ESPEN guidelines recommend a minimum protein intake of 1.0 g/kg body weight (BW) per day to maintain or restore lean body mass in patients with cancer but during cancer treatment, optimal protein intake is difficult to achieve.
In fact, a recent Ipsos survey, commissioned by Nutricia reveals up to 70% of patients with cancer are malnourished, and 3 out of 5 patients report losing weight at some point during their cancer journey.
Aiming to discover if the Nutricia's Fortimel protein medical drink could stem this issue, researchers from the firm, alongside researchers from cancer institutes and hospitals across the Netherlands, conducted a study.
The authors say the study outcomes may be useful to support the implementation of current clinical practice guidelines, which highlight the importance of early nutritional intervention for patients with cancer.
An undiagnosed issue
To exemplify the importance of this health concern, Nutricia conducted a survey among 700 adult cancer patients across France, Germany, Italy, the Netherlands, Poland, Spain and the United Kingdom.
The survey results reveal that over 60% of patients experienced eating problems as a direct result of their cancer and treatment and one third of these found their weight loss led to delays, interruption or change to their treatment.
Professor Alessandro Laviano, associate professor of Internal Medicine at the Department of Clinical Medicine, Sapienza University of Rome, Italy, says: “This survey confirms what I see every day in clinical practice - patients with cancer struggle with eating, with a domino effect on their weight and muscle mass, and subsequently on their treatment plan."
Hélène Blanchard, Head of Global Medical Affairs Oncology & Recovery at Danone, asserts that malnutrition screening is not systematically conducted in clinical practice, resulting in many patients becoming malnourished over the course of their cancer journey.
She explains: "This can be due to low awareness of the role of nutrition and the risks of malnutrition in disease management among healthcare providers, or due to a lack of time to address the multiple topics related to cancer care. At the same time, clinical decision making often relies on patient-reported symptoms (e.g., loss of appetite) or observations (e.g., weight loss), further reinforcing the need for patient education and patient voice inclusion in clinical settings."
Fortimel study
A multi-centre, randomised, controlled, open-label, parallel-group study was carried out in nine hospitals (five countries) between January 2019 and July 2021 in colorectal and lung cancer patients undergoing first-line systemic treatment with chemo(radio-) or immunotherapy.
Subjects (29 subjects completed the study, mean age 66.1 years) were randomised (2:1) to receive Fortimel Compact Protein twice daily (each containing 18 g protein, 300 kcal) or standard care. Protein intake was the primary outcome, assessed with a three-day food diary, and body weight was a secondary outcome. The researchers had aimed to recruit 126 participants but faced challenges in recruitment.
As subjects had treatment cycles of varying length (2, 3 or 6 weeks); assessment timepoints differed accordingly. Assessments at timepoint 0 (T0) were related to the start of the study (baseline); assessments at timepoint 1 (T1) were related to the planned end of the first treatment cycle; assessments at timepoint 2 (T2) were related to the planned end of treatment cycle 2.
Assessments at timepoint 3 (T3) occurred at the end of the 12-week intervention period. However, due to challenges in recruitment, the study was terminated early.
At baseline, only 65% of the intervention group and 45% of the control group met ESPEN minimum protein intake recommendations. However, at T1 and T2 a higher proportion of patients met recommendations in the intervention group than in the control group (88% vs. 55% and 40%).
The researchers conclude: "Despite the challenges in patient recruitment and early termination of this study, we demonstrated that intervention twice daily with a high-protein, high-energy, low-volume [oral nutrition supplement] was effective at increasing protein intake in patients with [colorectal cancer] and [non-small cell lung cancer] undergoing first-line systemic treatment with chemo-, concurrent chemoradio- or immunotherapy."
Source: Nutrients
https://doi.org/10.3390/nu15245030
"High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study"
Authors: Dingemans, A.-M.; van Walree, N.; Schramel, F.; Soud, M.Y.-E.; Baltruškevičienė, E.; Lybaert, W.; Veldhorst, M.; van den Berg, C.A.; Kaasa, S.