Originally published as JCO Early Release 10.1200/JCO.2005.02.054 on January 31 2005

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Dietary Counseling Improves Patient Outcomes: A Prospective, Randomized, Controlled Trial in Colorectal Cancer Patients Undergoing Radiotherapy

From Center of Nutrition and Metabolism, Institute of Molecular Medicine; Faculty of Medicine of the University of Lisbon; and Radiotherapy Department of the Santa Maria University Hospital, Lisbon, Portugal

Address reprint requests to Paula Ravasco, MD, Unidade de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal; e-mail: p.ravasco{at}fm.ul.pt

PURPOSE: 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.

PATIENTS AND METHODS: 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.

RESULTS: At radiotherapy completion, energy intake increased in G1/G2 (P .04), G1 more than G2 (P = .001), and decreased in G3 (P < .01). Protein intake increased in G1/G2 (P .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).

CONCLUSION: 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.

Supported by a grant from Núcleo Regional do Sul da Liga Portuguesa contra o Cancro-Terry Fox Foundation.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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