Therapeutic Fasting in Reducing Chemotherapy Side Effects in Cancer Patients: A Systematic Review and Meta-Analysis

Abstract

The aim of this study was to assess the available evidence regarding the effect of a variety of fasting-like regimens on preventing chemotherapy-related side effects. PubMed, Scopus and Embase were used to select the studies for this review, which concluded on 24 November 2022. All types of clinical trials and case series reporting chemotherapy toxicity associated with fasting regimens and any comparison were considered. A total of 283 records were identified, of which 274 were excluded, leaving only nine studies that met the inclusion criteria. Five of these trials were randomized. Overall, moderate to high-quality evidence showed that several fasting regimens did not provide benefits compared to a conventional diet or other comparators in reducing the risk of adverse events. The overall pooled estimate for a variety of fasting regime when compared to non-fasting, indicated no significant difference in the side effects (RR = 1.10; 95% CI: 0.77-1.59; I² = 10%, p = 0.60), including neutropenia alone (RR = 1.33; 95% CI: 0.90-1.97; I² = 0%, p = 0.15). A sensitivity analysis confirmed these results. Based on our systematic review and meta-analysis, there is currently no evidence supporting the superiority of therapeutic fasting over non-fasting in preventing chemotherapy toxicity. The development of cancer treatment that do not entail toxicities remains imperative.

Keywords: chemotherapy; chemotherapy toxicity; fasting; intermittent fasting; time-restricted eating.

Figure 1

PRISMA flowchart for the selection of studies.

Figure 2

Forest plot for total chemotherapy-related toxicity (Grade > 2). de Groot et al. [16], de Groot et al. [37], Dorff et al. [17], Omar et al. [38], Riedinger et al. [36], Zorn et al. [39]; CI, confidence interval. I² measure of heterogeneity.

Figure 3

Forest plot for total chemotherapy-related toxicity (Grade > 2)—Sensitivity analysis. de Groot et al. [16], de Groot et al. [37], Omar et al. [38], Riedinger et al. [36]; CI, confidence interval. I² measure of heterogeneity.

Figure 4

Forest plot for chemotherapy-related toxicity: neutropenia (Grade > 2) sensitivity analysis. Groot et al. [37], Omar et al. [38], Riedinger et al. [36]; CI, confidence interval. I² measure of heterogeneity.