Systematic review and meta‐analyses of foodservice interventions and their effect on nutritional outcomes and satisfaction of adult oncology patients

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Abstract

Aim

An understanding of effective foodservice interventions on nutrition outcomes in adult patients with cancer is required to support clinical decision making. This systematic review aimed to determine the effect of foodservice interventions across a range of nutritional outcomes and satisfaction of hospitalised and ambulatory adult oncology patients.

Methods

The review protocol was registered with PROSPERO ( CRD42016045772). Six databases were searched using search terms associated with the intervention and population. No date or language restrictions were applied. Authors applied the inclusion criteria to titles and abstracts and then full‐text papers. The final library was assessed for risk of bias. Outcome data were combined narratively and, where possible, by meta‐analysis.

Results

From the title and abstract review of 4414 studies, 12 studies testing the effect of foodservice interventions were included in this review. Meta‐analyses demonstrated significantly greater energy (mean difference 1.54 MJ/day; 95% CI 0.85–2.23 MJ/day) and protein (mean difference 18.98 g/day; 95% CI 11.58–26.39 g/day) intake through the addition of oral nutrition supplements. Other positive effects on anthropometric outcomes were also recorded. Patient satisfaction was enhanced through other foodservice interventions.

Conclusions

Limited original research was found exploring the effect of foodservice interventions in oncology patients. Significant findings were found in favour of the intervention across a range of nutritional outcomes, suggesting that foodservice interventions may improve clinical outcomes and satisfaction in this population. Effective foodservice interventions for oncology patients remain under‐researched, so we encourage dietitians and foodservice staff to implement rigorous study designs to evaluate and publish interventions in this clinical group.

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Most cited references 21

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Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality.

Su Lim, Kian Ong, Yiong Huak Chan … (2012)

The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the prevalence of malnutrition in a tertiary hospital in Singapore and its impact on hospitalization outcomes and costs, controlling for DRG. This prospective cohort study included a matched case control study. Subjective Global Assessment was used to assess the nutritional status on admission of 818 adults. Hospitalization outcomes over 3 years were adjusted for gender, age, ethnicity, and matched for DRG. Malnourished patients (29%) had longer hospital stays (6.9±7.3 days vs. 4.6±5.6 days, p<0.001) and were more likely to be readmitted within 15 days (adjusted relative risk=1.9, 95% CI 1.1-3.2, p=0.025). Within a DRG, the mean difference between actual cost of hospitalization and the average cost for malnourished patients was greater than well-nourished patients (p=0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p<0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio=4.4, 95% CI 3.3-6.0, p<0.001). Malnutrition was evident in up to one third of the inpatients and led to poor hospitalization outcomes and survival as well as increased costs of care, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy.

Pedro Marques-Vidal, Maria Ermelinda Camilo, Paula Ravasco … (2005)

To investigate the impact of dietary counseling or nutritional supplements on outcomes in cancer patients: nutritional, morbidity, and quality of life (QoL) during and 3 months after radiotherapy. A total of 111 colorectal cancer outpatients referred for radiotherapy, stratified by staging, were randomly assigned: group 1 (G1; n = 37), dietary counseling (regular foods); group 2 (G2; n = 37), protein supplements; and group 3 (G3; n = 37), ad libitum intake. Nutritional intake (diet history), status (Ottery's Subjective Global Assessment), and QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0) were evaluated at baseline, at the end, and 3 months after radiotherapy. At radiotherapy completion, energy intake increased in G1/G2 (P < or = .04), G1 more than G2 (P = .001), and decreased in G3 (P < .01). Protein intake increased in G1/G2 (P < or = .007), G1 less than G2 (not significant), and decreased in G3 (P < .01). At 3 months, G1 maintained nutritional intake and G2/G3 returned to baseline. After radiotherapy and at 3 months, rates of anorexia, nausea, vomiting, and diarrhea were higher in G3 (P < .05). At radiotherapy completion, in G1 all QoL function scores improved proportionally to adequate intake or nutritional status (P < .05); whereas in G2 only three of six function scores improved proportionally to protein intake (P = .04), and in G3 all scores worsened (P < .05). At 3 months, G1 patients maintained/improved function, symptoms, and single-item scores (P < .02); in G2, only few function and symptom scales improved (P < .05); in G3, QoL remained as poor as after radiotherapy. In G1/G2, respectively, improvement/deterioration of QoL correlated with better or poorer intake or nutritional status (P < .003). During radiotherapy, both interventions positively influenced outcomes; dietary counseling was of similar or higher benefit, whereas even 3 months after RT, it was the only method to sustain a significant impact on patient outcomes.

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Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial.

Timothy K. Thomas, Carole C. Baldwin, C McGough … (2011)

Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma. Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal (n = 277) and lung (n = 81) cancers were recruited. Median (range) follow-up was 6 (0-49) months. One-year survival was 38.6% (95% confidence interval 33.3-43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

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Author and article information

Contributors

Elizabeth Doyle: elizabeth.doyle@svha.org.au

Journal

Journal ID (nlm-ta): Nutr Diet

Journal ID (iso-abbrev): Nutr Diet

Journal ID (doi): 10.1111/(ISSN)1747-0080

Journal ID (publisher-id): NDI

Title: Nutrition & Dietetics

Publisher: John Wiley & Sons Australia, Ltd (Melbourne )

ISSN (Print): 1446-6368

ISSN (Electronic): 1747-0080

Publication date (Electronic): 29 March 2017

Publication date (Print): April 2017

Volume: 74

Issue: 2 ( doiID: 10.1111/ndi.2017.74.issue-2 )

Pages: 116-128

Affiliations

[ ¹ ] Nutrition DepartmentSt Vincent's Hospital Melbourne Melbourne VictoriaAustralia

[ ² ] Carl de Gruchy LibrarySt Vincent's Hospital Melbourne Melbourne VictoriaAustralia

[ ³ ] Allied Health Research OfficeEastern Health Melbourne VictoriaAustralia

[ ⁴ ] Department of Nutrition, Dietetics and FoodMonash University Melbourne VictoriaAustralia

Author notes

[*] [* ] Correspondence: E. Doyle, Nutrition Department, St Vincent's Hospital, PO Box 2900, Fitzroy, VIC 3065, Australia. Tel: +61 03 9231 2211.

Email: elizabeth.doyle@ 123456svha.org.au

Author information

Judi Porter http://orcid.org/0000-0002-7535-1919

Article

Publisher ID: NDI12342

DOI: 10.1111/1747-0080.12342

PMC ID: 5412690

SO-VID: bf82a1e9-561d-4378-8353-901265a725bc

License:

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 09 September 2016

Date revision received : 18 November 2016

Date accepted : 15 December 2016

Page count

Figures: 4, Tables: 2, Pages: 13, Words: 6556

Funding

Funded by: Department of Health and Human Services, Victoria

Funded by: Malnutrition in Victorian Cancer Services Community of Practice Group

Custom metadata

source-schema-version-number 2.0

component-id ndi12342

header-id ndi12342-hdr-0001

cover-date April 2017

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.9 mode:remove_FC converted:03.05.2017

Keywords: adult,foodservice,oncology,oral nutrition supplement,systematic review

Data availability:

Keywords: adult, foodservice, oncology, oral nutrition supplement, systematic review

Systematic review and meta‐analyses of foodservice interventions and their effect on nutritional outcomes and satisfaction of adult oncology patients

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Most cited references 21

Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality.

Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy.

Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial.

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