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Alternate therapies for Chemotherapy

Alternate therapies

An overview of and biomedical perspective on alternate cancer therapies used by patients with cancer.

Two recent studies reported on patients choosing alternate care products with limited and anecdotal information obtained from the lay literature and their social group. Yet, the biomedical community has access to numerous excellent studies, documentation resources, and commentaries related to alternate therapies.

Provision of known biomedical information related to alternate therapies would provide patients with an opportunity to make informed healthcare choices.

Montbriand-MJ: An overview of alternate therapies chosen by patients with cancer. Oncology-Nursing-Forum. 1994 Oct; 21(9): 1547-54 (74 ref).

Bone marrow & Chemotherapy

Bone marrow transplant

Bone marrow transplantation is a complex therapy designed as curative for a variety of malignant and nonmalignant diseases. It is a highly invasive procedure that uses high-dose chemotherapy and may also include radiation treatment. This results in immunosuppression that is often followed by infection, graft-vs-host disease, pulmonary complications, veno-occlusive disease of the liver, and metabolic and nutritional abnormalities.

Parenteral nutrition has been the mainstay of nutrition support in patients undergoing bone marrow transplantation. Parenteral nutrition has not been uniformly successful in improving nutritional status or outcome. Enteral nutrition offers many theoretical advantages but is often not well tolerated. Coordinated efforts of the health care team are needed to optimize the nutrition support of these complicated cases.

Herrmann-VM & Petruska-PJ: Nutrition support in bone marrow transplant recipients [see comments]. Nutr-Clin-Pract. 1993 Feb; 8(1): 19-27.

Breast cancer & Chemotherapy

Breast cancer (1)

Health professionals should assess the nutrition information needs of women with breast cancer in order to provide appropriate services.

The subjects were mostly concerned about and wanted information on diets for cancer prevention, low-fat diets, weight reduction, and vitamin supplements. Findings also showed the potential for excessive vitamin/mineral use among one-third of respondents and a tendency toward weight gain regardless of whether or not chemotherapy was received. The results provide direction for development of nutrition educational materials and programs for women with breast cancer.

Monnin-S: Nutritional concerns of women with breast cancer. Journal-of-Cancer-Education. 1993 Spring; 8(1): 63-9 (25 ref).

Breast cancer (2)

There was an interest in determining if there is a difference in the nutritional patterns of women with breast cancer who are receiving chemotherapy and healthy women as monitored over a six-month period.

Results indicated that, although alterations in taste did occur, food aversions resulting in the avoidance of the aversive foods did not occur. Throughout the study, women with breast cancer were eating a significantly greater number of calories and food servings than the non-cancer women.

Breast cancer patients were likely to report taste changes for foods such as beef, pork, chicken, coffee and cakes. These taste changes did not significantly alter dietary intake in the early months of chemotherapy. No direct relationship was found between appraisal or anxiety and nutritional patterns. Breast cancer women reported consistently higher levels of anxiety over the course of the six months. These women also assessed their disease, its treatment and their implications as more serious at the end of six months than at the onset of the study.

Grindel-CMG: The Effects Of Chemotherapy And Disease On The Nutritional Patterns Of Breast Cancer Women During The First Six Months Of Treatment. University Of Maryland At Baltimore 1988 Ph.D. (205 P).

Cancer & Chemotherapy

Cancer (1)

Nutritional support is often initiated in patients with cancer who are unable to meet their nutritional needs by the oral route.

Research exploring the dimensions of quality of life (physical functioning, psychological status, interpersonal relationships and social functioning, financial concerns, and symptoms, and complications of nutritional support) is presented.

The trend for increased numbers of patients on home nutrition support emphasizes the need to understand the patient's and family's experience in managing this treatment in the home.

Grindel-C et al: Quality of life and nutritional support in patients with cancer. Cancer-Practice:-A-Multidisciplinary-Journal-of-Cancer-Care (CANCER-PRACT) 1996 Mar-Apr; 4(2): 81-7 (36 ref).

