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

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.

[1]  G. García-Rayado,et al.  Nutritional Support in Pancreatic Diseases , 2022, Nutrients.

[2]  S. Rizzo,et al.  Body composition as a predictor of chemotherapy-related toxicity in pancreatic cancer patients: A systematic review , 2022, Frontiers in Oncology.

[3]  Kongcheng Wang,et al.  Impact of Nutrition Counseling in Head and Neck Cancer Sufferers Undergoing Antineoplastic Therapy: A Randomized Controlled Pilot Study , 2022, Current oncology.

[4]  A. Carrato,et al.  The impact of nutrition on the lives of patients with digestive cancers: a position paper , 2022, Supportive Care in Cancer.

[5]  J. Geoghegan,et al.  Measurement of Body Composition in Pancreatic Cancer: A Systematic Review, Meta-Analysis, and Recommendations for Future Study Design , 2022, Digestive Surgery.

[6]  H. Kong,et al.  Protein-energy malnutrition worsens hospitalization outcomes of patients with pancreatic cancer undergoing open pancreaticoduodenectomy , 2022, Updates in Surgery.

[7]  C. Prado,et al.  Effects of β‐hydroxy β‐methylbutyrate (HMB) supplementation on muscle mass, function, and other outcomes in patients with cancer: a systematic review , 2022, Journal of cachexia, sarcopenia and muscle.

[8]  Yoshihiro Tanaka,et al.  Effectiveness of elemental diets to prevent oral mucositis associated with cancer therapy: A meta-analysis. , 2022, Clinical Nutrition ESPEN.

[9]  M. Karamouzis,et al.  Pancreatic Cancer Prognosis, Malnutrition Risk, and Quality of Life: A Cross-Sectional Study , 2022, Nutrients.

[10]  T. Tamura,et al.  Impact of sarcopenia on prediction of progression-free survival and overall survival of patients with pancreatic ductal adenocarcinoma receiving first-line gemcitabine and nab-paclitaxel chemotherapy , 2021, Pancreatology.

[11]  A. Gasbarrini,et al.  The prognostic value of skeletal muscle index on clinical and survival outcomes after cytoreduction and HIPEC for peritoneal metastases from colorectal cancer: A systematic review and meta-analysis. , 2021, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[12]  W. Kycler,et al.  Beneficial Effects of Oral Nutritional Supplements on Body Composition and Biochemical Parameters in Women with Breast Cancer Undergoing Postoperative Chemotherapy: A Propensity Score Matching Analysis , 2021, Nutrients.

[13]  A. Gasbarrini,et al.  Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma , 2021, World journal of gastrointestinal surgery.

[14]  R. Qin,et al.  Controlling nutritional status (CONUT) score-based nomogram to predict overall survival of patients with pancreatic cancer undergoing radical surgery. , 2021, Asian journal of surgery.

[15]  K. Koike,et al.  Protein intake after the initiation of chemotherapy is an independent prognostic factor for overall survival in patients with unresectable pancreatic cancer: A prospective cohort study. , 2021, Clinical nutrition.

[16]  P. Delrio,et al.  The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review , 2021, Nutrients.

[17]  L. Engstrand,et al.  Pancreatic cancer cachexia: three dimensions of a complex syndrome , 2021, British Journal of Cancer.

[18]  P. Ravasco,et al.  ESPEN practical guideline: Clinical Nutrition in cancer. , 2021, Clinical nutrition.

[19]  A. Jemal,et al.  Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries , 2021, CA: a cancer journal for clinicians.

[20]  A. Fayh,et al.  Nutritional Intervention Contributes to the Improvement of Symptoms Related to Quality of Life in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Randomized Clinical Trial , 2021, Nutrients.

[21]  A. Gasbarrini,et al.  Prognostic value of skeletal muscle mass during tyrosine kinase inhibitor (TKI) therapy in cancer patients: a systematic review and meta-analysis , 2020, Internal and Emergency Medicine.

[22]  X. Lao,et al.  Worldwide Burden of, Risk Factors for, and Trends in Pancreatic Cancer. , 2020, Gastroenterology.

[23]  Yiqun Ling,et al.  Effect of oral supplements on the nutritional status of nasopharyngeal carcinoma patients undergoing concurrent chemotherapy: A randomized controlled Phase II trial , 2020, Journal of Cancer Research and Therapeutics.

[24]  M. Allman-Farinelli,et al.  Oral nutrition interventions in patients undergoing gastrointestinal surgery for cancer: A systematic literature review , 2020, Supportive Care in Cancer.

[25]  K. Fragkos,et al.  Nutritional Status and Quality of Life in Hospitalised Cancer Patients Who Develop Intestinal Failure and Require Parenteral Nutrition: An Observational Study , 2020, Nutrients.

