Transcript File - Allison Rahman

The Effects of Nutrition Support on Malnourished Gastrointestinal
Cancer Patients Receiving Chemotherapy
Background
PROBLEM OF STUDY: Gastrointestinal (GI) cancer patients
who experience gastrointestinal mal-absorption, loss of
appetite and decreased intake due to chemotherapy side
effects or disease related can lead to a malnourished state,
and may not receive the full dose of chemotherapy required.
SIGNIFICANCE: The significance of this research study was to
find options that would help malnourished gastrointestinal
cancer patients respond better to chemotherapy so that they
could receive adequate doses of chemotherapy and improve
quality of life.
Data Analysis from Clinical Research Trials
Research Study Resource
Akbulut, Gazme
Supported the Hypothesis
Ended Inconclusively
Contradicted the
Hypothesis
✔
✔
Baldwin, C., et. al
Garth, A.K., et. al
✔
Hasenberg, T., et. al
✔
✔
Mason, J.B.
✔
Mutlu, Ece A, et. al
Read, JA, et. al
✔
Tong, H., et. al
✔
Objective & Hypothesis
Results
The main focus of our study was to find evidence that patients
receiving nutritional support, whether total parenteral nutrition
(TPN) or enteral nutrition (EN) responded to chemotherapy
more effectively than patients not receiving nutrition support.
Three specific objectives/aims emerged from the literature and
are as follows:
1. Effect of malnutrition on GI cancer patients.
2. The benefits of medical nutrition therapy on GI cancer
patients receiving chemotherapy.
3. Provide evidence that nutrition support for malnourished
gastrointestinal cancer patients respond more positively to
the treatment.
HYPOTHESIS: Nutrition support given to malnourished GI
cancer patients benefited more from chemotherapy than those
that do not receive any type of NS.
50 patients, aged 28-50 years, were enrolled. 39 completed 6 months and 28
completed all 12 months. Of patients who underwent the malnutrition
screening tool, 32% were classified as mild-moderately malnourished and 16%
severely malnourished. There was a significant increase in mean weight (4.0
kg) at 6 weeks with those on parenteral nutrition (PN) or enteral nutrition (EN).
Lean body mass (LBM) was maintained. There was a significant increase in
energy levels while all other QOL measures were maintained. Chemotherapyassociated side effects were higher in PN. There was no difference in the
survival rate between patients who used PN or EN. Symptom prevalence was
determined by the proportion of patients experiencing at least one nutrition
impact symptom from chemotherapy was 79% and 72% at 1 and 6 months
after starting nutrition therapy. Even at 12 months, symptom prevalence was
46%. The most common symptoms included dry mouth, nausea, and
constipation with the most distressing symptoms reported as dry mouth,
diarrhea, and stomach pain.
Conclusions
In our findings whether nutrition support in malnourished cancer
patients enhanced the therapeutic effects of chemotherapy ended
inconclusively. To decide upon such a conclusion, several of the
studies that were reviewed resulted without enough evidence to
fully state that nutrition support in malnourished gastrointestinal
cancer patients benefited more therapeutically from
chemotherapy treatment than those that did not receive any
nutritional intervention. The evidence that was found to partially
support our research theory was that weight gain positively
affected patients undergoing chemotherapy than those that did
not, but to state that malnourished patients benefited
therapeutically involved a number of variables that were not
recognized before the study began. Another factor that drew to
this conclusion were previous research literatures that
contradicted our theory rather than supporting it. Although, further
identifying possible modifications to the nutrition support diets and
the mode of nutrition support used in certain cases increases the
chance that nutrition support benefits the malnourished GI cancer
patient, and that our scope of research was too broad.
Contact Information
Western Kentucky University
College of Health and Human Services
Allison Rahman
[email protected]
Zachary Clark
[email protected]
Lauren Shivers
[email protected]
Methodology
The research design was a double blind study involving 50 GI
cancer patients undergoing chemotherapy. The age group
consisted of those between 25 to 50 years of age. Following
the IRB approval, we obtained consent from those willing to
participate in the study. Before the research began, the
administration of a Malnourishment Screening tool was given
on each participant. For the first three months of the study
each patient was monitored every three weeks based on
nourishment, quality of life and effects of chemotherapy.
Following the three month mark of the study, each patient was
monitored every six weeks of the remaining year to track their
behavior. The study lasted approximately one year from the
time of IRB approval.
Acknowledgements:
Dr. Maggie Cook-Newell
Family and Consumer Scienecs
College of Health and Human Services
Western Kentucky University
Akbulut, Gazme, Experimental and Therapeutic Medicine (2011); Baldwin,
C., et Al, Journal of Human Nutrition and Dietetics (2011); Garth, A.K., et. Al,
Journal of Human Nutrition and Dietetics (2010); Hasenberg, T, et. Al,
Colorectal Disease (2010); Mason, J. B., Principles and Practices of
Gastrointestinal Oncology Second Edition (2008); Mutlu, Ece A., et. Al,
Nutrition in Clinical Care (2000); Read JA, et. Al, Support Care Cancer
(2007); Tong, H., et. Al, Supportive Care Cancer (2009)
© 2011 Western Kentucky University. Printing paid from state funds, KRS 57.375
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