The frequency and impact on cachexia of secondary causes of impaired oral nutritional intake in advanced cancer patients: A systematic review of the literature

Abstract

20658 Background: Secondary causes (SecC) of impaired oral nutritional intake (O-NI) - a common and devastating complication of advanced cancer - remain poorly recognised in daily practice. They may be classified as O-NI with impaired (e.g. mucositis) or normal (e.g. dyspnea, body-pain) gastrointestinal function/integrity. To evaluate systematically the frequency and the impact on cancer cachexia of SecC of impaired O-NI. Methods: A systematic review of the literature (MedLine, Cochrane, Embase, PsycINFO, CinAhl; 1995–2007) applied 3 combined search strings ([MeSH], free text): 1. cachexia/anorexia/wasting/malnutrition, 2. cancer and 3. classification/staging. Inclusion criteria of citations, then abstracts and finally papers were advanced cancer, original work, and either A) O-NI correlated with SecC or B) twenty-one predefined factors (SecC) know to be associated with O-NI correlated with weight loss. (O-NI had to be objectively assessed by any method, SecC were based on checklists used by experts in daily clinical practice in 3 independent clinics). Results: Of 7,655 citations, 1,409 abstracts and 130 full-papers were reviewed, 7 papers (A: 4, B: 3) were included. From A, two studies (75 & 59 HNO patients [pts]) report impaired O-NI by radiation induced symptoms (oral dryness, swallowing discomfort), depression and taste disturbances. Of 66 pts (solid tumors), those with severe (n=16), moderate (18), and mild (15) chemosensory complaints had lower O-NI (900, 350, 250 kcal/day) than those without. In 40 pts (colorectal cancer) with or without GI-symptoms (lack of appetite, nausea, vomiting) O-NI was not different. From B, only for muscositis and dysphagia (from the list of 21 SecC) significant correlations with weight loss are reported from 481 pts (HNO, esophageal cancer). 18 descriptive and 2 qualitative (n=39, HNO) studies did not fulfil the inclusion criteria but support the observations of SecC as a frequent problem in clinical care. Conclusions: The concept of Sec-C of cachexia seems to be well known but so far only little data have been systematically collected. The awareness for SecC may help in palliating the causes and effects of cachexia and may be of value when identifying patients for therapy studies. No significant financial relationships to disclose.