[26]  A. Gasbarrini,et al.  Effects of nutritional interventions on nutritional status in patients with gastric cancer: A systematic review and meta-analysis of randomized controlled trials. , 2020, Clinical nutrition ESPEN.

[27]  G. Capurso,et al.  Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis , 2020, United European gastroenterology journal.

[28]  A. Gasbarrini,et al.  Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis , 2020, International Journal of Gynecological Cancer.

[29]  M. Falconi,et al.  Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer , 2020, Cancers.

[30]  R. Uslu,et al.  The Relationship Between Nutritional Status, Performance Status, and Survival Among Pancreatic Cancer Patients , 2020, Nutrition and cancer.

[31]  A. Gasbarrini,et al.  Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis. , 2019, Clinical nutrition.

[32]  M. Yano,et al.  The utility of nutritional supportive care with an eicosapentaenoic acid (EPA)-enriched nutrition agent during pre-operative chemoradiotherapy for pancreatic cancer: Prospective randomized control study. , 2019, Clinical nutrition ESPEN.

[33]  K. Roberts,et al.  Body composition assessment and sarcopenia in patients with pancreatic cancer: a systematic review and meta-analysis. , 2019, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[34]  I. Herr,et al.  Broccoli sprout supplementation in patients with advanced pancreatic cancer is difficult despite positive effects—results from the POUDER pilot study , 2019, Investigational New Drugs.

[35]  P. Layer,et al.  Contribution of pancreatic enzyme replacement therapy to survival and quality of life in patients with pancreatic exocrine insufficiency , 2019, World journal of gastroenterology.

[36]  Joon Seong Park,et al.  The Effect of Nutrition Intervention with Oral Nutritional Supplements on Pancreatic and Bile Duct Cancer Patients Undergoing Chemotherapy , 2019, Nutrients.

[37]  M. Tempero NCCN Guidelines Updates: Pancreatic Cancer. , 2019, Journal of the National Comprehensive Cancer Network : JNCCN.

[38]  J. Kleeff,et al.  The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma , 2017, Annals of surgery.

[39]  R. Turkington,et al.  Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes , 2018, World journal of gastroenterology.

[40]  J. Iglesias-Garcia,et al.  Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: a retrospective analysis , 2018, BMC Cancer.

[41]  V. Baracos,et al.  Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials , 2018, Annals of oncology : official journal of the European Society for Medical Oncology.

[42]  G. Tortora,et al.  Prognostic impact of early nutritional support in patients affected by locally advanced and metastatic pancreatic ductal adenocarcinoma undergoing chemotherapy , 2018, European Journal of Clinical Nutrition.

[43]  Bechien U. Wu,et al.  Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy. , 2018, Journal of gastrointestinal oncology.

[44]  G. Mercadal Orfila,et al.  [Improvement of the nutritional status and quality of life of cancer patients through a protocol of evaluation and nutritional intervention]. , 2018, Nutrición Hospitalaria.

[45]  M. Vidyasagar,et al.  Quality of Life among Cancer Patients , 2017, Indian journal of palliative care.

[46]  D. Lobo,et al.  ESPEN expert group recommendations for action against cancer-related malnutrition. , 2017, Clinical nutrition.

[47]  T. Keck,et al.  Dietary supplementation with n-3-fatty acids in patients with pancreatic cancer and cachexia: marine phospholipids versus fish oil - a randomized controlled double-blind trial , 2017, Lipids in Health and Disease.

[48]  J. Permert,et al.  Pancreatic Exocrine Insufficiency in Pancreatic Cancer , 2017, Nutrients.

[49]  Vickie Baracos,et al.  ESPEN guidelines on nutrition in cancer patients. , 2017, Clinical nutrition.

[50]  E. Assenat,et al.  A phase III study evaluating oral glutamine and transforming growth factor-beta 2 on chemotherapy-induced toxicity in patients with digestive neoplasm. , 2016, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[51]  M. Metcalfe,et al.  Cellular and plasma uptake of parenteral omega-3 rich lipid emulsion fatty acids in patients with advanced pancreatic cancer. , 2014, Clinical Nutrition.

[52]  M. Metcalfe,et al.  Reduction in circulating pro-angiogenic and pro-inflammatory factors is related to improved outcomes in patients with advanced pancreatic cancer treated with gemcitabine and intravenous omega-3 fish oil. , 2013, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[53]  P. Malfertheiner,et al.  L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN) - a randomized multicentre trial , 2012, Nutrition Journal.

[54]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[55]  M. Bartels,et al.  A systematic review of prospective studies on attention problems and academic achievement , 2010, Acta psychiatrica Scandinavica.

[56]  Michele Tarsilla Cochrane Handbook for Systematic Reviews of Interventions , 2010, Journal of MultiDisciplinary Evaluation.

[57]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[58]  J. Bauer,et al.  Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy—a pilot study , 2005, Supportive Care in Cancer.

[59]  D. Karnofsky,et al.  The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma , 1948 .