Responsiveness and convergent validity of QLU-C10D and EQ-5D-3L in assessing short-term quality of life following esophagectomy.

AIM: This study assessed the responsiveness and convergent validity of two preference-based measures; the newly developed cancer-specific EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D) relative to the generic three-level version of the EuroQol 5 dimensions (EQ-5D-3L) in evaluating short-term health related quality of life (HRQoL) outcomes after esophagectomy. METHODS: Participants were enrolled in a multicentre randomised controlled trial to determine the impact of preoperative and postoperative immunonutrition versus standard nutrition in patients with esophageal cancer. HRQoL was assessed seven days before and 42 days after esophagectomy. Standardized Response Mean and Effect Size were calculated to assess responsiveness. Ceiling effects for each dimension were calculated as the proportion of the best level responses for that dimension at follow-up/post-operatively. Convergent validity was assessed using Spearman's correlation and the level of agreement was explored using Bland-Altman plots. RESULTS: Data from 164 respondents (mean age: 63 years, 81% male) were analysed. HRQoL significantly reduced on both measures with large effect sizes (> 0.80), and a greater mean difference (0.29 compared to 0.16) on QLU-C10D. Both measures had ceiling effects (> 15%) on all dimensions at baseline. Following esophagectomy, ceiling effects were observed with self-care (86%), mobility (67%), anxiety/depression (55%) and pain/discomfort (19%) dimensions on EQ-5D-3L. For QLU-C10D ceiling effects were observed with emotional function (53%), physical function (16%), nausea (35%), sleep (31%), bowel problems (21%) and pain (20%). A strong correlation (r = 0.71) was observed between EQ-5D-3L anxiety and QLU-C10D emotional function dimensions. Good agreement (3.7% observations outside the limits of agreement) was observed between the utility scores. CONCLUSION: The QLU-C10D is comparable to the more widely applied generic EQ-5D-3L, however, QLU-C10D was more sensitive to short-term utility changes following esophagectomy. Cognisant of requirements by policy makers to apply generic utility measures in cost effectiveness studies, the disease-specific QLU-C10D should be used alongside the generic measures like EQ-5D-3L. TRIAL REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12611000178943) on the 15th of February 2011.

The effect of oral omega-3 polyunsaturated fatty acid supplementation on muscle maintenance and quality of life in patients with cancer: A systematic review and meta-analysis.

BACKGROUND & AIMS: Omega-3 polyunsaturated fatty acid (PUFA) supplementation has been proposed as a potential therapy for cancer-related malnutrition, which affects up to 70% of patients with cancer. The aim of this systematic review and meta-analysis was to examine the effects of oral omega-3 PUFA supplementation on muscle maintenance, quality of life, body weight and treatment-related toxicities in patients with cancer. METHODS: Randomised controlled trials in patients with cancer aged ≥18 years were retrieved from 5 electronic databases: MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL (via EBSCOhost), and Web of Science, from database inception until 31st of December 2019. The quality of included studies was assessed using the Cochrane risk of bias tool. Trials supplementing ≥600 mg/d omega-3 PUFA (oral capsules, pure fish oil or oral nutritional supplements) compared with a control intervention for ≥3 weeks were included. Meta-analyses were performed in RevMan to determine the mean differences (MD) in muscle mass, quality of life and body weight, and odds ratio (OR) for the incidence of treatment-related toxicities between omega-3 PUFA and control groups with 95% confidence intervals (CI) and I2 for heterogeneity. RESULTS: We included 31 publications in patients with various types of cancers and degrees of malnutrition. The Cochrane risk of bias tool graded most trials as 'unclear' or 'high' risk of bias. Meta-analyses showed no significant difference between omega-3 PUFA supplements and control intervention on muscle mass, quality of life and body weight. Oral omega-3 PUFA supplements reduced the likelihood of developing chemotherapy-induced peripheral neuropathy (OR: 0.20; 95% CI: 0.10-0.40; p < 0.001; I2 = 0%). CONCLUSION: This systematic review and meta-analysis indicates that oral omega-3 PUFA supplementation does not improve muscle maintenance, quality of life or body weight in patients with cancer, but may reduce the incidence of chemotherapy-induced peripheral neuropathy. Well-designed large-scale randomised controlled trials in homogenous patient cohorts are required to confirm these findings.

Serum vitamin D decreases during chemotherapy: an Australian prospective cohort study.

