Nutritional Intervention May Improve Outcomes but Is Underresearched in Ovarian Cancer

Interventions such as nutritional counseling in additional to usual disease management have shown promise in the treatment of ovarian cancer based on limited evidence, according to a review published in Maturitas, the official peer-reviewed journal of the European Menopause and Andropause Society. The authors highlighted the need for prospective studies with large sample sizes to adequately evaluate the efficacy of nutritional interventions for patients with ovarian cancer.

Ovarian cancer is often diagnosed at advanced stages, and tumors spreading intra-abdominally can impact nutrient intake and absorption, the authors explained. Therefore, up to 70% of women who present with ovarian cancer are malnourished at the time of diagnosis, and approximately 40% have experienced muscle loss by the time of diagnosis.

During treatments for advanced ovarian cancer, such as cytoreductive surgery or chemotherapy, patients may continue to experience nausea, vomiting, and altered nutrient absorption, increasing the risk of malnutrition. Further, malnutrition in this patient population is associated with postoperative complications, such as longer hospitalization, worse quality of life, and reduced overall survival (OS).

Up to 70% of women who present with ovarian cancer are malnourished at the time of diagnosis, and approximately 40% have experienced muscle loss by the time of diagnosis.

The authors noted that while numerous national and international guidelines are available to guide appropriate nutritional care from diagnosis to treatment, there are no guidelines specific to ovarian cancer. The review explores current evidence on nutritional interventions to mitigate nutritional decline and muscle loss both before and during ovarian cancer treatment.

“In view of the high prevalence of malnutrition and muscle loss among women with ovarian cancer, nutrition interventions are crucial to mitigate the impact of treatment-related side effects, prevent nutritional decline, enhance treatment tolerance, and improve outcomes in this vulnerable patient group,” the authors wrote.

The authors searched Medline, EMBASE, Cochrane, and CINHAL databases from inception though 2023, identifying a total of 7 relevant publications. One study assessed nutritional status and OS, 3 assessed nutritional intervention and surgical outcomes, and 3 explored the impact of nutritional intervention during treatment with chemotherapy.

In 1 retrospective study assessing nutritional intervention and OS, patients who received individualized nutritional counseling with or without oral nutritional supplements showed improved nutritional status based on Subjective Global Assessment. The changes were also associated with improved survival. Improving from malnourished to well-nourished after 3 months of nutrition intervention also correlated with increased OS and reduced mortality risk (HR, 0.30; 95% CI, 0.13-0.69; P = .005). Maintaining nutritional status during treatment was also associated with a lower risk of mortality (HR, 0.15; 95% CI, 0.07-0.32; P < .001). Although the findings were promising, the authors noted that prospective randomized trials are needed because there was heterogeneity among participants and treatment schedules.

There were mixed results in 2 small studies examining oral immunonutrition—or intervention with specific nutrients to modulate immune activity—on length of hospitalization and surgical complications in women with ovarian cancer undergoing surgery. In one study of 28 patients, oral immunonutrition containing arginine, omega-3 fatty acids and nucleotides for 5 days prior to and 5 days after surgery did not impact perioperative or infectious complications. The small sample size may limit the study’s power, the authors noted. Another study including 42 patients suggested that 5 to 10 days of oral immunonutrition preoperatively was associated with shorter length of hospitalization (7.5 days vs 9.2 days [OR, 0.30; 95% CI, 0.10-0.80, P = .01]) as well as a lower rate of serious complications (OR, 0.40; 95% CI, 0.10-0.90; P = .049).

“Although the use of perioperative oral immunonutrition is recommended for all people undergoing major surgery, particularly abdominal surgery and is associated with reduced rates of wound infection in other cancer types, more evidence is required to confirm the benefit in women undergoing surgery for ovarian cancer specifically,” the authors wrote.

Nutritional counseling during treatment with chemotherapy was found to be feasible and acceptable in 2 small mixed-methods studies included in the review, with high adherence and perceived improvements from patients’ viewpoints in 1 study. However, a validated assessment method was not used to determine quality-of-life improvements, the authors noted. In another study, clinically meaningful improvements in both mean protein and energy intakes and quality of life were seen when nutritional interventions were implemented. However, larger studies that are adequately powered must be conducted to confirm such benefits.

Additionally, a randomized controlled trial conducted in 60 women undergoing chemotherapy for ovarian cancer found that a 15-week intervention with oral nutritional supplement and nutrition education was associated with improved Patient Generated-Subjective Global Assessment scores vs a control group only receiving nutrition education.

Overall, while current evidence suggests benefits with nutritional intervention for patients with ovarian cancer, the review highlights the need for more research in this area to confirm these benefits and determine optimal use of such interventions.

“The integration of evidence-based, personalized nutrition care into routine cancer care is an opportunity to improve outcomes and equip women with ovarian cancer with strategies for maintaining nutritional status beyond treatment,” the authors concluded. “Thus, there remains an urgent need for further intervention research to determine appropriate nutrition care.”

Reference

Benna-Doyle S, Baguley BJ, Laing E, Kiss N. Nutritional interventions during treatment for ovarian cancer: A narrative review and recommendations for future research. Maturitas. Published online February 10, 2024. doi:10.1016/j.maturitas.2024.107938