Nutrition therapy in cachectic cancer patients. The Tight Caloric Control (TiCaCo) pilot trial.
BACKGROUND
Cancer is a common disease and many patients are diagnosed with advanced stages. Due to cancer generalization, patients may become ill-nourished and even cachectic. Malignancy-related cachexia is associated with worsening physical function, reduced tolerance to anticancer therapy and increased mortality. We assessed the effect of a patient-tailored nutritional approach in newly discovered, treatment-naive cancer patients with cachexia.


METHODS
In a randomized, single-blinded, controlled pilot study, patients were treated with either intensive, biometric parameter-oriented dietary counseling (nutrition therapy) compared to regular dietary counseling (control), before and during conventional cancer treatment. Twenty patients were enrolled over a one-year period, 10 receiving nutrition therapy and 10 controls. The primary endpoint was recovery of body composition after nutrition therapy. Secondary endpoints declined in morbidity and mortality with nutrition therapy.


RESULTS
Average weight evolution in the control group after 3, 6 and 12 months was 0.19 ± 7.87 kg, -9.78 ± 7.00 kg and -5.8 kg, and in the nutrition therapy group 0.69 ± 2.4 kg, 0.77 ± 2.58 kg and 1.29 ± 3.76 kg. Control patients had a significantly longer average hospital stay than subjects from the nutrition therapy group (37.6 vs. 3.4 days). Eight nutrition therapy patients and 1 control patient were still alive after 2 years.


CONCLUSIONS
Nutrition therapy based on patient-specific biophysical parameters helps to maintain body weight and induces a more optimal nutritional balance in cachectic cancer patients. Moreover, survival in cancer patients improved when their nutritional status, even partially, ameliorated.
Department of Intensive Care, UZ Brussel, Brussels, Belgium.
Elisabeth
E
De Waele
Department of Nutrition, UZ Brussel, Brussels, Belgium.
Sabrina
S
Mattens
Department of Intensive Care, UZ Brussel, Brussels, Belgium.
Patrick Maurice
PM
Honoré
Department of Intensive Care, UZ Brussel, Brussels, Belgium.
Herbert
H
Spapen
Department of Medical Oncology, UZ Brussel, Brussels, Belgium.
Jacques
J
De Grève
Department of Internal Medicine, UZ Brussel, Brussels, Belgium. Electronic address: joeripen@gmail.com.
Joeri J
JJ
Pen
D000368:Aged; D001823:Body Composition; D001835:Body Weight; D002100:Cachexia / Q000178:diet therapy*; D003376:Counseling; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D044623:Nutrition Therapy / Q000379:methods*; D009752:Nutritional Status; D010865:Pilot Projects; D016037:Single-Blind Method
Cachexia; Cancer; Nutrition; Supportive care