1. Introduction
colorectal and lung cancer, colorectal cancer, skeletal muscle, toxicity, cancer, sarcopenia, malnutrition
COLORECTAL CANCER, CANCER, MALNUTRITION, LUNG TUMOURS, ADVANCED CANCER, SARCOPENIA, MALNUTRITION, COMPLICATIONS
ESPEN guidelines recommend a minimum protein intake of 1.0 g/kg body weight (BW) per day to maintain or restore lean body mass in patients with cancer. During anti-cancer treatment, optimal protein intake is difficult to achieve. We investigated whether a high-protein, low-volume oral nutritional supplement (ONS) supports patients in meeting recommendations. A multi-centre, randomised, controlled, open-label, parallel-group study was carried out in nine hospitals (five countries) between January 2019 and July 2021 in colorectal and lung cancer patients undergoing first-line systemic treatment with chemo(radio-) or immunotherapy. Subjects were randomised (2:1) to receive Fortimel Compact ProteinIt is well established that malnutrition is a common feature not just at diagnosis but throughout the patient’s cancer journey and is associated with treatment toxicity, complications, reduced physical function and reduced survival [Malnutrition prevalence varies by cancer type with the highest frequency of malnutrition seen in gastroesophageal, pancreatic, head and neck, and lung tumours at diagnosis [Expert guidelines have been published over recent years highlighting the importance of the early recognition and management of the risk of malnutrition throughout the patient’s cancer journey [An adequate protein intake is one aspect of nutritional intervention to optimise muscle protein anabolism with current cancer specific guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) recommending a protein intake of 1.0–1.5 g/kg BW/day [Studies have shown that optimal protein intake is hard to achieve in practice with 66% of patients with advanced cancer [Oral nutritional supplements (ONS) are an established part of the broader nutritional support strategy for cancer patients at risk of malnutrition. Studies have shown that compared to controls who receive dietary advice alone, ONS and dietary advice for 3 months post-surgical discharge result in higher skeletal muscle index, lower sarcopenia prevalence and less chemotherapy modifications (reduced dose, delay or termination) in patients at nutritional risk with colorectal cancer [As part of a preventative approach to limit deterioration in nutritional intake and status, it could be reasonable to attempt to overcome the deficit in protein intake by early intervention using a high-protein, high-energy, low-volume ONS. The current study was undertaken to address a gap in the evidence to ascertain whether a high-protein, high-energy, low-volume ONS could be used to increase protein intake and achieve an adequate protein intake (in line with ESPEN recommendations) in patients with cancer receiving systemic anti-cancer treatment compared to standard care. The study outcomes may be useful to support the implementation of current clinical practice guidelines, which highlight the importance of early nutritional intervention for patients with cancer.