Probiotics Use During Oncological Surgery: Findings from a Systematic Review and Case-based Discussion with Mohamed Elsayed, ND
Background: Probiotics are live beneficial microorganisms that have shown promise in preventing post-operative complications, and impact on quality of life and symptoms related to the cancer surgery experience. Variations in probiotic interventions, the surgical milieu, and inconsistent outcomes require nuanced synthesis work to inform clinical decisions. One example of this is the recent Nutritional – Enhanced Recovery After Surgery (N-ERAS) protocols, which are increasingly used at some hospitals before, during and after surgery, and can incorporate probiotics alongside other nutritional components aiming to decrease post-operative morbidities and to shorten hospital stays.
Objectives: To evaluate the evidence base for the safety and efficacy of probiotics in patients with cancer during the peri-operative period. To support the concept of integrating naturopathic care with conventional oncology care, particularly in the hospital setting and during the surgical period. Moreover, this evidence base will enable informed decisions to take place with cancer patients about probiotic use around the surgical period and formulate the basis for examination within evidence-informed clinical practice guidelines.
Methods: A rigorous systematic review was conducted following an a priori protocol (PROSPERO registration CRD42018086168). Primary review outcomes were: mortality, cancer treatment response, recurrence, remission, metastasis/disease progression, and stable disease. Secondary outcomes were: adverse events, post-operative infections and antibiotic use, other post-operative complications (i.e., nausea and vomiting, diarrhea, constipation, intestinal obstruction, and ileus), bleeding, length of hospitalization, quality of life, wound healing, pain, anthropometrics, fatigue, cancer biomarkers, immune cells, and inflammatory markers levels. MEDLINE, Embase and Cochrane CENTRAL databases were searched (inception to September 19, 2020) for human studies in English. Study selection and data extraction were done independently in duplicate. Risk-of-bias was appraised for RCTs using the original Cochrane Risk-of-Bias tool, and quality assessment of observational studies was conducted with Newcastle-Ottawa Scale.
Results: 41 articles were included reporting on 38 studies, comprising 32 RCTs (in 35 reports) and 6 comparative observational studies. Many diverse multi-ingredient combinations were evaluated in all but four of the 32 RCTs (87.5%), including one specific formulation (containing Lactobacillus casei strain Shirota, Bifidobacterium breve strain Yakult, and galacto-oligosaccharides) that was used in 6 (19%) RCTs. 28 (87.5%) RCTs investigated oral products, while four (12.5%) administered interventions by enteral nutrition tubes during hospitalization. 29 (91%) RCTs dealt with digestive system cancers; bladder, laryngeal, and head and neck cancers each had one RCT. 22 (69%) RCTs were conducted in Asia, five (15.5%) in Brazil, four (12.5%) in Europe, and one (3%) in USA.
Conclusions: Following the analysis of this large systematic review, which is currently being finalized, results and conclusions will be presented including discussion of study quality. It will focus on presenting the evidence regarding the effects and safety of using probiotics around the surgical period in cancer patients, particularly on post-operative morbidities and their consequences on hospital stay, mortality, other outcomes measured, and the adverse effects related to the use of probiotics. Clinical considerations for application to individual scenarios will also be discussed in a case-based format.
Learning Objectives
-To evaluate the evidence base for the effects and safety of probiotics use in patients with cancer during the peri-operative period.
-To enable informed decisions to take place with cancer patients about probiotic use around the surgical period.
– To formulate the basis for examination within evidence-informed clinical practice guidelines.
-To support the concept of integrating naturopathic care with conventional oncology care, particularly in the hospital setting and during the surgical period.
– To enable collaboration between naturopathic medicine providers and conventional medicine providers.
Background: Probiotics are live beneficial microorganisms that have shown promise in preventing post-operative complications, and impact on quality of life and symptoms related to the cancer surgery experience. Variations in probiotic interventions, the surgical milieu, and inconsistent outcomes require nuanced synthesis work to inform clinical decisions. One example of this is the recent Nutritional – Enhanced Recovery After Surgery (N-ERAS) protocols, which are increasingly used at some hospitals before, during and after surgery, and can incorporate probiotics alongside other nutritional components aiming to decrease post-operative morbidities and to shorten hospital stays.
Objectives: To evaluate the evidence base for the safety and efficacy of probiotics in patients with cancer during the peri-operative period. To support the concept of integrating naturopathic care with conventional oncology care, particularly in the hospital setting and during the surgical period. Moreover, this evidence base will enable informed decisions to take place with cancer patients about probiotic use around the surgical period and formulate the basis for examination within evidence-informed clinical practice guidelines.
Methods: A rigorous systematic review was conducted following an a priori protocol (PROSPERO registration CRD42018086168). Primary review outcomes were: mortality, cancer treatment response, recurrence, remission, metastasis/disease progression, and stable disease. Secondary outcomes were: adverse events, post-operative infections and antibiotic use, other post-operative complications (i.e., nausea and vomiting, diarrhea, constipation, intestinal obstruction, and ileus), bleeding, length of hospitalization, quality of life, wound healing, pain, anthropometrics, fatigue, cancer biomarkers, immune cells, and inflammatory markers levels. MEDLINE, Embase and Cochrane CENTRAL databases were searched (inception to September 19, 2020) for human studies in English. Study selection and data extraction were done independently in duplicate. Risk-of-bias was appraised for RCTs using the original Cochrane Risk-of-Bias tool, and quality assessment of observational studies was conducted with Newcastle-Ottawa Scale.
