Download Effects of Nutrition Support on GI Cancer Patients Receiving

Effects of Nutrition Support on GI
Cancer Patients Receiving
Chemotherapy
ZACHARY CLARK
ALLISON RAHMAN
LAUREN SHIVERS
WESTERN KENTUCKY UNIVERSITY
FACS – 361
SPRING 2013
Abstract
 Background: To identify the relationship between nutrition support and
chemotherapy, and find evidence that malnourished GI cancer patients
may not respond to treatment as positively as those that receive nutrition
support.
 Approach/Methodology: 6 main articles were identified and reviewed.
Double blind study using 50 participants (25 male & 25 female) monitoring
patients health status during chemotherapy treatment.
 Results: 3 supported our hypothesis, 1 found no association and 2
opposed. Nutrition support does generate many benefits throughout
treatment, but may not contribute to overall chemotherapy acceptance.
 Conclusion: More research needed, however a change in concentration
could increase the results.
Problem Statement
 Gastrointestinal cancer patients, who experience altered
gastrointestinal absorption, may not receive the full dose of
chemotherapy required. Additionally, these cancer patients
may develop loss of appetite and decreased intake leading
to a malnourished state, which also affects the
chemotherapy dose. The malnourished cancer patient may
not respond to treatment as positively, and may experience
increased infections and other adverse nutritional
outcomes as opposed to GI cancer patients that do receive
NS.
Hypothesis
 Malnourished gastrointestinal cancer patients that
receive nutrition support respond better to
chemotherapy than malnourished GI cancer patients
that do not.
Specific Aims
 To substantiate the role of nutrition support in GI
cancer treatment peer reviewed, evidence based
studies were identified to achieve these goals:
1.
2.
3.
Effect of malnutrition on GI cancer patients
The benefits of MNT on GI cancer patients receiving
chemotherapy
Provide evidence that NS for malnourished GI cancer
patients respond more positively to chemotherapy
Significance
 To find optimal ways that nutrition support can
benefit the malnourished patient.
 To receive the required dose of chemotherapy
Synthesis (Literature Reviewed)
 The side effects of cancer and chemotherapy
treatment drastically reduce the intake of these
patients, known as anorexia, resulting in
malnutrition (3)
 Studies show that those who receive total parenteral
nutrition for ten days before surgery and continue
with it postoperatively, lessen their complication rate
by one third (3)
Synthesis (Literature Reviewed) Cont..
 Malnourished GI patients do not receive full dosage
of chemotherapy for risk of toxicity (2)
 Patients that are given nutritional support through
dietetic intervention are more likely to gain weight
and reach adequate nourishment, allowing adequate
doses of chemotherapy (2)
Extraction of Data
Number of Research
Studies
Akbulut, Gazme
Supported the
Hypothesis
Ended Inconclusively
Contradicted the
Hypothesis
✔
Baldwin, C., et. al
✔
Garth, A.K., et. al
✔
Hasenberg, T., et. al
✔
Mason, J.B.
✔
Mutlu, Ece A, et. al
✔
Read, JA, et. al
✔
Tong, H., et. al
✔
Synthesis (Literature Reviewed) Cont…
 Patient-tailored nutritional support should be
prescribed as early as possible (1).
 Early NS improves their nutritional status,
performance and also their quality of life (1).
 Inadequate nourishment is associated with:




Lowered QoL,
Lower patient activity levels
Increased chemo related side effects
Reduced tumor response to chemotherapy and survival. (1)
Beyond the Research Scope
 More clinical evidence needs to be obtained in order
to support the benefits of glutamine, omega-3 fatty
acids and prebiotics and probiotic oligosaccharides
within NS therapy
 Testing of their nutritional significance has been in
mostly animal subjects
Limitations
 Patients did not follow through with their dietary
interventions
 Only small groups were studied
 Patients dropped out of the study
Methodology
 Double-blind study
 Recruit 50 GI cancer patients
 Clinical setting
 Check patients’ nutritional and health status every 3
weeks, and then continue to check after every 6
weeks
 Study will last for 1 year
 Patients will complete a malnutrition screening tool
(MST)
Conclusion
 Inconclusive
 Several of the studies that were reviewed resulted
without enough evidence to fully state our hypothesis
 More research needed, however a change in
concentration could increase the results
References
1.
Akbulut, Gazme. "New Perspective for Nutrition Support of Cancer Patients: Parenteral/enteral Nutrition”.
Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler,
Anakara, Turkey. Experimental and Therapeutic Medicine 2 (2011): 675-84. DOI: 10.3892/etm.
2011.247
2.
Baldwin, C., Spiro, A., McGough, C., Norman, A.R., Gillbanks, A., Thomas, K., Cunningham, D., O’Brien, M.,
& Andreyev, H.J. "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." Journal of Human Nutrition and Dietetics 24.5
(2011): 431-40. Print.
3.
Garth, A.K., Newsome, C.M., Simmance, N., & Crowe, T.C. (2010). Nutritional status, nutrition practices and
post-operative complications in patients with gastrointestinal cancer [Abstract]. Journal of Human
Nutrition and Dietetics,23(4), 393-401. doi: 10.1111/j.1365-277X.2010.01058.x
4.
Hasenberg, T., M. Essebreis, A. Herold, S. Post, and E. Shang. "Early Supplementation of Parenteral
Nutrition Is Capable of Improving Quality of Life, Chemotherapy-related Toxicity and Body
Composition in Patients with Advanced Colorectal Carcinoma Undergoing Palliative Treatment:
Results from a Prospective, Randomized Clinical Trial." Colorectal Disease 2010 Association of
Coloproctology of Great Britian and Ireland 12 (2009): E190-199. Academic Search Premier. Web.
9 Apr. 2013.
References
5.
Mason, J. B. (2008). Gastrointestinal Cancer: Nutritional Support. In D. P. Kelsen,
J. M. Daly, S. E. Kern, B. Levin, J. E. Tepper, & E. V. Cutsem, Principles and
Practices of Gastrointestinal Oncology Second Edition (pp. 87-95).
Philadelphia: Lippincott Williams & Wilkins.
6.
Mutlu, Ece A., MD, MHS, and Sohrab Mobarhan, MD. "Nutrition in the Care of the
Cancer Patient." Nutrition in Clinical Care 3.1 (2000): 3-23. Academic
Search Premier. Web. 9 Apr. 2013.
7.
Read JA, Beale PJ, Volker DH, Smith N, Childs A and Clarke SJ. “Nutrition
intervention using an eicosapentaenoic acid (EPA)-containing supplement in
patients with advanced colorectal cancer. Effects on nutritional and
inflammatory status: a phase II trial”. Support Care Cancer 15: 301-307,
2007.
8.
Tong, H., E. Isenring, and P. Yates. "The Prevalence of Nutrition Impact Symptoms
and Their Relationship to Quality of Life and Clinical Outcomes in Medical
Oncology Patients." Supportive Care in Cancer 17.1 (2009): 83-90. Print.