Pensa meetingCancer cachexia and its treatment with fish-oil-enriched nutritional supplementation☆
Introduction
Pancreatic adenocarcinoma is a common condition with a dismal outlook. It is responsible for about 5% of cancer deaths, with a median survival of 4.1 mo.1, 2 More than 80% of cancers are unresectable at diagnosis, and even in those patients suitable for surgical resection the 5-y survival rate is less than 25%.3 The limited effects of chemotherapy and radiotherapy leave little in the way of treatment options for the vast majority of patients with unresectable disease, thus providing a valuable model in which to study the mechanisms and mediators of decline in patients with advanced cancer to maximize supportive treatment with the potential to improve quality and perhaps length of life.
Wigmore et al. reported that 85% of patients with unresectable pancreatic cancer have unintentionally lost weight by the time of diagnosis, with a median weight loss of almost 25% close to the time of death.4 This is a manifestation of the syndrome of cachexia, characterized by anorexia, early satiety, changes in taste perception, weight loss, weakness, anemia, and edema.5 Cachexia is associated with a shorter survival time and reduced quality of life and is the cause of death in perhaps 20% of cancer patients.6, 7, 8, 9, 10 Cachexia is not exclusive to cancer but is also seen in a variety of other inflammatory conditions.
The fundamental difference between the weight loss observed in cachexia and that seen in, e.g., starvation, is the lack of reversibility with feeding.11, 12 This seems to be due to metabolic changes in cachexia similar to those seen after surgery, trauma, or sepsis and driven by similar mediators.
Section snippets
Mechanisms and mediators of cachexia
Most patients with pancreatic cancer likely have inadequate nutrition intake, which contributes substantially to weight loss.13, 14 Patients with cancer cachexia frequently have specific problems that reduce nutrition intake, including physical obstruction of the gastrointestinal tract, nausea, constipation and debility, psychological problems such as depression, and pain and the side effects of treatment with opiates, radiotherapy, and chemotherapy. However, even if these factors are well
Treatment of cancer cachexia
The best way to treat cancer cachexia is to cure the cancer. Unfortunately, this remains a rare achievement. The next obvious option is to increase nutrition intake by enteral or parenteral means.
Two substantial randomized trials have examined the effect of enteral feeding in patients with advanced cancer undergoing chemotherapy.63, 64 Both studies included patients with a variety of cancer types who were randomized to receive or not receive nutrition counseling (to raise their energy and
Fish-oil-based interventions in cancer cachexia
General interest has focused on the properties of ω-3 fatty acids. These are an essential component of the diet and are involved in the synthesis of eicosanoids (prostaglandins, leukotrienes, and thromboxanes) and in membrane, receptor, and enzyme functions. Their usual source in the diet is oily fish. Interest in fish oils, notably eicosapentaenoic acid (EPA), was initially in the cardiovascular field, where their consumption was associated with a reduced tendency to platelet aggregation,
Conclusions
Although progress has been made in understanding the physiologic changes in advanced cancer that give rise to cachexia, it remains a significant cause of morbidity and mortality in malignant disease. The metabolic alterations that occur in these patients might prevent the effective use of additional calories supplied, resulting in ongoing wasting. Broadly speaking, antiinflammatory agents such as fish oil have the potential to normalize these metabolic alterations and may allow the supply of
Acknowledgements
The substantial contribution to work performed in Edinburgh described in this review by Professor Kenneth C. H. Fearon is gratefully acknowledged.
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Nutritional Therapy in Gastrointestinal Cancers
2018, Gastroenterology Clinics of North AmericaRandomized trial of the effects of individual nutritional counseling incancer patients
2014, Clinical NutritionCitation Excerpt :In this study it was demonstrated that there was a relationship between EPA intake and weight maintenance during the treatment period, but this finding was purely observational and not documented in the randomized trial. This is consistent with previous studies showing that supplementation with n-3 fatty acids, particularly EPA, has a positive influence on weight development in cancer patients.7,25–27 Individual dietary counseling had a beneficial effect in the treatment of cancer, but it is debatable whether the effect is reasonably related to the use of resources and side effects.
Dietary energy density, inflammation and energy balance in palliative care cancer patients
2013, Clinical NutritionCitation Excerpt :Energy balance became more negative during the final 5 months of life, and patients with inflammation differed from those without, especially in patients in the 2nd and 3rd tertiles of survival (Fig. 1). Our results thus highlight the importance of targeting systemic inflammation in the prevention and treatment of cancer cachexia with nutrition support.21,26,28–30 The effects of concomitant anti-inflammatory treatment should be considered when evaluating our results, since more than 90% of patients were being treated with indomethacin.
Control of food intake and muscle wasting in cachexia
2013, International Journal of Biochemistry and Cell BiologyImmunonutritional diet modulates natural killer cell activation and Th17 cell distribution in patients with gastric and esophageal cancer
2011, NutritionCitation Excerpt :Furthermore, the European Society for Clinical Nutrition and Metabolism guidelines have indicated that immunonutrition is useful not only in malnourished patients but also in the well-nourished patients [7]. However, the detailed mechanisms behind the immunonutrition leading to more favorable clinical outcomes are still unclear, although it has been demonstrated that immunonutrition can induce an increase in total T lymphocytes, decrease the serum level of interleukin (IL)-6, and upregulate phagocytosis by polymorphonuclear leukocytes [6,11,13–17]. In the present study, we investigated if immunonutrition could affect T-cell and natural killer (NK) cell functions, with a particular focus on type 17 helper T (Th17) cells and NK cell-activating markers, in patients with esophageal and gastric cancer and in healthy volunteers.
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Financial support was provided by the Ross Products Division, Abbott Laboratories, Columbus, Ohio, USA