• Intervention
    Is there a relationship between intervention by a dietitian to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemoradiation therapy for esophageal cancer patients, and the reduction of complications associated with treatment?
    • Conclusion

      One retrospective chart review of neutral quality found that implementation of a standard nutrition pathway by a dietitian is associated with improved outcomes in esophageal cancer patients, including decreased weight loss (P<0.03), fewer unplanned hospital admissions during treatment (p<0.04), shorter LOS during unplanned hospital admissions (P< 0.002), and improved tolerance of treatment as assessed by completion of the prescribed treatment course (P< 0.003) and percent desired radiation received (P< 0.004).  The researchers recommended that all esophageal cancer patients planning chemoradiation treatment receive a proactive nutrition assessment by a trained oncology dietitian on initial presentation, and that all patients receive appropriate nutrition support by a multidisciplinary team.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between enteral nutrition to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemoradiation therapy for esophageal cancer patients, and the reduction of complications associated with treatment?
    • Conclusion

      One prospective, non-randomized controlled trial of positive quality found that EN for severely dysphagic esophageal cancer patients, providing 37 kcals/kg/day and 2.0 g protein/kg/day, delivered for 34 days, resulted in weight maintenance (p = 0.01) and unchanged total protein/albumin status (p = 0.01) when compared to patients without dysphagia who received a standard, ad libitum diet during chemoradiation therapy for esophageal cancer.  There were no significant differences between groups in terms of tolerance of therapy, response to therapy, suitability for radical resection, or median survival time. 

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Protein and Symptoms/Complications: Chemotherapy 2006
       
    Is there a relationship between parenteral nutrition to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemoradiation therapy for esophageal cancer patients, and the reduction of complications associated with treatment?
    • Conclusion

      One neutral quality retrospective review found that patients who received PN during CRT for esophageal cancer, at 30-35 kcals/kg/day and 1.0 - 1.5 g protein/kg/day, during the treatment period (21 - 28 days), were able to tolerate higher doses of 5-fluorouracil (p=0.02), cisplatin (p = 0.05), and interferon alpha 2b (p = 0.05) and a greater percentage of total radiation dose than a comparison group which received no PN support.  The PN group experienced significant decreases in weight (p = 0.04) during treatment.  There were no significant differences between the groups in CRT toxicities, CRT-related deaths, post-surgical complications, total hospital stay, total days in the ICU, treatment response, or mortality.  Patients receiving PN were more likely to receive scheduled CRT compared to patients who did not receive PN.  However, it did not result in improved effectiveness of this treatment regimen in esophageal cancer patients. 

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Protein and Symptoms/Complications: Chemotherapy 2006