Nutritional Intervention Effectiveness in Oncology Patients Receiving Active Anti-Cancer Treatment: A Systematic Review

Purpose: This systematic review seeks to determine if an individual or combination nutritional intervention (education and/or supplementation) would significantly impact weight maintenance in adult cancer patients undergoing active anti-cancer treatment. Active anti-cancer treatment is defined as chemotherapy, radiation therapy, or combination chemoradiotherapy. Background: Many aspects of nutritional intake are hindered in patients with cancer. Malnutrition related to cancer can occur either directly because of the tumor, the body’s response to the tumor, or the treatment modalities utilized to inhibit the cancer’s growth. The Integrated Theory of Health Behavior Change was used to guide the synthesis and implications of the review’s results. The theory helps to guide the potential impacts a nutritional intervention program can have on nursing-led, evidence-based practice in treating cancer patients undergoing chemotherapy and/or radiation. Proximal goals, or short-term goals, in improving nutritional intake were defined as weight increases or negligible weight loss. Distal goals, or long-term goals, were performance status improvement and decrease hospital admissions. These goals were used to guide the synthesis of this review. Methods: Medline and CINAHL Plus databases were searched. After duplicates were removed, 81 articles were identified as eligible. After title, abstract, and full-text screening, seven articles were included in the final review and synthesis. The matrix method was used to extract data and analyze the articles. Results: Six out of the seven articles found that nutritional intervention, through intensive education, supplementation, or a combination of these measures significantly benefitted the patient in the outcomes of weight, improved performance status, and a reduction in hospital stays. Limitations: The types of cancers included in the seven studies were esophageal, head and neck, gastrointestinal, or lung. It is of note that esophageal, head and neck, and gastrointestinal cancers each carry their own specific challenges in weight maintenance based on location of disease and localized morbidity of disease-specific treatments. It is also important for future studies and literature reviews to include additional cancer types. Other solid and liquid cancers are also of concern when it comes to weight losses and malnutrition. Of additional note, all of the studies included in the review took place outside of the United States. The healthcare systems, nutritional programs, education and supplementation may be different than that in the United States, limiting the applicability of this review. This review did not consider unpublished materials and the search of databases was small, encompassing only two major databases. These factors limit the amount of knowledge represented in the review, thereby limiting the scope of the review. With the inclusion of unpublished materials and a more expansive search of additional databases, the inclusiveness and the validity of the review would be enhanced. Conclusion: Of the studies done, the results suggest that nutritional interventions, either through supplementation, intensive education, or a combination of these factors, significantly impact the proximal goal of improving weight maintenance and distal goals of improving performance status and decreasing hospital admissions. However, additional research needs to be done in the area of nutritional interventions and their effects in oncology patients undergoing active anti-cancer treatment. The role of the nurse can be utilized to deliver nutritional interventions including education and supplementation to significantly impact proximal and distal health behavior goals of weight maintenance, performance status, and hospital admission stays.