Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: a two-year randomized controlled trial

• Published in: PloS one 2014-09, Vol.9 (9), p.e108687
• Main Authors: Bourdel-Marchasson, Isabelle, Blanc-Bisson, Christelle, Doussau, Adélaïde, Germain, Christine, Blanc, Jean-Frédéric, Dauba, Jérôme, Lahmar, Cyril, Terrebonne, Eric, Lecaille, Cédric, Ceccaldi, Joël, Cany, Laurent, Lavau-Denes, Sandrine, Houede, Nadine, Chomy, François, Durrieu, Jessica, Soubeyran, Pierre, Senesse, Pierre, Chene, Geneviève, Fonck, Mariane
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Biology and Life Sciences; Body weight; Cachexia; Cancer; Cancer therapies; Care and treatment; Cell cycle; Chemotherapy; Clinical trials; Colon; Colorectal cancer; Counseling; Diet; Dietary intake; Elderly patients; Energy Intake; Female; Gerontology; Health aspects; Humans; Intervention; Life Sciences; Lungs; Lymphoma; Lymphomas; Male; Malnutrition; Malnutrition - mortality; Medical prognosis; Medicine and Health Sciences; Mortality; Neoplasms - drug therapy; Neoplasms - mortality; Nutrition assessment; Nutrition research; Nutritional assessment; Nutritional Status; Pancreas; Patient satisfaction; Patients; Quality of life; Radiation therapy; Randomization; Risk; Sarcopenia; Solid tumors; Toxicity; Weight Loss
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0108687

We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy, versus usual care, on one-year mortality. We conducted a multicentre, open-label interventional, stratified (centre), parallel randomised controlled trial, with a 1∶1 ratio, with two-year follow-up. Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition (MNA, Mini Nutritional Assessment 17-23.5). Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d, by face-to-face discussion targeting the main nutritional symptoms, compared to usual care. Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months. The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality, toxicities and chemotherapy outcomes. Between April 2007 and March 2010 we randomised 341 patients and 336 were analysed: mean (standard deviation) age of 78.0 y (4·9), 51.2% male, mean MNA 20.2 (2.1). Distribution of cancer types was similar in the two groups; the most frequent were colon (22.4%), lymphoma (14.9%), lung (10.4%), and pancreas (17.0%). Both groups increased their dietary intake, but to a larger extent with intervention (p