Abstract
Among all gynaecological neoplasms, ovarian cancer has the highest rate of disease-related malnutrition, representing an important risk factor of postoperative mortality and morbidity. Hence, the importance of finding effective nutritional interventions is crucial to improve ovarian cancer patient’s well-being and survival. This systematic review of randomized controlled trials (RCTs) aims at assessing the effects of nutritional interventions on clinical outcomes such as overall survival, progression-free survival, length of hospital stay (LOS), complications following surgery and/or chemotherapy in ovarian cancer patients. Three electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until December 2018. A total of 14 studies were identified. Several early postoperative feeding interventions studies (n = 8) were retrieved mainly demonstrating a reduction in LOS and an ameliorated intestinal recovery after surgery. Moreover, innovative nutritional approaches such as chewing gum intervention (n = 1), coffee consumption (n = 1), ketogenic diet intervention (n = 2) or fruit and vegetable juice concentrate supplementation diet (n = 1) and short-term fasting (n = 1) have been shown as valid and well-tolerated nutritional strategies improving clinical outcomes. However, despite an acceptable number of prospective trials, there is still a lack of homogeneous and robust endpoints. In particular, there is an urgent need of RCTs evaluating overall survival and progression-free survival during ovarian oncology treatments. Further high-quality studies are warranted, especially prospective studies and large RCTs, with more homogeneous types of intervention and clinical outcomes, including a more specific sampling of ovarian cancer women, to identify appropriate and effective nutritional strategies for this cancer, which is at high risk of malnutrition.
Highlights
Ovarian cancer is one of the most common cancers worldwide with an estimated global incidence in 2018 of 295,414 new cases [1]
This study demonstrated that the ketogenic diet (KD), compared with american cancer society (ACS) diet, produced significantly lower levels of adjusted total (35.3 kg compared with 38.0 kg; p < 0.05) and android (3.0 kg compared with 3.3 kg; p < 0.05) fat mass
Compared to the ACS, the KD group improved perceived physical functional status as well as reduced cravings for starchy food and fast food fats (p < 0.05 for both). These findings suggest that a KD is feasible for ovarian cancer patients and may provide several benefits that improve quality of life (QoL) [27]
Summary
Ovarian cancer is one of the most common cancers worldwide with an estimated global incidence in 2018 of 295,414 new cases [1]. Women with this malignancy tend to have a higher incidence of malnourishment at the time of diagnosis [5] Since oncology treatments, such as surgery and chemotherapy, produce additional adverse effects such as short bowel, diarrhoea, malabsorption and fatigue [6], malnutrition in these cancer patients has a multifactorial origin and is not often recognized [7]. Many laboratory and clinical tools have been employed to identify malnutrition in this setting, such as prealbumin or albumin [4,9,10], Nutritional Risk Score (NRS) [8], Subjective Global Assessment (SGA) [11], and bioelectrical impedance analysis (BIA)-derived phase angle [12] These scores are able to predict longer hospital stays and impaired therapeutic outcomes in malnourished patients [4,9,10,11,12]. This systematic review aims at examining the impact of several types of nutrition interventions on clinical outcomes in ovarian cancer patients
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