Nutrition intervention is beneficial to the quality of life of patients with gastrointestinal cancer undergoing chemotherapy in Vietnam

Linh Thuy Nguyen, Anh Kim Dang, Phuong Thi Duong, Hanh Bich Thi Phan, Chinh Tuyet Thi Pham, Anh Tuan Le Nguyen, Huong Thi Le, Linh Thuy Nguyen, Anh Kim Dang, Phuong Thi Duong, Hanh Bich Thi Phan, Chinh Tuyet Thi Pham, Anh Tuan Le Nguyen, Huong Thi Le

Abstract

Introduction: The best treatment therapy for gastrointestinal cancer patients is assessed by the improvement of health status and quality of life (QoL) after treatments. Malnutrition is related to loss of muscle strengths which leads to lower physical performance and emotional status. Thus, this study aimed to estimate the effects of nutritional interventions on the improvement of QoL among gastrointestinal patients undergoing chemotherapy in Vietnam.

Methods: A quasi-experiment with intervention and control groups for pre- and post-intervention assessment was carried out at the Department of Oncology and Palliative Care-Hanoi Medical University Hospital from 2016 to 2019. Sixty gastrointestinal cancer patients were recruited in each group. The intervention regimen consisted of nutritional counseling, a specific menu with a recommended amount of energy, protein, and formula milk used within 2 months. Nutritional status and QoL of patients were evaluated using The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and The European Organization for Research and Treatment of Cancer (EORTC). The difference in differences (DiD) method was utilized to estimate the outcome between control and intervention groups.

Results: After the intervention, patients of the intervention group had better changes in scores of global health status (Coef =16.68; 95% CI =7.90; 25.46), physical (Coef =14.51; 95% CI =5.34; 23.70), and role functioning (Coef =14.67; 95% CI =1.63; 27.70) compared to the control group. Regarding symptom scales, the level of fatigue, pain, and insomnia symptoms significantly reduced between pre- and post-intervention in the intervention group. In addition, living in urban areas, defined as malnourished and having low prealbumin levels, were positively associated with the lower global health status/QoL score.

Conclusion: Nutritional therapy with high protein was beneficial to the improvement in QoL, physical function and the reduction of negative symptoms among gastrointestinal cancer patients. Early individualized nutritional support in consultation with professional dietitians during chemotherapy plays an integral part in enhancing the QoL and better treatment prognosis.

Clinical trial registration number: NCT04517708.

Keywords: digestive cancer; gastric cancer; nutrition; quality of life.

Conflict of interest statement

The authors reported no conflicts of interest.

© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Flow chart of the intervention
FIGURE 2
FIGURE 2
Global health status and Functional scales scores of pre‐ and post‐intervention among Intervention (n = 53) and Control group (n = 50)
FIGURE 3
FIGURE 3
Symptom scales and Financial scores of pre‐ and post‐intervention among Intervention (n = 53) and Control group (n = 50)

