New evidence reveals that protein-rich oral supplements can support cancer recovery with fewer complications and shorter hospital stays, offering hope for better supportive care.
Study: High-protein oral nutritional supplement use in patients with cancer reduces complications and length of hospital stay: a systematic review and meta-analysis. Image credit: LightField Studios/Shutterstock.com
A recent systematic review and meta-analysis published in Frontiers in Nutrition highlighted the potential use of high-protein oral nutritional supplements in reducing clinical complications and length of hospital stay in cancer patients. However, the review noted variability in the certainty of evidence and patient populations studied.
Background
Cancer is a leading cause of mortality worldwide, posing significant challenges to the healthcare systems. Malnutrition, or poor nutrition, is one of the major challenges that cancer patients experience throughout the disease course. Malnutrition can reduce treatment effectiveness, negatively affect clinical outcomes, and increase disease severity in cancer patients.
Some estimates suggest that malnutrition may contribute to around 20% of cancer-related deaths, although figures vary depending on cancer type and stage. High metabolic demands of cancer together with adverse side-effects of chemotherapy, radiotherapy, and surgery significantly reduce appetite and dietary intakes in cancer patients, which collectively result in malnutrition, weight loss, and functional impairments.
Multi-nutrient oral nutritional supplements and dietary advice are often recommended to cancer patients to optimize nutritional intake and reduce malnutrition risk. Many studies have highlighted the clinical benefits of these supplements in various cancer patients.
Cancer therapy-related metabolic derangements often increase protein requirements in cancer patients. However, inadequate protein intake due to reduced appetite in these patients often leads to protein loss, muscle mass decline, impaired tissue repair, and suppressed immune functions. High-protein oral nutritional supplements are particularly recommended for cancer patients to counteract these deficits.
In this systematic review and meta-analysis, the researchers thoroughly analyzed existing literature on the effect of high-protein oral nutritional supplements on clinical outcomes in cancer patients.
Study design
The researchers conducted systematic literature screening to identify randomized controlled trials that investigated the effect of high-protein oral nutritional supplements (≥20% energy from protein) on nutritional, clinical, and functional outcomes in cancer patients, including complications, length of hospital stay, readmissions to hospital, and mortality.
The screening included 29 studies in the systematic review and 19 studies in the meta-analysis. The studies included 2,279 patients with gastrointestinal, lung, head and neck, liver, breast, and mixed cancers across hospital and community settings, who were undergoing surgery, chemotherapy, and/or radiotherapy.
Key findings
The systematic review and meta-analysis findings revealed that high-protein oral nutritional supplements can significantly reduce both infectious and non-infectious complications and post-operative and treatment-related complications in cancer patients. The observed reduction of complications was similar for supplements with and without omega-3 fatty acids.
The meta-analysis also indicated that treating 12 cancer patients with supplements would prevent one additional complication compared to control patients receiving routine care.
The meta-analysis of studies that investigated the effect of supplements containing omega-3 fatty acids mainly included patients with gastrointestinal cancers with a range of nutritional statuses undergoing surgery. The interventions ranged from very short pre-operative durations (five days) in patients undergoing surgery to extended community-based nutritional support during cancer therapy (up to one year) as clinically indicated. The majority of these studies reported the impact of supplements on surgical and post-operative complications, except for one study that reported treatment-related toxicities.
On the other hand, the meta-analysis of studies using supplements without omega-3 included various cancer patients with different nutritional statuses across hospital and community settings. These studies focused on a range of complications, including chemotherapy- and radiotherapy-related toxicities, as well as post-operative infectious and non-infectious complications.
The difference in cancer types, treatments, settings, and nutritional status of included patients is a critical factor that can potentially influence the interpretation and generalizability of findings. However, the findings support the broader utility of high-protein oral nutritional supplements.
Regarding healthcare use, the meta-analysis revealed that intake of high-protein oral nutritional supplements is associated with a significant reduction in hospital stay duration, which may be attributed to decreased perioperative complications and faster recovery.
Specifically, it was observed that pre- and post-operative supplement use is associated with a significant reduction in hospital stay in patients with colorectal cancer, regardless of initial nutritional status, with some evidence suggesting this may lower treatment costs. However, formal economic evaluation was not a central focus of the review.
In this meta-analysis, no significant impact of supplement use was observed on hospital readmissions, possibly due to the short intervention period in patients undergoing surgery. Several other factors may also influence hospital readmission, including existing health conditions, post-discharge care, and adherence to nutritional recommendations. Further research is needed to explore whether longer intervention periods with high-protein oral nutritional supplements benefit hospital readmission.
Similarly, the meta-analysis found no significant impact of supplement use on mortality. The authors emphasized that evidence for survival outcomes was limited, with one small study reporting higher one-year survival benefits associated with omega-3-enriched supplements in pancreatic cancer patients undergoing chemotherapy.
The benefits of high-protein supplements observed in this systematic review and meta-analysis may be associated with the intake of energy, protein, and other key nutrients that help preserve or restore body reserves, such as body weight and muscle mass. These factors can potentially improve patients' ability to tolerate side effects associated with surgery and cancer therapies.
Furthermore, macronutrients and micronutrients in these supplements can potentially improve wound healing and tissue regeneration and modulate inflammatory and immune responses. However, the review cautions that mechanisms were not the primary focus of the analysis.
Given the observed clinical benefits of consuming high-protein supplements, the researchers highlight the need for further research with robust controlled designs and greater standardization of patient groups, cancer treatment regimens, and nutritional interventions to more conclusively understand these associations and enable practice recommendations.
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