Cancer (2) - patients

The potential of a high intake of fresh fruits and vegetables in cancer prevention is well established. Epidemiological studies support carotene, vitamins A, C, E and selenium as the active compounds.

Chemotherapy and radiation increase the requirements for antioxidant compounds. Supplementation can diminish the damage induced by peroxidation.

Stahelin-HB: Critical reappraisal of vitamins and trace minerals in nutritional support of cancer patients. Support-Care-Cancer. 1993 Nov; 1(6): 295-7.

Childhood cancer & Chemotherapy

Where treatment lasted for 9 months or more, the initial Nutritional Status score was correlated with infection rate during the subsequent 3-month period. Among the leukemic patients, a statistically significant inverse correlation was found between nutritional status and ensuing infection rate. No such correlation was found in children with solid tumors. Based on these findings, we recommend nutritional support to children with leukemia during chemotherapy to attempt to reduce the infection rate.

Taj-MM: Effect of nutritional status on the incidence of infection in childhood cancer. Pediatr-Hematol-Oncol. 1993 Jul-Sep; 10(3): 283-7.

Chinese medicine & Chemotherapy

Chinese medicinal herbs

This study suggested that chemotherapy could be used early after operation of gastric cancer in combination with Chinese medicinal herbs.

Complications of incision and anastomoses of the treated group did not rise and all kinds of blood cells reduce in comparison with those of control group.

Yu-QS: [Clinical study on early use of Chinese medicinal herbs and chemotherapy after operation of gastric cancer]. Chung-Kuo-Chung-Hsi-I-Chieh-Ho-Tsa-Chih. 1995 Aug; 15(8): 459-61.

Diet & Chemotherapy


Diet therapy in cancer
Dietary counseling

Diet therapy in cancer

Cancer cachexia is a syndrome with weight loss, anorexia, and loss of host body cell mass. Tumor cachexia may be an early symptom of a neoplasm. Low food intake is the main reason for weight loss. Surgery, chemotherapy and radiation remain primary therapeutic modalities to overcome cancer cachexia.

Artificial nutrition is able to avoid progressive weight loss; nutrition alone may not preserve fat-free body cell mass.

Parenteral nutrition reduces perioperative morbidity and mortality.

Nutritional support failed to show a benefit in patients with malignancies which are treated with therapeutic radiation or chemotherapy. For patients with unresectable neoplasms of the upper GI-tract conventional palliative regimens (bougienage, laser, etc.) do not support a satisfactory nutritional state. Ambulatory enteral tube feeding via percutaneous endoscopic gastrotomy (PEG) as an adjunct to therapy is useful and safe in providing adequate fluid and substrates.

Lubke-HJ & Kalde-S: [Diet therapy in cancer] Schweiz-Rundsch-Med-Prax. 1995 Nov 21; 84(47): 1383-8.

Dietary counseling

This study examined the effect of frequent nutritional counseling on oral intake, body weight, response rate, survival, and quality of life in patients with cancer of the lung (small-cell), ovary, or breast undergoing cyclic chemotherapy.

Dietary counseling increased daily energy intake by approximately 1 MJ and protein intake by 10 g over the entire study period. There was no change in the control group.

No clinical benefit could be demonstrated despite long-term and continuous improved food intake in cancer patients with solid tumors undergoing aggressive chemotherapy.

Ovesen-L et al: Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. J-Clin-Oncol. 1993 Oct; 11(10): 2043-9.

Nutrition & Chemotherapy


In-hospital nutrition therapy
Parenteral nutrition

In-hospital nutrition therapy

The purpose of the study was to evaluate the feasibility of nutritional therapy in a university hospital.

The energy requirement included a surplus for weight gain. In patients with benign disease only, the average weight gain was as expected from energy balance but in patients with a benign stress-catabolic disease weight gain was only 40% of that expected.

In malnourished patients with malignant disease, radiation- or chemotherapy could be carried out without further loss of body weight. During bone-marrow transplantation only a minor weight loss occurred. In conclusion, nutritional therapy is feasible in a clinical setting and the methods employed can identify groups of patients that require only nutritional support and other groups of patients that in addition require treatment of a stress-catabolic state.

