Discussion
colorectal cancer, tumor, nausea/vomiting, fatigue, breast cancer, diarrhea, cancer, nausea and vomiting, leukemia, inflammation, cachexia, intestinal mucositis, dysmotility, anorexia
COLORECTAL CANCER, TUMOR, BREAST TUMORS, METASTASIS, BREAST CANCER, PROLIFERATION, CANCER, INFLAMMATION, LEUKEMIA, LOSS OF APPETITE, DYSMOTILITY, EFFECTS OF CHEMOTHERAPY, ANOREXIA, COMPLICATIONS
To the best of our knowledge, to date, this is the first randomized clinical trial to assess the contributory effects of oral synbiotics intake on common side effects of chemotherapy, such as nausea and vomiting, defecation quality, fatigue, sleep quality, anorexia, and mental status in women with breast cancer. Due to annual increase of breast cancer around the world, and the disruptive effects of chemotherapy agents on the quality of patients’ lives as the main treatment to control breast tumors, we conducted this randomized clinical trial to realize if synbiotics therapy can effectively reduce common annoying complications of chemotherapy. So far, all studies investigating the effects of synbiotics on breast cancer have examined the paraclinical indicators or were conducted on breast cancer survivors after completing chemotherapy courses [Several studies have focused on the beneficial effects of live bacteria on cancer outcomes. Likewise, in their systematic review, Eslami et al. ( 2019 ) claimed that using probiotic microorganisms can beneficially affect the management and treatment of colorectal cancer through positive alteration of intestinal microflora, fighting against inflammation, reducing cytotoxic and genotoxic agents, suppressing tumor cell proliferation, growth and metastasis, and invigorating gut permeability [The results of this study are consistent with those of the study by Reyna-Figueroa et al. (2019) on 60 leukemia children undergoing chemotherapy. They found that the intake of Probiotics increase mucin secretion which leads to the prevention of dysmotility and modulates defecation volume and texture [One of the probable mechanistic pathways of synbiotics on nausea/vomiting is that probiotics decrease inflammation levels and protect immune barriers, and down-regulate the pre-inflammatory cytokines (e.g., TNF-α, IL-6, IL-8, IL-1β) that results in suppressing the toxic effects of chemotherapy drugs [Among non-gastrointestinal side effects, we observed a significant reduction in fatigue experience in both week 4 and week 8 in the synbiotics group. In contrary, the placebo group experienced more fatigue at the end of study. These changes were also statistically significant between the two groups and didn’t change even after adjusting the confounders. These results are in line with those of the study by Lee et al. (2014,) who reported that probiotics consumption (In addition to the above complications, the results of our study indicated that anorexia reduced significantly at both week 4 and week 8 although the changes of anorexia were not significant between the two groups. Insufficient dietary intake and cachexia, following the loss of appetite and food aversion, is associated with lower treatment response and quality of life in these patients [The improvement of diarrhea following a better intestinal absorption and lower intestinal mucositis [