References

    1. Bray Freddie, Ferlay Jacques, Soerjomataram Isabelle, Siegel Rebecca L., Torre Lindsey A., Jemal Ahmedin. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018;68(6):394–424. 10.3322/caac.21492
    1. The World Health Organization . Globocan 2018 – Vietnam. 2018. .
    1. Gupta D, Lis CG, Granick J, Grutsch JF, Vashi PG, Lammersfeld CA. Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol. 2006;59(7):704‐709.
    1. Lim HS, Cho GS, Park YH, Kim SK. Comparison of quality of life and nutritional status in gastric cancer patients undergoing gastrectomies. Clin Nutr Res. 2015;4(3):153‐159.
    1. Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in patients with gastric cancer: an update. Gastrointest Tumors. 2016;2(4):178‐187.
    1. Marin Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007;26(3):289‐301.
    1. Vergara N, Montoya JE, Luna HG, Amparo JR, Cristal‐Luna G. Quality of life and nutritional status among cancer patients on chemotherapy. Oman Med J. 2013;28(4):270‐274.
    1. Kim DH. Nutritional issues in patients with cancer. Intest Res. 2019;17(4):455‐462.
    1. Marin Caro MM, Laviano A, Pichard C. Impact of nutrition on quality of life during cancer. Curr Opin Clin Nutr Metab Care. 2007;10(4):480‐487.
    1. Bosaeus I. Nutritional support in multimodal therapy for cancer cachexia. Support Care Cancer. 2008;16(5):447‐451.
    1. Bicakli DH, Ozveren A, Uslu R, et al. The effect of chemotherapy on nutritional status and weakness in geriatric gastrointestinal system cancer patients. Nutrition. 2018;47:39‐42.
    1. Ustundag S, Zencirci AD. Factors affecting the quality of life of cancer patients undergoing chemotherapy: a questionnaire study. Asia Pac J Oncol Nurs. 2015;2(1):17‐25.
    1. Paltiel O, Avitzour M, Peretz T, et al. Determinants of the use of complementary therapies by patients with cancer. J Clin Oncol. 2001;19(9):2439‐2448.
    1. Schlettwein‐Gsell D. Nutrition and the quality of life: a measure for the outcome of nutritional intervention.? Am J Clin Nutr. 1992;55(6 Suppl):1263S‐S1266.
    1. Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer–a systematic review of the epidemiological literature. Nutr J. 2012;11:27.
    1. O'Gorman P, McMillan DC, McArdle CS. Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients. Nutr Cancer. 1998;32(2):76‐80.
    1. Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta‐analysis. J Natl Cancer Inst. 2012;104(5):371‐385.
    1. Balhareth A, Aldossary MY, McNamara D. Impact of physical activity and diet on colorectal cancer survivors’ quality of life: a systematic review. World J Surg Oncol. 2019;17(1):153.
    1. Ko LK, Campbell MK, Lewis MA, Earp J, Devellis B. Mediators of fruit and vegetable consumption among colorectal cancer survivors. J Cancer Surviv. 2010;4(2):149‐158.
    1. Grimmett C, Bridgewater J, Steptoe A, Wardle J. Lifestyle and quality of life in colorectal cancer survivors. Qual Life Res. 2011;20(8):1237‐1245.
    1. Ngoc Thi Dang D, Ngoc Thi Nguyen L, Thi Dang N, Quang Dang H, Ta TV. Quality of life in Vietnamese gastric cancer patients. Biomed Res Int. 2019;2019:7167065.
    1. Pham T, Bui L, Kim G, Hoang D, Tran T, Hoang M. Cancers in Vietnam‐burden and control efforts: a narrative scoping review. Cancer Control. 2019;26(1).1073274819863802.
    1. Linh NT, Tu NH, Phuong DT, Nhung NT, Huong LT. Relationship between nutritional status and quality of life in gastrointestinal cancer patients on chemotherapy. Asian J Dietetics. 2019;1(1):18‐22.
    1. Rydwik E, Lammes E, Frandin K, Akner G. Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial. Aging Clin Exp Res. 2008;20(2):159‐170.
    1. Zhong B. How to calculate sample size in randomized controlled trial? J Thorac Dis. 2009;1(1):51‐54.
    1. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11‐48.
    1. Quiñonez‐Olivas CG, Salinas‐Martínez R, Ortiz‐Jiménez XA, Gámez‐Treviño DG, Guajardo‐Álvarez G, González‐García B. Muscle mass measured using bioelectrical impedance analysis, calf circumference and grip strength in older adults. Medicina Universitaria. 2016;18(72):158‐162.
    1. Franco‐Villoria M, Wright CM, McColl JH, Sherriff A, Pearce MS. Gateshead Millennium Study core Team . Assessment of adult body composition using bioelectrical impedance: comparison of researcher calculated to machine outputted values. BMJ Open. 2016;6(1):e008922.
    1. Jebb SA, Cole TJ, Doman D, Murgatroyd PR, Prentice AM. Evaluation of the novel Tanita body‐fat analyser to measure body composition by comparison with a four‐compartment model. Br J Nutr. 2000;83(2):115‐122.
    1. Unal D, Orhan O, Eroglu C, Kaplan B. Prealbumin is a more sensitive marker than albumin to assess the nutritional status in patients undergoing radiotherapy for head and neck cancer. Contemp Oncol (Pozn). 2013;17(3):276‐280.
    1. Bauer J, Capra S, Ferguson M. Use of the scored Patient‐Generated Subjective Global Assessment (PG‐SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56(8):779‐785.
    1. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ‐C30: a quality‐of‐life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365‐376.
