Oral Supplement in Malnourished Cancer Patients Does Not Improve Survival

Oral nutritional interventions do increase nutritional intake and result in weight gain in some malnourished patients with cancer as well as improve some aspects of quality of life (QOL), but do not seem to increase survival, according to a systematic review and meta-analysis of the literature (Baldwin C, et al. J Natl Cancer Inst. 2012;104:371-385).

Lead author Christine Baldwin, PhD, RD, School of Medicine, King’s College, London, United Kingdom, said that current international guidelines recommend oral interventions in this group of patients, assuming they are able to swallow, but this recommendation is not based on level A evidence from well-designed randomized trials. Since several studies have attempted to evaluate the effect of oral interventions in cancer patients but have reached variable conclusions, she and her colleagues wanted to revisit the question by reviewing the literature.

The systematic review and metaanalysis included 13 studies with a total of 1414 adult cancer patients with cancer of all sites and stages who were either malnourished or at risk of malnutrition and compared oral nutritional interventions versus usual care. The patient population, quality, and design of these studies were quite heterogeneous, which is a limitation of the review, Baldwin said.

Seven of the studies included assessment of QOL, 5 of them using the EORTC cancer-specific questionnaire. There was a great deal of variability in the findings, but after adjusting for heterogeneity, oral nutritional interventions were associated with statistically significant improvement in “emotional functioning,” “global QOL,” and “dyspnea” and “loss of appetite” symptom scales. Changes in other QOL scales did not reach statistical significance. No effect on mortality was observed in patients who received oral nutritional intervention.

“The findings suggest that oral nutritional interventions have no effect on survival and that the effect on body weight and energy intake is inconsistent, but that statistically significant improvements in some aspects of QOL may be achieved,” wrote Baldwin. She pointed out that several of the studies included in the review were of poor quality, emphasizing the need for more in-depth research to characterize the benefits of oral nutritional support in cancer patients and to strengthen the evidence base for nutritional management in this group of patients.