Results: 41 articles were included reporting on 38 studies, comprising 32 RCTs (in 35 reports) and 6 comparative observational studies. Many diverse multi-ingredient combinations were evaluated in all but four of the 32 RCTs (87.5%), including one specific formulation (containing Lactobacillus casei strain Shirota, Bifidobacterium breve strain Yakult, and galacto-oligosaccharides) that was used in 6 (19%) RCTs. 28 (87.5%) RCTs investigated oral products, while four (12.5%) administered interventions by enteral nutrition tubes during hospitalization. 29 (91%) RCTs dealt with digestive system cancers; bladder, laryngeal, and head and neck cancers each had one RCT. 22 (69%) RCTs were conducted in Asia, five (15.5%) in Brazil, four (12.5%) in Europe, and one (3%) in USA.
Conclusions: Following the analysis of this large systematic review, which is currently being finalized, results and conclusions will be presented including discussion of study quality. It will focus on presenting the evidence regarding the effects and safety of using probiotics around the surgical period in cancer patients, particularly on post-operative morbidities and their consequences on hospital stay, mortality, other outcomes measured, and the adverse effects related to the use of probiotics. Clinical considerations for application to individual scenarios will also be discussed in a case-based format.
Learning Objectives
-To evaluate the evidence base for the effects and safety of probiotics use in patients with cancer during the peri-operative period.
-To enable informed decisions to take place with cancer patients about probiotic use around the surgical period.
– To formulate the basis for examination within evidence-informed clinical practice guidelines.
-To support the concept of integrating naturopathic care with conventional oncology care, particularly in the hospital setting and during the surgical period.
– To enable collaboration between naturopathic medicine providers and conventional medicine providers.
Background: Probiotics are live beneficial microorganisms that have shown promise in preventing post-operative complications, and impact on quality of life and symptoms related to the cancer surgery experience. Variations in probiotic interventions, the surgical milieu, and inconsistent outcomes require nuanced synthesis work to inform clinical decisions. One example of this is the recent Nutritional – Enhanced Recovery After Surgery (N-ERAS) protocols, which are increasingly used at some hospitals before, during and after surgery, and can incorporate probiotics alongside other nutritional components aiming to decrease post-operative morbidities and to shorten hospital stays.
Objectives: To evaluate the evidence base for the safety and efficacy of probiotics in patients with cancer during the peri-operative period. To support the concept of integrating naturopathic care with conventional oncology care, particularly in the hospital setting and during the surgical period. Moreover, this evidence base will enable informed decisions to take place with cancer patients about probiotic use around the surgical period and formulate the basis for examination within evidence-informed clinical practice guidelines.
Methods: A rigorous systematic review was conducted following an a priori protocol (PROSPERO registration CRD42018086168). Primary review outcomes were: mortality, cancer treatment response, recurrence, remission, metastasis/disease progression, and stable disease. Secondary outcomes were: adverse events, post-operative infections and antibiotic use, other post-operative complications (i.e., nausea and vomiting, diarrhea, constipation, intestinal obstruction, and ileus), bleeding, length of hospitalization, quality of life, wound healing, pain, anthropometrics, fatigue, cancer biomarkers, immune cells, and inflammatory markers levels. MEDLINE, Embase and Cochrane CENTRAL databases were searched (inception to September 19, 2020) for human studies in English. Study selection and data extraction were done independently in duplicate. Risk-of-bias was appraised for RCTs using the original Cochrane Risk-of-Bias tool, and quality assessment of observational studies was conducted with Newcastle-Ottawa Scale.
Results: 41 articles were included reporting on 38 studies, comprising 32 RCTs (in 35 reports) and 6 comparative observational studies. Many diverse multi-ingredient combinations were evaluated in all but four of the 32 RCTs (87.5%), including one specific formulation (containing Lactobacillus casei strain Shirota, Bifidobacterium breve strain Yakult, and galacto-oligosaccharides) that was used in 6 (19%) RCTs. 28 (87.5%) RCTs investigated oral products, while four (12.5%) administered interventions by enteral nutrition tubes during hospitalization. 29 (91%) RCTs dealt with digestive system cancers; bladder, laryngeal, and head and neck cancers each had one RCT. 22 (69%) RCTs were conducted in Asia, five (15.5%) in Brazil, four (12.5%) in Europe, and one (3%) in USA.
Conclusions: Following the analysis of this large systematic review, which is currently being finalized, results and conclusions will be presented including discussion of study quality. It will focus on presenting the evidence regarding the effects and safety of using probiotics around the surgical period in cancer patients, particularly on post-operative morbidities and their consequences on hospital stay, mortality, other outcomes measured, and the adverse effects related to the use of probiotics. Clinical considerations for application to individual scenarios will also be discussed in a case-based format.
Learning Objectives
-To evaluate the evidence base for the effects and safety of probiotics use in patients with cancer during the peri-operative period.
-To enable informed decisions to take place with cancer patients about probiotic use around the surgical period.
– To formulate the basis for examination within evidence-informed clinical practice guidelines.
-To support the concept of integrating naturopathic care with conventional oncology care, particularly in the hospital setting and during the surgical period.
– To enable collaboration between naturopathic medicine providers and conventional medicine providers.