Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa, Tokyo 141-8625, Japan.
Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan.
Clin Nutr. 2023 Feb;42(2):227-234. doi: 10.1016/j.clnu.2022.12.013. Epub 2023 Jan 7.
BACKGROUND & AIMS: This systematic review aims to determine whether nutritional counseling by registered dietitians and/or nutritional specialists is recommended for adult patients with incurable advanced or recurrent cancer who are refractory to or intolerant of anticancer therapy.
This systematic review analyzed randomized controlled trials (RCTs) of nutritional counseling in cancer patients older than 18 years, primarily those with stage 4 cancer. Nutrition counseling was performed by registered dietitians and/or nutritional specialists using any method, including group sessions, telephone consultations, written materials, and web-based approaches. We searched the Medline (PubMed), Medline (OVID), EMBASE (OVID), CENTRAL, Emcare, and Web of Science Core Collection databases for articles published from 1981 to 2020. Two independent authors assessed the risk of bias used the Cochrane Risk of Bias 2 tool. Meta-analysis was performed for results and outcomes that allowed quantitative integration. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (ID: CRD42021288476) and registered in 2021.
The search yielded 2376 studies, of which 7 assessed 924 patients with cancer aged 24-95 years. Our primary outcome of quality of life (QoL) was reported in 6 studies, 2 of which showed improvement with nutritional counseling. Our other primary outcome of physical symptoms was reported in two studies, one of which showed improvement with nutritional counseling. Quantitative integration of both QoL and physical symptoms was difficult. A meta-analysis of energy and protein intake and body weight was performed for secondary outcomes. Results showed that nutrition counseling increased energy and protein intake, but total certainty of evidence (CE) was low. Bodyweight was not improved by nutrition counseling.
Nutrition counseling is shown to improve energy and protein intake in patients with incurable cancer. Although neither nutrient intake can be strongly recommended because of low CE, nutrition counseling is a noninvasive treatment strategy that should be introduced early for nutrition intervention for patients with cancer. This review did not find sufficient evidence for the effect of nutrition counseling on QoL, a patient-reported outcome. Overall, low-quality and limited evidence was identified regarding the impact of nutrition counseling for patients with cancer, and further research is needed.
本系统评价旨在确定注册营养师和/或营养专家提供的营养咨询是否对接受姑息治疗或不耐受抗肿瘤治疗的晚期或复发性不可治愈的成年癌症患者有益。
本系统评价分析了 18 岁以上癌症患者的营养咨询随机对照试验（RCT），主要为 4 期癌症患者。营养咨询由注册营养师和/或营养专家使用任何方法进行，包括小组会议、电话咨询、书面材料和基于网络的方法。我们检索了 Medline（PubMed）、Medline（OVID）、EMBASE（OVID）、CENTRAL、Emcare 和 Web of Science Core Collection 数据库，检索时间为 1981 年至 2020 年发表的文章。两名独立作者使用 Cochrane 风险偏倚工具 2 评估了风险偏倚。对允许定量整合的结果和结局进行了荟萃分析。本系统评价方案已在国际前瞻性系统评价注册库（ID：CRD42021288476）中注册，并于 2021 年注册。
检索得到 2376 项研究，其中 7 项研究评估了 924 名年龄在 24-95 岁的癌症患者。我们报告了 6 项研究中的生活质量（QoL）这一主要结局，其中 2 项研究显示营养咨询可改善 QoL。我们的另一个主要结局是身体症状，两项研究报告了该结局，其中一项研究显示营养咨询可改善身体症状。由于证据的确定性水平低，我们难以对 QoL 和身体症状进行定量整合。对能量和蛋白质摄入及体重的次要结局进行了荟萃分析。结果表明，营养咨询可增加能量和蛋白质摄入，但总证据确定性水平低。营养咨询并不能改善体重。
营养咨询可改善不可治愈癌症患者的能量和蛋白质摄入。虽然由于证据确定性水平低，不能强烈推荐这两种营养素的摄入，但营养咨询是一种非侵入性的治疗策略，应尽早为癌症患者进行营养干预。本研究没有发现足够的证据表明营养咨询对患者报告的结局之一——生活质量有影响。总体而言，关于营养咨询对癌症患者的影响，证据质量低且有限，需要进一步研究。
