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. 2023 May 2;7(3):pkad035.
doi: 10.1093/jncics/pkad035.

Nutrition as prevention for improved cancer health outcomes: a systematic literature review

Helen M Parsons  1 , Mary L Forte  1 , Hamdi I Abdi  1 , Sallee Brandt  1 , Amy M Claussen  1 , Timothy Wilt  1   2   3   4 , Mark Klein  3   4 , Elizabeth Ester  5 , Adrienne Landsteiner  2 , Aasma Shaukut  6 , Shalamar S Sibley  3   4 , Joanne Slavin  7 , Catherine Sowerby  2 , Weiwen Ng  1 , Mary Butler  1
Affiliations

Nutrition as prevention for improved cancer health outcomes: a systematic literature review

Helen M Parsons et al. JNCI Cancer Spectr. .

Abstract

Background: Among adults with cancer, malnutrition is associated with decreased treatment completion, more treatment harms and use of health care, and worse short-term survival. To inform the National Institutes of Health Pathways to Prevention workshop, "Nutrition as Prevention for Improved Cancer Health Outcomes," this systematic review examined the evidence for the effectiveness of providing nutrition interventions before or during cancer therapy to improve outcomes of cancer treatment.

Methods: We identified randomized controlled trials enrolling at least 50 participants published from 2000 through July 2022. We provide a detailed evidence map for included studies and grouped studies by broad intervention and cancer types. We conducted risk of bias (RoB) and qualitative descriptions of outcomes for intervention and cancer types with a larger volume of literature.

Results: From 9798 unique references, 206 randomized controlled trials from 219 publications met the inclusion criteria. Studies primarily focused on nonvitamin or mineral dietary supplements, nutrition support, and route or timing of inpatient nutrition interventions for gastrointestinal or head and neck cancers. Most studies evaluated changes in body weight or composition, adverse events from cancer treatment, length of hospital stay, or quality of life. Few studies were conducted within the United States. Among intervention and cancer types with a high volume of literature (n = 114), 49% (n = 56) were assessed as high RoB. Higher-quality studies (low or medium RoB) reported mixed results on the effect of nutrition interventions across cancer and treatment-related outcomes.

Conclusions: Methodological limitations of nutrition intervention studies surrounding cancer treatment impair translation of findings into clinical practice or guidelines.

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Conflict of interest statement

HMP, MF, HIA, SB, AC, TW, MK, EE, AL, AS, SS, JS, CS, WN, and MB have no disclosures to report.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) diagram.
Figure 2.
Figure 2.
Number of studies evaluating outcomes by key question (KQ), N = 206. Studies may evaluate more than 1 outcome; + Symptoms may include cancer or cancer treatment related symptoms such as fatigue, nausea and vomiting, appetite. KQs: In adults diagnosed with cancer who have or are at risk for cancer-associated malnutrition: What is the effect of nutrition interventions before (KQ1) or during (KQ2) cancer treatment in preventing negative treatment outcomes such as effects on dose tolerance, hospital use, adverse events, and survival? What is the effect of nutrition interventions before or during cancer treatment on associated symptoms such as fatigue, nausea and vomiting, appetite, physical and functional status (eg, frailty), and quality of life (KQ3)? In adults with cancer who are overweight or obese, what is the effect of nutrition interventions before or during cancer treatment in preventing negative treatment outcomes such as effects on dose, hospital use, adverse events and survival (KQ4)?
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