Do Nutrition Interventions Improve Gastrointestinal Symptoms During Cancer Treatment?

Newswise — This systematic review and meta-analysis from the University of Illinois Urbana-Champaign analyzed 150 studies to determine the effect of nutritional interventions on GI symptoms during cancer treatment. Meta analyses indicated that collectively (all interventions combined), oral intake reduced nausea, vomiting, and diarrhea incidence (p < 0.001). Probiotic supplementation had one of the strongest effect on reducing diarrhea incidence during chemotherapy (p < 0.001), and dietary counseling reduced diarrhea incidence (p = 0.01). Oral nutrition supplements [ONS] had no effects on GI symptoms (all p > 0.05). 

Objectives: Cancer therapy is associated with various gastrointestinal (GI) symptoms. The most common symptoms: nausea, diarrhea, vomiting, and constipation can be dose-limiting, potentially leading to treatment failure, and reduce overall patient quality of life. Preventing weight loss and malnutrition are common targets of nutrition therapy in these patients, but less attention has been given to their ability to reduce GI symptoms. Therefore, the objective of this study was to assess the ability of nutrition therapy to reduce GI side-effects of cancer treatment via systematic review and meta-analysis of the literature.

Methods: A systematic keyword search was conducted in Scopus and PubMed databases. The search algorithm included all possible combinations of terms from the following 3 groups: (1) GI Symptoms; (2) Cancer Treatment; and (3) Nutrition. Potentially relevant articles were screened by title and abstract, then full text against the study inclusion criteria. A meta-analysis was performed on articles meeting inclusion criteria to estimate the pooled effect size on GI symptoms, divided by nutrition intervention type (oral intake, oral nutrition supplement [ONS], or dietary counseling). Subgroup analyses were further conducted based on cancer therapy, and specific nutrient intervention. All statistical analyses were performed in Stata using 2-sided tests with p < 0.05 as the threshold for statistical significance.

Results: 16,013 articles were captured by the search algorithm, and 150 studies met inclusion criteria for meta-analysis. Articles reported 13 different GI symptoms, resulting in 152 total meta-analyses by symptom, cancer treatment, and nutrition intervention subtype. Meta analyses indicated that collectively (all interventions combined), oral intake reduced nausea, vomiting, and diarrhea incidence (p < 0.001). Probiotic supplementation had one of the strongest effect on reducing diarrhea incidence during chemotherapy (p < 0.001). ONS had no effects on GI symptoms (all p > 0.05). Dietary counseling reduced diarrhea incidence (p = 0.01).

Conclusions: This meta-analysis supports use of specific nutrition therapies in treatment of cancer therapy induced GI symptoms and identifies those requiring additional investigation. Future studies should explore personalized nutrition strategies to combat these symptoms.