Abstract
BackgroundCancer-related anorexia remains one of the most prevalent and troublesome clinical problems experienced by patients with cancer during and after therapy. To ensure high-quality care, systematic reviews (SRs) are seen as the best guide. Considering the methodology quality of SRs varies, we undertook a comprehensive overview, and critical appraisal of pertinent SRs.MethodsEight databases (between the inception of each database and September 1, 2017) were searched for SRs on the management of cancer-related anorexia. Two researchers evaluated the methodological quality of each SR by using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. Characteristics of the “high quality” SRs were abstracted, included information on relevant studies numbers, study design, population, intervention, control, outcome and result.ResultsEighteen SRs met the inclusion criteria. The R-AMSTAR scores of methodological quality ranged from 18 to 41 out of 44, with an average score of 30. Totally eight SRs scored ≥31 points, which showed high methodological quality, and would be used for data extraction to make summaries. Anamorelin had some positive effects to relieve cancer anorexia-cachexia syndrome (CACS) and improve the quality of life (QoL). Megestrol Acetate (MA) could improve appetite, and was associated with slight weight gain for CACS. Oral nutritional interventions were effective in increasing nutritional intake and improving some aspects of QoL in patients with cancer who were malnourished or at nutritional risk. The use of thalidomide, Eicosapentaenoic Acid, and minerals, vitamins, proteins, or other supplements for the treatment of cachexia in cancer were uncertain, and there was inadequate evidence to recommend it to clinical practices, the same situation in Chinese Herb Medicine and acupuncture (acupuncture and related therapies were effective in improving QoL) for treating anorexia in cancer patients, warranting further RCTs in these areas.ConclusionsAnamorelin, MA, oral nutrition interventions, and acupuncture could be considered to be applied in patients with cancer-related anorexia. Future RCTs and SRs with high quality on the pharmaceutical or non-pharmaceutical interventions of anorexia in cancer patients are warranted.
Highlights
Cancer-related anorexia remains one of the most prevalent and troublesome clinical problems experienced by patients with cancer during and after therapy
Oral nutritional interventions were effective in increasing nutritional intake and improving some aspects of quality of life (QoL) in patients with cancer who were malnourished or at nutritional risk
The use of thalidomide, Eicosapentaenoic Acid, and minerals, vitamins, proteins, or other supplements for the treatment of cachexia in cancer were uncertain, and there was inadequate evidence to recommend it to clinical practices, the same situation in Chinese Herb Medicine and acupuncture for treating anorexia in cancer patients, warranting further randomized clinical trials (RCTs) in these areas
Summary
Cancer-related anorexia remains one of the most prevalent and troublesome clinical problems experienced by patients with cancer during and after therapy. Towards the end of life, individuals with cancer experience substantial symptom burden [2, 3]. The top three common symptoms in patients with cancer at the end of life are fatigue, pain, and anorexia (appetite loss) [4, 5]. Cancer-related anorexia is a major clinical problem, and adversely influences nutritional status of patients, which may negatively impact patients’ quality of life and increase the burden on healthcare resources [7]. It is upsetting to both patients and their caregivers, who need supportive care from healthcare professionals [8]. Scientific and effective management strategies for cancer-related anorexia are urgently needed
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