Kondrup-J et al: [Nutrition therapy in 542 hospitalized patients]. Ugeskr-Laeger. 1996 Feb 12; 158(7): 893-7.

Parenteral nutrition

Recent meta-analyses of published controlled studies concluded that adult patients with cancer randomly assigned to receive parenteral nutrition had higher rates of infectious complications than control subjects.

These data confirm that administration of parenteral nutrition is associated with an increased risk of infection in children who have CVAD in place for cancer therapy.

Christensen-ML et al: Parenteral nutrition associated with increased infection rate in children with cancer. Cancer. 1993 Nov 1; 72(9): 2732-8.

Lung cancer & Chemotherapy

To describe the relationship of nutritional intake to weight change, symptom distress, and functional status over a six-month period in 28 subjects with progressive lung cancer.

Weight change was not directly related to kilocalorie intake.

Percentage of weight loss over time was greater in subjects younger than 65 years of age, in those with small cell lung cancer, and in those who received chemotherapy.

Sarna-L et al: Nutritional intake, weight change, symptom distress, and functional status over time in adults with lung cancer [published erratum appears in Oncol Nurs Forum 1993 Jul;20(6):851] Oncol-Nurs-Forum. 1993 Apr; 20(3): 481-9.

Lymphoma & Chemotherapy

Nutritional status (NS) was measured by the combination of triceps skinfold, arm circumference and serum determinations of albumin and transferrin.

Chemotherapy was better tolerated in the well-nourished cases with less delay in treatment schedule, less episodes of severe myelosuppression and infection and more dose intensity.

Aviles-A: Malnutrition as an adverse prognostic factor in patients with diffuse large cell lymphoma. Arch-Med-Res. 1995 Spring; 26(1): 31-4.

Leukemia & Chemotherapy

Determined if children with high risk acute lymphoblastic leukemia (ALL) exhibit higher frequency of alterations in nutritional state during the phases of induction and consolidation of chemotherapy than children with low risk ALL, based on the arm muscle area.

Altered nutritional state during follow-up was defined as the loss of 10% or more of the arm muscular area (AMA) measured at diagnosis.

High-risk patients show a higher frequency of nutritional state alterations reflected in AMA during the second month after diagnosis. This may be caused by the more aggressive chemotherapy received by these patients.

Mejia-Arangure JM et al., Nutritional state alterations in children with acute lymphoblastic leukemia during induction and consolidation of chemotherapy. Arch Med Res, 1997 Summer, 28:2, 273-9.

Glutamine & Chemotherapy


Glutamine (2)

Glutamine (1)

Although enteral nutrition is generally advocated in the care of children with cancer, those patients receiving intensive chemotherapy alone, or in combination with bone marrow transplantation, often require total parenteral nutrition (TPN).

Nasogastric glutamine-supplemented tube feedings were well tolerated both in the hospital and at home. The cost of care for the enterally supported child was less than one third of the TPN-supported child.

Although TPN appears to be beneficial in some patients with cancer, it is expensive and is associated with several significant disadvantages. Among these are: an increased incidence of both gram-positive and gram-negative infections and an increased incidence of gastrointestinal symptoms.

Enteral nutrition is less costly than TPN and maintains the structural and functional integrity of the intestinal mucosa. The addition of certain substrates such as glutamine, arginine and omega-3 fatty acids may improve the body's immune response as well.

Early glutamine supplemented tube feedings in children receiving intensive chemotherapy will result in improved nutrition with fewer infections and lower cost than TPN-supplemented patients.

In addition, a shorter hospital stay and improved quality of life are anticipated.

Ford C et al., Glutamine-supplemented tube feedings versus total parenteral nutrition in children receiving intensive chemotherapy. J Pediatr Oncol Nurs, 1997 Apr, 14:2, 68-72.

Glutamine (2)

Glutamine-supplemented total parenteral nutrition (TPN) improved the nitrogen balance in catabolic situations. In animal studies, parenteral glutamine supplementation appeared to maintain gut integrity.

