The benefits of oral nutritional supplements in patients with cancer receiving chemotherapy

The March 2024 issues of Annals of Palliative Medicine featured 7 Original Articles, 11 Review Articles, 4 Editorial Commentary Articles, 2 Case Reports, and 1 Letter to the Editor, as well as a Meeting Report from the Society for Palliative Radiation Oncology Tenth Annual Meeting.

One of the Original Articles focusing on the efficacy of oral nutritional supplements in patients with cancer will be the focus of this Message from the Editor-in-Chief. In that article, Sa-nguansai and colleagues performed a systematic review and meta-analysis of randomized control trials in patients receiving chemotherapy (1).

Cancer is a leading cause of morbidity and mortality worldwide and a major scope focus of this journal (2). Malnutrition is a common morbidity faced by patients with cancer and can result from the underlying malignancy itself or the therapies—surgery, radiation therapy, and systemic therapy—used to treat the malignancies. In fact, over one-third of patients report weight loss at the time of their cancer diagnosis, including over 43% of patients newly diagnosed with stage IV disease (3). Furthermore, up to half of all patients with cancer suffer from malnutrition during the course of their cancer journey. Malnutrition can lead to shortened survivals, declines in quality of life, an inability to receive cancer therapies, and lower response rates to chemotherapy (4-6).

As such, screening for malnutrition and cachexia and initiating early interventions to address malnutrition and weight loss are critical. Yet, best approaches for treating cancer cachexia are not conclusively defined, and the potential benefits of using oral nutritional supplements to combat cancer-related malnutrition are an activate area of investigation (7). Oral nutritional supplements can help to achieve nutritional goals as an adjuvant to dietary counseling and have been reported to stabilize weight during chemotherapy (6,8). A prior systematic review reported moderate compliance with oral nutritional supplements, which improved the total energy intake of patients, but those investigators did not otherwise report on the effectiveness of such supplementation (9). An older meta-analysis reported that oral nutritional supplements can improvement body weights of patients with cancer (10), but numerous studies have been reported since the censor date of July 2016 used in that prior meta-analysis, and that meta-analysis included studies that allowed oral nutritional supplements in the control arm.

In the March 2024 issue of Annals of Palliative Medicine, Sa-nguansai et al. evaluated all randomized trials in adult cancer patients receiving chemotherapy that compared oral nutritional supplements to standard of care for body weight, nutritional status, or quality of life. They identified 10 such trials (9 phase II randomized, 1 phase III), including 6 trials published after 2016, involving 1,101 patients with gastrointestinal, head and neck, breast, and lung cancers receiving a mean caloric intake per day of 486.20 kilocalories.

The investigators found that oral nutritional supplementation did not significantly impact final body weight but trended towards an increase body weight, a benefit that was particularly noticeable in elderly patients, those with low baseline body weight, females, and non-Asian patients. In fact, after adjusting for risk of bias, they found that oral nutritional supplementation significantly increased body weight, enhanced Patient-Generated Subjective Global Assessment (PG-SGA) scores, improved global domain quality of life scores, and improved fatigue domain quality of life scores. Based on those findings, Sa-nguansai and colleagues concluded that oral nutritional supplements could help to increase body weight and improve quality of life in patients with cancer being administered chemotherapy (1). The particularly positive effects identified in elderly patients and patients with low baseline body weights are noteworthy, as those patients are often at higher risk of malnutrition and tend to consume fewer calories (11). The findings of the current analysis are largely in keeping with a prior meta-analysis specifically in malnourished patients with cancer finding that oral nutritional interventions are effective at increasing nutritional intake and improving quality of life measures in patients who are malnourished or at high nutritional risk (12).

Sa-nguansai and colleagues should be commented for performing the first meta-analysis to assess nutritional status using a PG-SGA and for performing a rigorous analysis that isolated the effectiveness of oral nutritional supplements in patients with cancer receiving chemotherapy. Their study, however, did not assess the impact of oral nutritional supplements on chemotherapy-induced toxicities. Furthermore, it did not assess oncologic outcomes, including tumor control or survival, since few studies included in the meta-analysis included those variables. Additional research is needed to better define how oral nutritional supplementation can impact oncological outcomes and treatment toxicities. Future investigation should also better assess how baseline nutritional status influences the potential benefits of oral nutritional supplementation. Based on the positive findings by Sa-nguansai et al. (1), however, oral nutritional supplements should be considered in patients with cancer receiving chemotherapy, particularly those at high risk of malnutrition.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-24-80/coif). The author serves as the Editor-in-Chief of Annals of Palliative Medicine. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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