    1. Fayers PMAN, Bjordal K, Groenvold M, Curran D, Bottomley A. The EORTC QLQ‐C30 Scoring Manual. 3rd ed. Brussels: European Organisation for Research and Treatment of Cancer; 2001.
    1. Wing C, Simon K, Bello‐Gomez RA. Designing difference in difference studies: best practices for public health policy research. Ann Rev Public Health. 2018;39(1):453‐469.
    1. Fredriksson A, Magalhães OGD. Impact evaluation using difference‐in‐differences. RAUSP Manage J. 2019;54(4):519‐532.
    1. Casals M, Girabent‐Farres M, Carrasco JL. Methodological quality and reporting of generalized linear mixed models in clinical medicine (2000–2012): a systematic review. PLoS One. 2014;9(11):e112653.
    1. Bauer JD, Capra S. Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy–a pilot study. Support Care Cancer. 2005;13(4):270‐274.
    1. Isenring E, Bauer J, Capra S. The scored Patient‐generated Subjective Global Assessment (PG‐SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr. 2003;57(2):305‐309.
    1. Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer. 2004;91(3):447‐452.
    1. Moses AW, Slater C, Preston T, Barber MD, Fearon KC. Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n‐3 fatty acids. Br J Cancer. 2004;90(5):996‐1002.
    1. Uster A, Ruefenacht U, Ruehlin M, et al. Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial. Nutrition. 2013;29(11–12):1342‐1349.
    1. Di Luzio R, Moscatiello S, Marchesini G. Role of nutrition in gastrointestinal oncological patients. Eur Rev Med Pharmacol Sci. 2010;14(4):277‐284.
    1. Prado CM, Lieffers JR, Bowthorpe L, Baracos VE, Mourtzakis M, McCargar LJ. Sarcopenia and physical function in overweight patients with advanced cancer. Can J Diet Pract Res. 2013;74(2):69‐74.
    1. Otsuji H, Yokoyama Y, Ebata T, et al. Preoperative sarcopenia negatively impacts postoperative outcomes following major hepatectomy with extrahepatic bile duct resection. World J Surg. 2015;39(6):1494‐1500.
    1. Mislang AR, Di Donato S, Hubbard J, et al. Nutritional management of older adults with gastrointestinal cancers: an International Society of Geriatric Oncology (SIOG) review paper. J Geriatr Oncol. 2018;9(4):382‐392.
    1. So JB, Lim ZL, Lin HA, Ti TK. Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer. Gastric Cancer. 2008;11(2):81‐85.
    1. Hirao M, Tsujinaka T, Takeno A, Fujitani K, Kurata M. Patient‐controlled dietary schedule improves clinical outcome after gastrectomy for gastric cancer. World J Surg. 2005;29(7):853‐857.
    1. Kapoor N, Naufahu J, Tewfik S, Bhatnagar S, Garg R, Tewfik I. A prospective randomized controlled trial to study the impact of a nutrition‐sensitive intervention on adult women with cancer cachexia undergoing palliative care in India. Integr Cancer Ther. 2017;16(1):74‐84.
    1. Kim SH, Lee SM, Jeung HC, et al. The effect of nutrition intervention with oral nutritional supplements on pancreatic and bile duct cancer patients undergoing chemotherapy. Nutrients. 2019;11(5):1145.
    1. Laird BJA, Scott AC, Colvin LA, et al. Pain, depression, and fatigue as a symptom cluster in advanced cancer. J Pain Symptom Manage. 2011;42(1):1‐11.
    1. Inglis JE, Lin P‐J, Kerns SL, et al. Nutritional interventions for treating cancer‐related fatigue: A qualitative review. Nutr Cancer. 2019;71(1):21‐40.
    1. Blauwhoff‐Buskermolen S, Versteeg KS, de van der Schueren MAE, et al. Loss of muscle mass during chemotherapy is predictive for poor survival of patients with metastatic colorectal cancer. J Clin Oncol. 2016;34(12):1339‐1344.
    1. Ravasco P, Monteiro‐Grillo I, Camilo M. Individualized nutrition intervention is of major benefit to colorectal cancer patients: long‐term follow‐up of a randomized controlled trial of nutritional therapy. Am J Clin Nutr. 2012;96(6):1346‐1353.
    1. Ravasco P. Nutrition in cancer patients. J Clin Med. 2019;8(8):1211.
    1. Cehreli R, Yavuzsen T, Ates H, Akman T, Ellidokuz H, Oztop I. Can inflammatory and nutritional serum markers predict chemotherapy outcomes and survival in advanced stage nonsmall cell lung cancer patients? Biomed Res Int. 2019;2019:1648072.
    1. Keller U. Nutritional laboratory markers in malnutrition. J Clin Med. 2019;8(6):775.
    1. Myron Johnson A, Merlini G, Sheldon J, Ichihara K. Scientific Division Committee on Plasma Proteins IFoCC, Laboratory M . Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clin Chem Lab Med. 2007;45(3):419‐426.
    1. Ding D, Feng Y, Song B, Gao S, Zhao J. Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients. Turkish J Gastroenterol. 2015;26(2):181‐185.
    1. Huang J, Wang Y, Yuan Y, et al. Preoperative serum pre‐albumin as an independent prognostic indicator in patients with localized upper tract urothelial carcinoma after radical nephroureterectomy. Oncotarget. 2017;8(22):36772‐36779.
    1. Depta A, Jewczak M, Skura‐Madziala A. Quality of life of patients from rural and urban areas in Poland with head and neck cancer treated with radiotherapy. A study of the influence of selected socio‐demographic factors. Arch Med Sci. 2017;13(6):1474‐1482.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe