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Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy.

Abstract

BACKGROUND

In our published randomized trial in colorectal cancer, group 1 (n = 37) received individualized nutritional counseling and education about regular foods, group 2 (n = 37) received dietary supplements and consumed their usual diet of regular foods, and group 3 (n = 37) consumed their usual diet of regular foods. Neither group 2 nor group 3 received individualized counseling. Early nutritional counseling during radiotherapy was highly effective at reducing acute radiotherapy toxicity and improving nutritional intake/status and quality of life (QoL). Efficacy persisted for 3 mo after the intervention.

OBJECTIVE

The objective was to perform long-term follow-up in survivors of that clinical trial to specifically evaluate survival, late toxicity, QoL, and nutritional variables.

DESIGN

Medical data were collected from patients' records, and prescheduled interviews were conducted by dietitians for individualized evaluations. Analyses and comparisons between groups (adjusted for stage) were performed after a median follow-up of 6.5 (range: 4.9-8.1) y.

RESULTS

Patients complied with the Radiotherapy Department's follow-up protocol. Nutritional deterioration was higher (P < 0.001) in group 3 (n = 26) and group 2 (n = 29) than in group 1 (n = 34). Adequate nutritional status was maintained in 91% of group 1 patients but not in any of the group 3 patients (P < 0.002). Intakes in group 1 were similar to reference values, and the patients adhered to the prescribed recommendations. Intakes in groups 2 and 3 were lower than recommended intakes: group 3 ≃ group 2 < group 1 (P = 0.001). Median survival in group 3 was 4.9 y (30% died), in group 2 was 6.5 y (22% died), and in group 1 was 7.3 y (only 8% died): group 3 > group 2 > group 1 (P < 0.01). Late radiotherapy toxicity was higher in group 3 (n = 17; 65%) and group 2 (n = 17; 59%) than in group 1 (n = 3; 9%): group 3 ≃ group 2 > group 1 (P < 0.001). QoL was worse in groups 3 and 2 than in group 1: group 3 ≃ group 2 < group 1 (P < 0.002). Worse radiotherapy toxicity, QoL, and mortality were associated with deteriorated nutritional status and intake (P < 0.001). Likewise, depleted intake, nutritional status, and QoL predicted shorter survival and late toxicity (HR: 8.25; 95% CI: 2.74, 1.47; P < 0.001).

CONCLUSIONS

This study conveys novel information about the effectiveness of nutrition at improving long-term prognosis in colorectal cancer. Overall, the data indicate that early individualized nutritional counseling and education during radiotherapy is valuable for patients.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Unidade de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal. p.ravasco@fm.ul.pt

    ,

    Source

    MeSH

    Aged
    Antineoplastic Combined Chemotherapy Protocols
    Colorectal Neoplasms
    Combined Modality Therapy
    Female
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Neoadjuvant Therapy
    Nutritional Sciences
    Nutritional Status
    Patient Compliance
    Patient Education as Topic
    Precision Medicine
    Quality of Life
    Radiation Injuries
    Severity of Illness Index
    Single-Blind Method
    Survival Analysis

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23134880

    Citation

    Ravasco, Paula, et al. "Individualized Nutrition Intervention Is of Major Benefit to Colorectal Cancer Patients: Long-term Follow-up of a Randomized Controlled Trial of Nutritional Therapy." The American Journal of Clinical Nutrition, vol. 96, no. 6, 2012, pp. 1346-53.
    Ravasco P, Monteiro-Grillo I, Camilo M. Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy. Am J Clin Nutr. 2012;96(6):1346-53.
    Ravasco, P., Monteiro-Grillo, I., & Camilo, M. (2012). Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy. The American Journal of Clinical Nutrition, 96(6), pp. 1346-53. doi:10.3945/ajcn.111.018838.
    Ravasco P, Monteiro-Grillo I, Camilo M. Individualized Nutrition Intervention Is of Major Benefit to Colorectal Cancer Patients: Long-term Follow-up of a Randomized Controlled Trial of Nutritional Therapy. Am J Clin Nutr. 2012;96(6):1346-53. PubMed PMID: 23134880.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy. AU - Ravasco,Paula, AU - Monteiro-Grillo,Isabel, AU - Camilo,Maria, Y1 - 2012/11/07/ PY - 2012/11/9/entrez PY - 2012/11/9/pubmed PY - 2013/1/26/medline SP - 1346 EP - 53 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 96 IS - 6 N2 - BACKGROUND: In our published randomized trial in colorectal cancer, group 1 (n = 37) received individualized nutritional counseling and education about regular foods, group 2 (n = 37) received dietary supplements and consumed their usual diet of regular foods, and group 3 (n = 37) consumed their usual diet of regular foods. Neither group 2 nor group 3 received individualized counseling. Early nutritional counseling during radiotherapy was highly effective at reducing acute radiotherapy toxicity and improving nutritional intake/status and quality of life (QoL). Efficacy persisted for 3 mo after the intervention. OBJECTIVE: The objective was to perform long-term follow-up in survivors of that clinical trial to specifically evaluate survival, late toxicity, QoL, and nutritional variables. DESIGN: Medical data were collected from patients' records, and prescheduled interviews were conducted by dietitians for individualized evaluations. Analyses and comparisons between groups (adjusted for stage) were performed after a median follow-up of 6.5 (range: 4.9-8.1) y. RESULTS: Patients complied with the Radiotherapy Department's follow-up protocol. Nutritional deterioration was higher (P < 0.001) in group 3 (n = 26) and group 2 (n = 29) than in group 1 (n = 34). Adequate nutritional status was maintained in 91% of group 1 patients but not in any of the group 3 patients (P < 0.002). Intakes in group 1 were similar to reference values, and the patients adhered to the prescribed recommendations. Intakes in groups 2 and 3 were lower than recommended intakes: group 3 ≃ group 2 < group 1 (P = 0.001). Median survival in group 3 was 4.9 y (30% died), in group 2 was 6.5 y (22% died), and in group 1 was 7.3 y (only 8% died): group 3 > group 2 > group 1 (P < 0.01). Late radiotherapy toxicity was higher in group 3 (n = 17; 65%) and group 2 (n = 17; 59%) than in group 1 (n = 3; 9%): group 3 ≃ group 2 > group 1 (P < 0.001). QoL was worse in groups 3 and 2 than in group 1: group 3 ≃ group 2 < group 1 (P < 0.002). Worse radiotherapy toxicity, QoL, and mortality were associated with deteriorated nutritional status and intake (P < 0.001). Likewise, depleted intake, nutritional status, and QoL predicted shorter survival and late toxicity (HR: 8.25; 95% CI: 2.74, 1.47; P < 0.001). CONCLUSIONS: This study conveys novel information about the effectiveness of nutrition at improving long-term prognosis in colorectal cancer. Overall, the data indicate that early individualized nutritional counseling and education during radiotherapy is valuable for patients. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/23134880/full_citation L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.111.018838 DB - PRIME DP - Unbound Medicine ER -