Evaluated the possible positive effects of glutamine supplementation in catabolic hematologic patients.

[40 g L-alanyl-L-glutamine (26 g glutamine)]

Supplementation of glutamine dipeptide was safe but had no significant positive clinical effect.

van Zaanen HC et al., Parenteral glutamine dipeptide supplementation does not ameliorate chemotherapy-induced toxicity. Cancer, 1994 Nov 15, 74:10, 2879-84.

Ovarian cancer & Chemotherapy

Patients (# 21) with advanced epithelial ovarian carcinoma had been treated with IV chemotherapy in an attempt to restore intestinal function following small-bowel obstruction. All patients had a drainage gastrostomy tube placed for palliation of vomiting, and 11 patients received concomitant total parenteral nutrition (TPN).

The median survival for all patients post-gastrostomy tube placement was 84 days. The median survival for patients with recurrent ovarian cancer who received salvage chemotherapy and TPN was 89 days, longer than for patients who received salvage chemotherapy alone (71 days).

Two of three patients with newly diagnosed ovarian cancer and concomitant bowel obstruction had sufficient temporary response from chemotherapy with resolution of obstruction and removal of the gastrostomy tube.

Chemotherapy was ineffective in restoring bowel function in heavily pretreated patients with recurrent disease.

Abu-Rustum NR et al., Chemotherapy and total parenteral nutrition for advanced ovarian cancer with bowel obstruction. Gynecol Oncol, 1997 Mar, 64:3, 493-5.

UTI & Chemotherapy

Urinary tract infection

This study was performed to evaluate the role of the nutritional and immune status on the prognosis of urinary tract infections (UTI) in the elderly.

A prospective study was done to confirm that these nutritional and immunological changes become risk factors in the prognosis of UTI with long-term and low-dose chemotherapy.

Results suggest that poor nutrition-related immune dysfunction contributes to the vulnerability of elderly patients to UTI and becomes risks for he prognosis of UTI.

Toba-K et al: [The importance of the host nutritional and immune status on the prognosis of urinary tract infection in the elderly] Nippon-Ronen-Igakkai-Zasshi. 1993 Jun; 30(6): 487-96.

Trauma & Chemotherapy

Trauma patients

The addition of an anabolic stimulant during intensive nutrition therapy in trauma patients seems to be a reasonable adjuvant for minimizing muscle-mass erosion. The plasma free amino acid pattern is the mirror of the net amino acid metabolism, and we have measured the progressive changes resulting from recombinant human growth hormone therapy in trauma victims during nutritional repletion in the early catabolic flow phase of injury.

Recombinant human growth hormone treatment in combination with conventional total parenteral nutrition in the immediate posttraumatic period improved nitrogen metabolism and normalized the plasma free amino acid levels.

Jeevanandam-M: Adjuvant recombinant human growth hormone normalizes plasma amino acids in parenterally fed trauma patients. J-Parenter-Enteral-Nutr. 1995 Mar-Apr; 19(2): 137-44.

Neoplasms & Chemotherapy

Neoplasms (1)

The authors review the literature on problems of nutrition in patients with operable maxillofacial neoplasms (for example, as a side-effect of chemotherapy).

Artificial nutritional therapy makes absolutely no difference to the prognosis but allow the patient to undergo the appropriate therapy.

Carbone-M: [Clinical nutrition in maxillofacial cancer surgery. A review of the literature]. Minerva-Stomatol. 1994 May; 43(5): 239-46.

Neoplastic lesions

The aim of the work reported here was to evaluate the effects of an adjuvant treatment composed of an association of vitamins with an amino acid: beta-alanine, in cancer patients.

Physical comfort and the immune defenses improved.

Rougereau-A: [Adjuvant treatment of patients with neoplastic lesions using the combination of a vitamin complex and an amino acid. Apropos of a series of 17 cases of epidermoid carcinoma of the upper aerodigestive tract]. Ann-Gastroenterol-Hepatol-Paris. 1993 Mar-Apr; 29(2): 99-102.

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