adult patients with cancer is required to support clinical decision making .
This systematic review aim ed to determine the effect of foodservice interventions across a range of nutritional outcomes and satisfaction of hospitalised and ambulatory adult oncology patients .