Or do they give little help to Cancer Patients?
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The Journal of the National Cancer Institute recently published a meta-analysis of oral nutritional supplementation in cancer patients.
They found no significant improvement in mortality, weight, or energy consumption.
However, some measures of quality of life were improved with nutritional supplementation, although included studies were heterogeneous and generally not of high quality.
Supplements are something that come into every cancer patient’s life.
- Well-meaning friends say “you should be taking xxxxxx”
- Advertisements bombard you with carefully-worded advice that makes you question if you should be taking X – and paying for it.
- And you want to do the best for yourself to help your recovery
And meantime a huge industry coins in the money – but is what they are making necessary?
If you are serious about these supplements, then here is some serious information from MedPage and other sources. A bit dry, but what The Journal of the National Cancer Institute reports is useful. They have no axe to grind, but their report on surveys and research into this area says:
“Malnourished cancer patients had some improvement in quality of life (QOL) but did not live longer when they received oral nutrition supplements”, a meta-analysis showed.
An analysis of 13 trials found that the only persistent benefits from the supplements related to certain aspects of QOL, including emotional function, dyspnea, loss of appetite, and global QOL, investigators reported online in the Journal of the National Cancer Institute. A preliminary analysis showed improved weight and caloric intake, but the benefit disappeared after adjustment for differences in the studies examined.
“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,” Christine Baldwin, PhD, of King’s College London, and co-authors wrote of their findings.
“This review identified few studies, some of which were of poor quality; therefore, more research is needed to characterize the benefits of oral nutritional support in patients with cancer.”
Difficulty getting accurate data
Malnutrition and weight loss affect many cancer patients, reducing the odds of objective response to treatment and survival and leading to poorer QOL. Whether a causal link exists has not been demonstrated, the authors noted. Nonetheless, clinical guidelines in North America, Europe, and Australia recommend prompt attention to cancer patients’ nutrition.
The National Institute for Health and Clinical Excellence (NICE) in England has recommended oral nutrition support for cancer patients who can swallow. However, that recommendation has its origin in data obtained largely from studies that did not involve cancer patients, the authors continued.
In an effort to identify and describe potential benefits of oral nutrition support in cancer, Baldwin and colleagues performed a meta-analysis of clinical trials conducted from 1998 to February 2010. The final analysis encompassed data from 13 randomized trials involving a total of 1,414 patients.
The authors acknowledged that the studies included in the analysis varied substantially in quality, clinical characteristics, and statistical methods.
The trials involved patients with a variety of cancers. All of the studies’ participants were receiving cancer treatment, and all trials compared oral nutrition supplements against routine care.
A preliminary analysis showed a significant 1.86-kg higher weight in patients who received supplements and a 432 kcal/d difference in daily energy intake (P=0.02 and P<0.001, respectively). After accounting for heterogeneity among the studies, neither difference remained statistically significant.
Analysis of survival showed no difference between the intervention and routine-care groups (RR 1.06, P=0.43).
After adjustment for heterogeneity, nutritional intervention favorably affected several aspects of QOL:
Emotional function, P=0.02
Global QOL, P=0.02
Loss of appetite, P=0.03
The analysis illustrates how research into nutritional support for cancer patients is “fraught with limitations; hence, it is challenging for clinicians to apply these results to everyday practice,” authors of an accompanying editorial wrote. In other words, manufacturers can publish their own studies – but there isn’t the money available for serious research to qualify these studies.
“Selecting the right patient for nutritional interventions, both in everyday practice as well as in the clinical research setting, cannot be overstated,” according to Ann O’Mara, PhD, RN, and Diane St. Germain, RN, MS, of the National Cancer Institute.
So what should we do?
Every major institution says you MUST discuss anything you take with your medical team. Frequently their response is on the lines of “if you want to, take this”. This is NOT approving the effects of the supplement – merely saying it won’t do you any harm. But neither does eating sensible food do you any har, and most dieticians will say that eating a varied and sensible diet will give you all the vitamins etc. a body needs.
As the report says, “Oral nutritional supplements are often recommended likely, in part, because they are perceived to carry no harm, but who will likely benefit remains an important question.”
Doctors say we know our own bodies best. So if you know a supplement is doing you good, and your doctor approves, go for it.
Otherwise, gnaw on some raw veggies instead – much cheaper and just as good, if not better for you.
Authors of the article and the editorial had no relevant disclosures.
Primary source: Journal of the National Cancer Institute of USA
Baldwin C, et al “Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis” J Natl Cancer Inst 2012; DOI: 10.1093/jnci/djr556.
Additional source: Journal of the National Cancer Institute
O’Mara A, St. Germain D “Improved outcomes in the malnourished patient: We’re not there yet” J Natl Cancer Inst 2012; DOI: 10.1093/jnci/djs031.