Article:

Nutritional Interventions during Chemotherapy for Pancreatic Cancer: A Systematic Review of Prospective Studies.

Cintoni M, Grassi F, Palombaro M, Rinninella E, Pulcini G, Di Donato A, Salvatore L, Quero G, Tortora G, Alfieri S, Gasbarrini A, Mele MC.Nutrients. 2023 Feb 1;15(3):727. doi: 10.3390/nu15030727.PMID: 36771433 Free PMC article. Review.

Abstract:

Background: Pancreatic cancer incidence is growing, but the prognosis for survival is still poor. Patients with pancreatic cancer often suffer from malnutrition and sarcopenia, two clinical conditions that negatively impact oncological clinical outcomes. The aim of this systematic review was to analyze the impact of different nutritional interventions on clinical outcomes in patients with pancreatic cancer during chemotherapy.

Methods: A systematic review of MedLine, EMBASE, and Web of Science was carried out in December 2022, identifying 5704 articles. Titles and abstracts of all records were screened for eligibility based on inclusion criteria, and nine articles were included.

Results: All nine articles included were prospective studies, but a meta-analysis could not be performed due to heterogenicity in nutritional intervention. This Systematic Review shows an improvement in Quality of Life, nutritional status, body composition, oral intake, and Karnofsky Performance Status, following nutritional interventions.

Conclusions: This Systematic Review in pancreatic cancer patients during chemotherapies does not allow one to draw firm conclusions. However, nutritional support in pancreatic cancer patients is advisable to ameliorate oncological care. Further well-designed prospective studies are needed to identify nutritional support’s real impact and to establish a reliable way to improve nutritional status of pancreatic cancer patients during chemotherapy.

Type of Study: Systematic Review

Why I selected this article: I selected this article because one of my patients is a 62 y/o F on palliative care for advanced localized pancreatic cancer. She had a stent in place that became clogged and suffered an iatrogenic tear of the jejunum during a replacement procedure. The patient underwent a procedure where passive drains were placed, and she was NPO for approximately two weeks. She was recently given methylene blue to ingest, and it was determined that it was safe for her to advance to clear liquids.

Summary:

                  Pancreatic cancer is among the most lethal of cancers due to its initial asymptomatic presentation. Signs and symptoms of pancreatic cancer present much later in disease progression, at which point the cancer has advanced. Because of this, pancreatic cancer bears poor prognosis even when managed with surgical resection and/or chemotherapy. Extensive chemotherapy coupled with the burden of disease makes patients susceptible to becoming malnourished which may contribute to worse overall outcomes. One way to mitigate these adverse outcomes is by providing nutritional support. According to the article I selected, nutritional support in pancreatic cancer has demonstrated increase in overall survival. In one study, patients who received oral L-carnitine vs placebo for 12 weeks lived a median of 469-569 days compared to 356-456. Another study revealed that patients who received nutritional interventions had better quality of life (as per the QLQ-C30 global scale), improved cognitive function and reduced gastrointestinal symptoms. The QLQ-C30 global scale is a questionnaire that measures the physical, psychological, and social functions of cancer patients. Additionally, authors of this systematic review selected studies which focused on the Karnofsky performance scale. This KPS scale is an assessment tool that providers can employ to determine a patient’s functional status. Namely, their ability to performs ADLs. Studies showed that patients who received nutritional therapy had better functional capacity and improved ability to resist the adverse effects of therapy. Authors also recommended adjunct pancreatic enzyme replacement therapy since reduction of pancreatic secretions associated with pancreatic cancer lead to maldigestion and malabsorption, thus contributing to malnutrition.