Efficacy of oral nutritional supplement in cancer patients receiving chemotherapy: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The use of oral nutritional supplement (ONS) is one of the modalities employed to manage cancer-associated malnutrition. However, evidence of its efficacy is limited. In 2018, a meta-analysis reported the statistical benefits of increased body weight from ONS. This study aimed to evaluate the efficacy of ONS in cancer patients receiving chemotherapy in more recent trials. METHODS: All randomized controlled trials (RCTs) of adult cancer patients receiving chemotherapy, which compared ONS with standard of care and reported on body weight, nutritional status, or quality of life (QoL), were included. Eligible RCTs were identified from PubMed, OVID, and the references of previous systematic reviews up until February 2023. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool. The outcomes of interest were pooled and analyzed using the mean difference (MD) with a corresponding 95% confidence interval (CI). This study was registered in PROSPERO, number CRD42023400471. RESULTS: Ten RCTs comprising 1,101 patients were included. ONS did not show a significant impact on final body weight (MD -0.07 kg, 95% CI: -0.99 to 0.84, P=0.88). It tended to increase body weight (MD 0.90 kg, 95% CI: -0.48 to 2.28, P=0.20), and this benefit was particularly noticeable in elderly patients, those with low baseline body weight, females, and non-Asian patients. After adjusting for risk of bias, ONS was found to significantly increase body weight (MD 1.32 kg, 95% CI: 0.12 to 2.52, P=0.03), and it also tended to enhance Patient-Generated Subjective Global Assessment (PG-SGA) score of -2.13 (95% CI: -5.07 to 0.82, P=0.16), global domain QoL score of 4.01 (95% CI: 0.08 to 7.94, P=0.05) and fatigue domain QoL score of -7.63 (95% CI: -13.87 to -1.39, P=0.02). CONCLUSIONS: ONS could help to increase body weight in cancer patients receiving chemotherapy. This benefit was especially notable in those at high risk of malnutrition, including elderly patients, those with low baseline body weight, females, and non-Asian patients. It also resulted in improved PG-SGA scores and significantly improved patients' QoL during chemotherapy treatment. Future studies should explore the potential benefit of ONS on oncological outcomes or improvements of chemotherapy-related toxicity.

A randomized, double-blind, placebo-controlled study evaluating the efficacy of combination olanzapine, ondansetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving doxorubicin plus cyclophosphamide.

BACKGROUND: Since most of Thai cancer patients receiving high emetogenic chemotherapy do not have access to neurokinin-1 (NK-1) receptor antagonists or palonosetron as recommended by international guidelines for chemotherapy-induced nausea and vomiting (CINV) prevention. We decided to evaluate the efficacy of olanzapine with the real-life practice antiemetic drugs ondansetron and dexamethasone, in prevention of CINV resulting from doxorubicin plus cyclophosphamide regimen in early-stage breast cancer patients. METHODS: In this randomized, double-blind, placebo-controlled trial, we compared olanzapine with a placebo in combination with ondansetron and dexamethasone in early-stage breast cancer patients receiving doxorubicin 60 mg/m2 plus cyclophosphamide 600 mg/m2. The intervention group received olanzapine 10 mg orally while the control group received a matching placebo daily on day 1 through day 4. All patients received ondansetron 8 mg and dexamethasone 20 mg intravenously 30 minutes before chemotherapy administration and then dexamethasone 10 mg daily orally from day 1 through day 4. The primary endpoint was no nausea rate in the early period. The secondary endpoints were no nausea rate in the delayed and overall periods and a complete response (no vomiting and no use of rescue drug). Outcomes were determined by patients' self-reported daily records of episodes of vomiting or retching, use of rescue therapy and daily levels of nausea based on a visual-analogue scale from the first cycle of chemotherapy. RESULTS: A total of 39 female patients were randomized in a 1:1 ratio to receive olanzapine (20 patients) or a matching placebo (19 patients). A significantly greater proportion of patients reported no nausea in the olanzapine group than in the placebo group in both the early period (0-24 hours after chemotherapy) and the overall period (0-120 hours after chemotherapy). Patients who reported no nausea in the early period accounted for 50% and 10.5% in the olanzapine group and in the placebo group respectively (P=0.008). In the overall period, 30.0% and 0% of patients reported no nausea in the olanzapine and placebo groups respectively (P=0.009). In the early period, there was a significantly different complete response rate between two treatment groups; 75.0% in the olanzapine group and 36.8% in the placebo group (P=0.016). Overall treatment-related adverse events were not significantly different between the two study groups except that somnolence was significantly more common in the olanzapine group than in the placebo group. CONCLUSIONS: Olanzapine 10 mg combined with ondansetron and dexamethasone was more effective than a placebo in preventing CINV resulting from doxorubicin plus cyclophosphamide in early-stage breast cancer patients, especially in the first 24 hours after chemotherapy administration. The short duration of olanzapine was safe and well tolerated.

Change of serum prealbumin levels and serum protein markers between egg white powder and casein protein additives in standard enteral feeding formulas in critically ill patients with acute respiratory failure.

BACKGROUND: Protein deficiency is a major problem in critically ill patients. Egg white powder recently became a standard additive for protein supplementation in our unit. However, clinical data are not available to support egg white powder supplementation compared to standard protein casein supplementation. This study aimed to determine the change of serum prealbumin (PAB) levels of egg white powder compared to casein additive in standard enteral feeding in critically ill patients with respiratory failure. METHODS: A prospective double-blind, randomized, non-inferiority study was conducted in patients with acute respiratory failure in the medical intensive care unit and respiratory care unit. These patients randomly received 1500 kcal/day of enteral nutrition support with 40 g/day of protein additives by either egg white protein powder or casein protein for 7 days. The serum PAB and C-reactive protein (CRP) levels were measured on days 1, 3, 5, and 7. Repeated-measures ANOVA determined the group effects displayed by serum PAB and CRP levels. p values <0.05 were considered statistically significant. RESULTS: Thirty-four patients were in two groups: 17 in the casein protein group and 17 in the egg white powder group. The clinical characteristics, baseline nutritional status, and biochemistries were not significantly different between the groups. No statistically significant differences were seen in the serum PAB and serum CRP levels between the two groups. The average mean ± SEM difference of serum PAB level between the groups was 2.3 ± 2.5 mg% (p = 0.58). CONCLUSIONS: The levels of PAB between the egg white protein additive and casein protein additive were not significantly different and less than the non-inferior margin. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20160126002.

A 2-year trend of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Thailand: an alert for infection control.

A variety of gram-negative bacteria, particularly Enterobacteriaceae, produce extended-spectrum beta-lactamase (ESBL) resulting in resistance to several beta-lactam agents. These bacteria play a major role in nosocomial infections. While the prevalence of ESBL producers appear to be rapidly increasing worldwide, data from Thailand are rarely reported. We analysed the recent trends in prevalence and antimicrobial resistance among ESBL-producing Escherichia coli and Klebsiella pneumoniae over the 2-year period of August 2005 to July 2007 at a major university hospital in Thailand. The results showed that the prevalence of ESBL producers was very high (up to 65.9% among sputum isolates) and continues to increase. These bacteria also demonstrated a significant increase in resistance rates to several non-beta-lactam antibiotics and expressed a multidrug resistance phenotype at a high rate. This study poses a serious concern for infection control in Thailand and indicates the need for immediate action to prevent further spread of these resistant bacteria.