ZACHARY CLARK ALLISON RAHMAN LAUREN SHIVERS WESTERN KENTUCKY UNIVERSITY FACS – 361 SPRING 2013 Effects of Nutrition Support on GI Cancer Patients Receiving Chemotherapy

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. Effect of malnutrition on GI cancer patients 2. The benefits of MNT on GI cancer patients receiving chemotherapy 3. 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 Supported the HypothesisEnded Inconclusively Contradicted the Hypothesis Akbulut, Gazme ✔ 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): DOI: /etm 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): 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), doi: /j X 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): E Academic Search Premier. Web. 9 Apr

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 ). 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): Academic Search Premier. Web. 9 Apr 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: , 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): Print.