NewsNew developments in cancer, from basic research to prevention, treatment, nursing and supportive care, were discussed at ECCO 12 - the European Cancer Conference – in Copenhagen, Denmark, September 21-25, 2003. With around 10,000 experts from over 100 countries, ECCO is now the major forum for leading oncologists from around the world to present their latest clinical research, set out the 'gold standards' of treatment and debate controversial issues involving the future of research, treatment and care.
Delegates attending the Abbott-sponsored symposium at ECCO 12 – Cancer induced weight loss – New approaches that make a difference - heard about a new science-based approach to managing cancer-induced weight loss, which can lead to a significant gain in lean body mass and an improved quality of life.
Chairing the symposium, Professor Dr Christian Manegold, professor of medicine and consultant, medical oncology, Thoraxklinik, Heidelberg University, Germany, told delegates that cancer-induced weight loss was a problem that was often under-estimated. 'Many of our cancer patients suffer from tumor-induced weight loss and these patients are usually not included in clinical trials and are often ineligible for further surgery or chemotherapy," he said.
He added that recent research indicates that the addition of protein rich supplements containing high quantities of eicosapentaenoic acid (EPA), an n-3 polyunsaturated fatty acid derived from fish oil, has produced promising results. Professor Manegold still feels that more information on nutritional approaches to cancer is required. 'For patients to benefit from new treatments we need to ensure that both cancer patients and their families and the whole oncology team are well informed about cancer-induced weight loss and how it can be managed.'
Dr Matthew Barber, specialist registrar, Department of Surgery, Edinburgh Royal Infirmary, Scotland, explained that weight loss, commonly seen in cancer patients, often has serious consequences. 'Patients have more complications and infections and a decreased response to surgery, radiotherapy and chemotherapy. They are usually in hospital for longer and have a shorter survival time.'
Delegates also heard that cancer-induced weight loss is a complex process. According to Dr Barber, a number of different factors are involved including mechanical obstruction, altered energy metabolism, anorexia, nausea, and altered taste. 'Patients with non-malignant disease gain weight when they are given enough energy and protein, whereas many patients with cancer continue to lose weight even when added energy and protein are provided," said Dr Barber. 'This irreversible weight loss, known as 'cachexia', is associated with an altered energy expenditure and is characterised by severe weight loss due to loss of both fat and lean muscle tissue.'
One of the mechanisms thought to contribute to cachexia is an increase in pro-inflammatory cytokines, such as interleukin-6, which are involved in breaking down proteins and 'speeding up' cell metabolism. In fact, this acute phase protein response (APPR) is part of the body's natural response to physical injury or to bacterial or viral infection, and helps the body to recover, explained Dr Barber. 'However, over-activation or persistent activation of the APPR pathway can lead to problems in chronic inflammatory illnesses and studies have now shown that if APPR is present, survival is shorter in patients with pancreatic cancer 4. APPR is thought to be involved in a whole range of metabolic pathways, leading to fat and protein breakdown, anorexia and increased energy expenditure.'
Conventional treatments such as steroids, megesterol acetate and non-steroidal anti-inflammatory drugs (NSAIDs) are all used to combat the effects of cancer-induced weight loss, but these have undesirable side effects. Now, new studies indicate that eicosapentaenoic acid (EPA), derived from fish oil, can reduce the pro-inflammatory cytokine production, attenuate the acute phase protein response and stabilise weight loss in patients with cancer cachexia.
'Evidence from pilot studies shows that supplements enriched with EPA and antioxidants can result in significant weight gain in cancer patients,' said Dr Barber. These promising findings led us to compare the effects of giving a high protein, energy dense (300kcals/serving) oral supplement with enhanced antioxidants and EPA (ProSure®) to an energy-dense oral supplement without EPA.' 2
The double blind, multi-centre trial randomized 200 patients with pancreatic cancer to either a high protein, energy dense oral supplement enriched with EPA or a control supplement without EPA for eight weeks. On an intention-to-treat basis there was no difference between the controls and the EPA subjects, with both groups gaining weight. Dr Barber explained that this was probably due to inadequate consumption of the supplement. 'Patients in this study only managed a mean 1.4 servings per day, while patients in the successful pilot study had managed 1.9 servings per day. When we examined the results from those who had consumed the recommended intake of 1.5-2.0 servings of ProSure® per day for 8 weeks, we found that they gained more weight (1.21 kg vs. 0.09 kg) and lean body mass (1.46 kg vs. 0.45 kg) than patients who were taking the oral supplement without EPA.'
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