Journal Article

Nutritional Advice in Older Patients at Risk of Malnutrition during Treatment for Chemotherapy: A Two-Year Randomized Controlled Trial

Chomy, François, Terrebonne, Eric, Blanc, Jean-Frédéric, Lahmar, Cyril, Durrieu, Jessica, Germain, Christine, Cany, Laurent, Blanc-Bisson, Christelle, Lavau-Denes, Sandrine, Lecaille, Cédric, Doussau, Adélaïde, Houede, Nadine, Soubeyran, Pierre, Senesse, Pierre, Bourdel-Marchasson, Isabelle, Dauba, Jérôme, Ceccaldi, Joël, Chene, Geneviève, Fonck, Mariane

2014

Overview

We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy, versus usual care, on one-year mortality. We conducted a multicentre, open-label interventional, stratified (centre), parallel randomised controlled trial, with a 1∶1 ratio, with two-year follow-up. Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition (MNA, Mini Nutritional Assessment 17-23.5). Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d, by face-to-face discussion targeting the main nutritional symptoms, compared to usual care. Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months. The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality, toxicities and chemotherapy outcomes. Between April 2007 and March 2010 we randomised 341 patients and 336 were analysed: mean (standard deviation) age of 78.0 y (4·9), 51.2% male, mean MNA 20.2 (2.1). Distribution of cancer types was similar in the two groups; the most frequent were colon (22.4%), lymphoma (14.9%), lung (10.4%), and pancreas (17.0%). Both groups increased their dietary intake, but to a larger extent with intervention (p<0.01). At the second visit, the energy target was achieved in 57 (40.4%) patients and the protein target in 66 (46.8%) with the intervention compared respectively to 13 (13.5%) and 20 (20.8%) in the controls. Death occurred during the first year in 143 patients (42.56%), without difference according to the intervention (p = 0.79). No difference in nutritional status changes was found. Response to chemotherapy was also similar between the groups. Early dietary counselling was efficient in increasing intake but had no beneficial effect on mortality or secondary outcomes. Cancer cachexia antianabolism may explain this lack of effect. ClinicalTrials.gov NCT00459589.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Aged, 80 and over / Antineoplastic Agents - adverse effects / Antineoplastic Agents - therapeutic use / Biology and Life Sciences / Body weight / Cachexia / Cancer / Cancer therapies / Care and treatment / Cell cycle / Chemotherapy / Clinical trials / Colon / Colorectal cancer / Counseling / Diet / Dietary intake / Elderly patients / Energy Intake / Female / Gerontology / Health aspects / Humans / Intervention / Life Sciences / Lungs / Lymphoma / Lymphomas / Male / Malnutrition / Malnutrition - mortality / Medical prognosis / Medicine and Health Sciences / Mortality / Neoplasms - drug therapy / Neoplasms - mortality / Nutrition assessment / Nutrition research / Nutritional assessment / Nutritional Status / Pancreas / Patient satisfaction / Patients / Quality of life / Radiation therapy / Randomization / Risk / Sarcopenia / Solid tumors / Toxicity / Weight Loss