Impact of Early and Active Nutritional and Dietary Management grade3 or More Toxicities Induced by Chemotherapy and Targeted Therapies Administered to Patients as First Intention for Non Surgical Metastatic Colorectal Cancer (CHIMIODIET)
Description of active nutritional support: Early and active nutritional support is mainly concerned with maintaining protein and energy intake levels despite chemotherapy. A part-time nutritionist will be assigned to each research centre. She will cover active nutritional support during a one-hour consultation and assist the investigating oncologist in filling out the e-CRF data. A two-day meeting prior to the beginning of the study will enable the standardization of active nutritional support strategy across all research centres:
- The nutritionist will explain the consequences of the side effects of chemotherapy on appetite levels and nutritional status.
- Spontaneous oral intake and eating habits will be assessed based on a qualitative and quantitative 3-day food record.
- Then the nutritionist will explain to patients how to adapt their diet (fortification, portion control etc.) according to personal preferences and dietary habits, appetite fluctuation and side effects.
- A booklet containing an overview of the nutritional counsel, recipe ideas, an example of a daily menu, energy equivalence tables and specific diet and hygiene tips for each possible side effects of chemotherapy will be given to all patients.
- During each consultation, patients will be weighed, appetite and food intake will be evaluated (24-hour record except for prospective 3-day record of V0, V3, V6, V9, V12, V13 and V14 consultations), chemotherapy side effects will be recorded and nutritional counsel will be adapted to each patient's individual situation. In case of decrease in food intake and/or weight loss, a protein- and energy-rich oral supplement will be given.
In both groups, if a patient exhibits signs of malnutrition (weight loss >5% over a one-month period or > 10% in total) and/or food intake less than 50% of estimated daily requirements, an oral supplement will be given after approval of the oncologist. If this measure is insufficient, artificial nutrition (enteral or parenteral) will be considered.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
|Official Title:||Chimiodiet Study:Impact of Early and Active Nutritional and Dietary Management on grade3 or More Toxicities Induced by Chemotherapy and Targeted Therapies Administered to Patients as First Intention for Non Surgical Metastatic Colorectal Cancer.|
- Toxicities frequently associated with chemotherapy [ Time Frame: 2 weeks ]Number and grade of: diarrhoea,nausea,vomiting, oral mucositis,fatigue, neurotoxicities, dysgeusia,haematological toxicities such as leukopenia neutropenia,anemia and thrombocytopenia.
- Nutritional status of patients [ Time Frame: 2 weeks ]Measures: weight, body mass index
- Appetite measures [ Time Frame: 2 weeks ]Spontaneous food intake, EVA
- Quality of life [ Time Frame: 3 months ]questionary EORTC QLQ-C30
- Number of occurrences of grades 1 and 2 toxicities [ Time Frame: 2 weeks ]
- The number of hospital days [ Time Frame: All study ]
- Overall survival [ Time Frame: All study ]
|Study Start Date:||April 2010|
|Study Completion Date:||April 2016|
|Primary Completion Date:||December 2014 (Final data collection date for primary outcome measure)|
Experimental: I - Early and active nutritional support.
During the initial consultation, the dietician will answer the questions of the patient and their family. Patients will be seen regularly in follow-up for weight measurement, serum albumin assay, a 1 or 3 day food record and an evaluation of appetite level. Nutritional counselling is then adjusted accordingly and:Balanced meals are continued if weight is stable and appetite is undiminished.Protein and energy fortification is recommended if weight loss is observed or if food intake decreases between 2 consultations leading to total food intake of less than 50% of required food intake. When a patient presents with signs of malnutrition according to the criteria set out by the Authority for Health, oral nutritional support (ONS) is set up, in agreement with the department head. Two 200ml bottles of Fortimel Extra are to be taken every day. If this ONS strategy is insufficient to improve the patient's nutritional status, artificial nutrition should be discussed.
Other: Early and active nutritional support.
The first nutritional consultation coincides with the 1st CT consultation. An overview of the nutritional support strategy is given, along with specific goals and the twice monthly follow-up schedule that accompanies the chemotherapy courses. The nutritionist once again goes over the various side effects of the medication. Special attention will be given to digestive side effects and their consequences on appetite levels and weight loss during treatment.A qualitative and quantitative 3-day food record will precede the 1st course of CT. This food record is given to patients during the 1st selection visit, in order to evaluate spontaneous oral food intake and dietary habits. Information from the different food groups serves as a starting point for the dietician to explain how to adapt food intake through fortification, portion control according to appetite fluctuations and the onset of side effects.
No Intervention: II - No nutritional support
Should malnutrition develop in a group II patient, ONS will be ordered. It will consist of two 200ml Fortimel Extra* bottles per day in addition to regular meals. Ideally, the ONS should be taken as a snack outside of meal times so as to not spoil the appetite. If this ONS is insufficient to improve the nutritional status of the patient, artificial nutrition (either enteral or parenteral) will be discussed.
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01143285
|Institut Sainte Catherine|
|Avignon, France, 84082|
|The Léon Bérard Cancer Centre|
|Lyon, France, 69373|
|Assistance Publique des hopitaux de Marseille|
|Marseille, France, 13385|
|The Val d'Aurelle Cancer Centre|
|Montpellier, France, 34298|
|University Hospital, Montpellier|
|Montpellier, France, 34298|
|The Antoine Lacassagne Cancer Centre|
|Nice, France, 06000|
|The digestive oncology departement of the Archet Hospital of the Nice University Hospital Centre|
|Nice, France, 06202|
|Hospital in Perpignan|
|Principal Investigator:||Xavier HEBUTERNE, PU-PH||CHU de NICE|