Background: Cancers of the colon and rectum are the third most common forms of cancer worldwide. The prognosis for survival
after disease progression is usually poor. Cancer anorexia-cachexia syndrome is prevalent among advanced cancer patients, and
has a large impact on morbidity, mortality, and a patient?s quality of life. Early intervention with nutritional supplementation has
been shown to halt malnutrition, and may improve outcome in some patients. In our study we assessed the influence of nutritional
support (counseling, nutritional supplements, and megestrol acetate) on the nutritional status and symptom prevalence in patients
with colorectal cancer during chemotherapy. The study was designed to investigate whether dietary counseling, oral nutrition
(commercial supplements), and megestrol acetate during chemotherapy affected nutritional status and survival in patients with
Methods: Six hundred and twenty-eight colorectal cancer patients were included in the study from January 2001 through
December 2009, and randomized into one of two groups. Group I consisted of 315 patients (50%) who were monitored
prospectively and were given nutritional support. Group II included 313 patients without nutritional counseling or nutritional
support, in whom data were collected prospectively during a 9-year period of time. Patients were well balanced between the two
groups. After evaluation, (Nottingham Screening Tool Score, Appetite Loss Scale, and ECOG PS, weight) all patients in Group I
received nutritional counseling, oral nutritional food supplements, and megestrol acetate.
Results: After the completion of chemotherapy, there were lower proportions of patients in Group I with a BMI < 20, NST
[greater than or equal to]5, loss of appetite, and decreased weight gain. Nutritional counseling, supplemental feeding, and
pharmacological support temporarily halted weight loss, and improved appetite. This improvement may have implications for
patient survival. Patients with early nutritional support lived 19.1 months while patients in the control group had a survival of
12.4 months (p=0.022).
Conclusion: This trial demonstrated that concurrent individualized dietary counseling, based on regular foods, is effective in
improving nutritional intake and status, thereby lessening chemotherapy-induced morbidity. These results encourage further
studies with more specific nutritional supplementation in patients with colorectal cancer.
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