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Noninvasive Nutritional Management of Ovarian Cancer Patients: Beyond Intestinal Obstruction

Balogun, Nyaladzi MSc, BSc*; Forbes, Alastair MD, BSc, FRCP, ILTM; Widschwendter, Martin MD, MRCOG*; Lanceley, Anne PhD*

International Journal of Gynecological Cancer: July 2012 - Volume 22 - Issue 6 - p 1089–1095
doi: 10.1097/IGC.0b013e318256e4d3
Quality of Life

Objective: Malnutrition, suffered by more than 50% of patients with ovarian cancer during the course of their disease, significantly compromises the effectiveness of treatment, causes distress, and increases morbidity and mortality. This review outlines the nutritional challenges faced by women with ovarian cancer and evaluates the evidence base for current practice and possible opportunities for intervention in clinical settings.

Methods: PubMed and MetaLib databases were searched for literature on nutrition and cancer/ovarian cancer using terms and truncations covering cancer, cachexia, mouse models, malnutrition, and nutrition intervention. MEDLINE and Cochrane databases were separately searched for interventional studies and clinical and randomized controlled trials published in English (UK/United States) that involved oral nutrition and/or supplementation/intervention in ovarian cancer patients.

Results: Malnutrition continues to be a significant challenge in ovarian cancer management despite significant improvement in treatment pathways and understanding of metabolic pathways and the role of inflammation. There is little evidence of studies designed to evaluate the impact of additional oral nutrients in this population. Seven studies found compared “early” versus “traditional” postoperative oral feeding after major gynecological/oncological surgery, and 1 study evaluated the impact of nutritional status on survival. The 7 studies found evidence of safety, tolerability, reduction in length of hospitalization, and rapid recovery after early feeding. There is no evidence of benefit of additional oral nutrients in this population.

Conclusions: Current guidelines and protocols of nutritional management of ovarian cancer seem to be based on expert opinion. There is need for extensive collaborative evidence for nutritional management decisions made in the treatment of patients. Prospective cohort studies could help evaluate the impact of changes in nutritional status on health/nutritional outcomes, disease recurrence, quality of life, and survival. These would form a basis for well-designed, targeted, randomized controlled trials with specific and controlled nutrients/counseling aimed at preventing rather than treating nutritional complications.

*Department of Women’s Cancer, EGA Institute for Women’s Health, and †Centre for Gastroenterology and Clinical Nutrition, University College London, London, United Kingdom.

Address correspondence and reprint requests to Anne Lanceley, PhD, Department of Women’s Cancer, UCL EGA Institute for Women’s Health, 1st Floor Maple House, 149 Tottenham Court Rd, London W1T 7DN. E-mail: a.lanceley@ucl.ac.uk.

This project was supported by a grant from the UCLH/UCL Comprehensive Biomedical Research Centre.

The authors declare that there are no conflicts of interest.

Received November 2, 2011

Accepted March 22, 2012

Copyright © 2012 by IGCS and ESGO