Effect of combined therapies including nutrition and physical exercise in advanced cancer patients: A pooled analysis

Lena J Storck; Alexandra Uster; Lucia Gafner; Maya Ruehlin; Sabine Gaeumann; David Gisi; Martina Schmocker; Peter J Meffert; Reinhard Imoberdorf; Miklos Pless; Peter E Ballmer

doi:10.3389/fnut.2023.1063279

Effect of combined therapies including nutrition and physical exercise in advanced cancer patients: A pooled analysis

Front Nutr. 2023 Mar 1:10:1063279. doi: 10.3389/fnut.2023.1063279. eCollection 2023.

Authors

Affiliations

¹ Zentrum für Allgemeine Innere Medizin, Ernährungstherapie/-Beratung, Kantonsspital Winterthur, Winterthur, Switzerland.
² Medizinische Kliniken, Klinikum Konstanz, Konstanz, Germany.
³ Division of Research, Innovation, and Development, Swiss Cancer League, Bern, Switzerland.
⁴ Institut für Therapien und Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland.
⁵ Corvus, Statistical Analysis Consulting, Altkalen, Germany.
⁶ Zentrum für Allgemeine Innere Medizin, Klinik für Innere Medizin, Kantonsspital Winterthur, Winterthur, Switzerland.
⁷ Klinik für Medizinische Onkologie und Hämatologie, Kantonsspital Winterthur, Winterthur, Switzerland.
⁸ Past President GESKES-SSNC, Winterthur, Switzerland.

Abstract

Background and aims: Although many cancer patients suffer from malnutrition or cancer cachexia, there is no standard of care so far due to limited intervention trials. Pooled data from two combined trials were analyzed regarding nutritional status and survival time.

Materials and methods: Data from two trials with advanced cancer patients were included. In both trials, patients in the intervention group received at least three times nutritional counseling and supervised training sessions. Patients in the control group continued being treated according to usual care. Nutritional status was measured using BMI, body composition and handgrip strength. Survival time was analyzed using the Cox proportional hazard model with the period between the beginning of the trial and death as underlying time scale.

Results: 68 men (61.8%) and 42 women (38.2%) were randomized either to the intervention (n = 56) or the control (n = 54) group. The inter-group difference for changes in BMI and body composition was not statistically significant after 3 months. Handgrip strength improved significantly from 34.4 ± 10.2 kg to 36.3 ± 9.9 kg at 3 months in the intervention compared to 33.9 ± 9.2 kg to 34.9 ± 9.1 kg in the control group (p = 0.006). The analysis of survival time showed no inter-group difference for all patients. A detailed analysis for different diagnoses showed that in patients with lung cancer, the covariates "CRP value," "days from first diagnosis to randomization" as well as "gender" were significantly associated with survival time. Patients with higher CRP value had a shorter survival time and female patients had a shorter survival time than male patients in our analysis. In addition, patients with pancreatic cancer randomized to the control group had a 20% shorter survival time than those in the intervention group (p = 0.048).

Conclusion: The pooled analysis showed a significant improvement of handgrip strength in advanced cancer patients through the implementation of a combined therapy. Handgrip strength is of prognostic significance in hospitalized patients due to its association with mortality and morbidity. However, no improvements in further tests were detected. There is great need for further investigations examining the effect of nutritional and exercise therapy on survival time with focus on different cancer diagnoses.

Keywords: cachexia; cancer; dietary counseling; malnutrition; physical exercise.

Grants and funding

Both studies were funded by grants provided by the Krebsforschung Schweiz (Swiss Cancer Research), Number: KFS-2833-08-2011 and KFS-3495-08-2014. In addition, one study received financial support by the Werner und Hedy Berger-Janser Stiftung.