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Effect of oral nutritional supplements with or without nutritional counselling on mortality, treatment tolerance and quality of life in head-and-neck cancer patients receiving (chemo)radiotherapy: a systematic review and meta-analysis.

Authors
  • Mello, Arthur T1
  • Borges, Dayanne S2
  • de Lima, Luana P3
  • Pessini, Júlia3
  • Kammer, Pedro V4
  • Trindade, Erasmo B S M3, 5
  • 1 Undergraduate Programme in Nutrition, Federal University of Santa Catarina, Campus Universitario Trindade, 88040970, Florianopolis, Santa Catarina, Brazil. , (Brazil)
  • 2 Postgraduate Programme in Neuroscience, Federal University of Santa Catarina, Campus Universitario Trindade, 88040970, Florianopolis, Santa Catarina, Brazil. , (Brazil)
  • 3 Postgraduate Programme in Nutrition, Federal University of Santa Catarina, Campus Universitario Trindade, 88040970, Florianopolis, Santa Catarina, Brazil. , (Brazil)
  • 4 Undergraduate Programme in Dentistry, Federal University of Santa Catarina, Campus Universitario Trindade, 88040970, Florianopolis, Santa Catarina, Brazil. , (Brazil)
  • 5 Department of Nutrition, Federal University of Santa Catarina, Campus Universitario Trindade, 88040970, Florianopolis, Santa Catarina, Brazil. , (Brazil)
Type
Published Article
Journal
British Journal Of Nutrition
Publisher
Cambridge University Press
Publication Date
Mar 14, 2021
Volume
125
Issue
5
Pages
530–547
Identifiers
DOI: 10.1017/S0007114520002329
PMID: 32594952
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Oral nutritional supplements are widely recommended to head-and-neck cancer patients undergoing anti-cancer treatment; however, their effects on the outcomes of most importance to patients are unclear. This study aimed to systematically review the evidence of effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status, body weight and adverse effects. We searched PubMed, Embase, CENTRAL, LILACS, Web of Science, CINAHL, two trial registry platforms, three sources of grey literature and reference lists of included studies. We assessed the risk of bias using the revised Cochrane risk-of-bias tool (RoB 2), and certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We used random-effects models with Hartung-Knapp correction for the meta-analyses. We included fifteen trials, of which five were ongoing or unpublished, providing evidence in four comparisons. We found very low to low certainty evidence for the effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status and adverse effects. When compared with nutritional counselling alone, nutritional counselling plus oral nutritional supplements probably increased body weight slightly. We also found adverse events relating to supplements use such as nausea, vomiting and feeling of fullness. Possible increases in mortality, treatment tolerance and quality of life besides a possible decrease in functional status are worthy of further investigation. Future research could attempt to address the clinical importance of a probable increase in body weight. Possible adverse effects of the use of oral nutritional supplements should not be overlooked.

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