BACKGROUND AND OBJECTIVES: Vitamin D plays an important role in bone and muscle function, and cell prolifera-tion. The impact of chemotherapy and associated behavioural changes such as fatigue and sun avoidance on vit-amin D (25(OH) D) is unknown. This study aims to evaluate variations in serum vitamin D during chemotherapy and the predictive value of latitude, season and pre-existing vitamin D deficiency. METHODS AND STUDY DESIGN: A 12-week prospective cohort study was conducted in chemotherapy-naïve patients in two Australian locations with different sun exposure. Vitamin D deficiency was defined as ≤25 nmol/L and insufficiency 26-50 nmol/L 25(OH) D. Demographics, chemotherapy regimen, nutritional status, sun exposure, geographic location, and sea-son were collected at baseline, 6 and 12 weeks after commencing chemotherapy. RESULTS: Eighty-five patients (µ55.3±13.4 years of age; 49% female) were recruited, 96% Caucasian. Fifty-four patients were treated with cura-tive intent (mostly for breast [n=29] or colorectal [n=12] cancers). At baseline, 10 patients were vitamin D defi-cient and 33 were insufficient. Mean serum 25(OH) D (nmol/L) was higher at latitude -27.5o (Brisbane) than lati-tude -34.9o (Adelaide) (µ61.9±22.1 vs µ42.2±19.2, p<0.001) and varied according to season (spring: µ46.9±20.3, summer: µ50.8±18.2, autumn: µ76.4±25.2, winter: µ36.5±15.7, p<0.001). Serum 25(OH) D decreased with chemotherapy (baseline: µ49.2±22.3, 6-weeks: µ40.9±19.0, 12-weeks: µ45.9±19.7, p=0.05), with a significant and more rapid decline in winter and autumn (p=0.03). CONCLUSIONS: Chemotherapy is associated with a decrease in serum vitamin D, particularly during winter and autumn. Investigations into the underlying mechanism and as-sociated potential outcomes with this decrease requires further investigation.

Nutritional counseling and nutritional supplements: a cornerstone of multidisciplinary cancer care for cachectic patients.

PURPOSE OF REVIEW: The challenge with cancer cachexia is that it is not fully reversed by nutrition support. The purpose of this review is to provide an opinion on the nutritional management of cancer cachexia based on the most recent available evidence. RECENT FINDINGS: There continues to be a paucity of nutrition intervention studies in patients with cancer cachexia. In patients with cancer undergoing radiotherapy, there is strong evidence that nutrition counseling increases dietary intake, body weight, nutritional status and quality of life with some suggestion that dietary counseling may improve nutrition impact symptoms, treatment response and survival. In patients with cancer undergoing chemotherapy, the evidence is less clear. The use of n-3 polyunsaturated fatty acids may have some positive effects in patients with cancer; however, clinical judgment and care need to be taken in its application. Preliminary results of studies in the use of L-carnitine in improving fatigue are promising; however, the largest trial in 'healthy' cancer patients showed no benefit. SUMMARY: Further research into the most appropriate methods for identifying and treating cancer cachexia is required. Regardless of whether patients are experiencing reduced dietary intake resulting in malnutrition or due to cachexia, nutrition remains a cornerstone of multimodal treatment.

Clinical outcomes of vitamin D deficiency and supplementation in cancer patients.

Results of recent studies suggest that circulating levels of vitamin D may play an important role in cancer-specific outcomes. The present systematic review was undertaken to determine the prevalence of vitamin D deficiency (<25 nmol/L) and insufficiency (25-50 nmol/L) in cancer patients and to evaluate the association between circulating calcidiol (the indicator of vitamin D status) and clinical outcomes. A systematic search of original, peer-reviewed studies on calcidiol at cancer diagnosis, and throughout treatment and survival, was conducted yielding 4,706 studies. A total of 37 studies met the inclusion criteria for this review. Reported mean blood calcidiol levels ranged from 24.7 to 87.4 nmol/L, with up to 31% of patients identified as deficient and 67% as insufficient. The efficacy of cholecalciferol supplementation for raising the concentration of circulating calcidiol is unclear; standard supplement regimens of <1,000 IU D3 /day may not be sufficient to maintain adequate concentrations or prevent decreasing calcidiol. Dose-response studies linking vitamin D status to musculoskeletal and survival outcomes in cancer patients are lacking.

Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients.

BACKGROUND & AIMS: Malnutrition and poor intake during hospitalisation are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. The aim of this study was to measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome. METHODS: Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia. RESULTS: Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding. CONCLUSIONS: Inadequate nutritional intake is common, and patient factors contributing to poor intake should be considered in designing nutritional interventions.