Advancing Naturopathic Care of Patients Undergoing Cancer Surgery: Examples from a Systematic Review and Meta-analysis of Branched-chain Amino Acids with Elise Cogo, ND, MSc, MLIS
Background: The Patterson Institute for Integrative Cancer Research was established at CCNM 4 years ago. Our mission is to support further integration of naturopathic and whole person care with conventional oncology care, providing the people living with cancer the opportunity to make informed choices about their care. High-quality systematic reviews can facilitate our goal of integrating patient care. We previously mapped evidence from over 200 reviews of human controlled trials in integrative oncology to focus our research agenda. We are conducting a series of systematic reviews to inform the development of evidence-informed best practice guidance in integrative oncology care.
A unique opportunity currently exists for integrating naturopathic care during the surgical period due to recent significant changes in many hospitals from the gradual implementation of new Enhanced Recovery After Surgery (ERAS©) guidelines. Among several recommendations related to nutrition, ERAS liver guidelines (2016) advise early oral intake of solid foods post-operatively, with oral nutritional supplementation being reserved for malnourished patients or those with prolonged fasting due to complications and preference in these cases is given to enteral over parenteral nutrition. However, current conventional recommendations for the optimal specific types of oral nutritional supplements are unclear.
The branched-chain amino acids (BCAAs) leucine, isoleucine and valine are essential amino acids involved in protein synthesis and immune responses. Patients undergoing cancer surgery are often protein malnourished or at risk of malnutrition, and can be in a catabolic state, thus increasing the demand for BCAAs. Furthermore, patients with liver cancer can have a decreased ratio of BCAAs to aromatic amino acids (Fischer’s ratio), and BCAAs administration may help correct this imbalance. A comprehensive systematic review of BCAAs use during the oncology peri-operative period has not been published.
Research Objectives: To evaluate and synthesize the evidence base on the safety and efficacy of BCAAs use in patients with cancer undergoing surgery.
Methods: A rigorous systematic review with meta-analysis was conducted following an a priori protocol. Detailed methods were registered on the PROSPERO website (CRD42018086168).
Results: 20 articles were included comprising 13 RCTs and 6 observational cohort studies (in 7 reports) and 2019 total participants. 77% of RCTs involved liver cancer. 69% of RCTs evaluated oral intake of BCAAs, while 31% administered them intravenously. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analyses found BCAAs had several significant beneficial effects compared to controls, including 38% decreased risk of post-operative infections (p=0.006), 45% reduction in the risk of ascites (p=0.008), 3 kg greater body weight (p=0.02), and 2-day shorter hospital stay (p=0.03). No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns were identified from observational studies.
Conclusions: BCAAs during the oncological surgical period demonstrated promise in reducing important post-operative morbidity. In addition to summarizing the main systematic review and meta-analysis methods, results and conclusions, including a discussion of study quality, this presentation will outline the opportunities that currently exist for advancing naturopathic oncology care during the surgical period due to recent hospital ERAS protocols.
Learning Objectives
Evaluate the evidence base for the safety and efficacy of branched-chain amino acids use during the oncology surgical period.
Appreciate the clinical application of branched-chain amino acids for patients undergoing cancer surgery.
Analyze the opportunities for advancing the integration of naturopathic oncology within the context of recent hospital Enhanced Recovery After Surgery guidelines.
Background: The Patterson Institute for Integrative Cancer Research was established at CCNM 4 years ago. Our mission is to support further integration of naturopathic and whole person care with conventional oncology care, providing the people living with cancer the opportunity to make informed choices about their care. High-quality systematic reviews can facilitate our goal of integrating patient care. We previously mapped evidence from over 200 reviews of human controlled trials in integrative oncology to focus our research agenda. We are conducting a series of systematic reviews to inform the development of evidence-informed best practice guidance in integrative oncology care.
A unique opportunity currently exists for integrating naturopathic care during the surgical period due to recent significant changes in many hospitals from the gradual implementation of new Enhanced Recovery After Surgery (ERAS©) guidelines. Among several recommendations related to nutrition, ERAS liver guidelines (2016) advise early oral intake of solid foods post-operatively, with oral nutritional supplementation being reserved for malnourished patients or those with prolonged fasting due to complications and preference in these cases is given to enteral over parenteral nutrition. However, current conventional recommendations for the optimal specific types of oral nutritional supplements are unclear.
The branched-chain amino acids (BCAAs) leucine, isoleucine and valine are essential amino acids involved in protein synthesis and immune responses. Patients undergoing cancer surgery are often protein malnourished or at risk of malnutrition, and can be in a catabolic state, thus increasing the demand for BCAAs. Furthermore, patients with liver cancer can have a decreased ratio of BCAAs to aromatic amino acids (Fischer’s ratio), and BCAAs administration may help correct this imbalance. A comprehensive systematic review of BCAAs use during the oncology peri-operative period has not been published.
Research Objectives: To evaluate and synthesize the evidence base on the safety and efficacy of BCAAs use in patients with cancer undergoing surgery.
Methods: A rigorous systematic review with meta-analysis was conducted following an a priori protocol. Detailed methods were registered on the PROSPERO website (CRD42018086168).
Results: 20 articles were included comprising 13 RCTs and 6 observational cohort studies (in 7 reports) and 2019 total participants. 77% of RCTs involved liver cancer. 69% of RCTs evaluated oral intake of BCAAs, while 31% administered them intravenously. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analyses found BCAAs had several significant beneficial effects compared to controls, including 38% decreased risk of post-operative infections (p=0.006), 45% reduction in the risk of ascites (p=0.008), 3 kg greater body weight (p=0.02), and 2-day shorter hospital stay (p=0.03). No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns were identified from observational studies.
Conclusions: BCAAs during the oncological surgical period demonstrated promise in reducing important post-operative morbidity. In addition to summarizing the main systematic review and meta-analysis methods, results and conclusions, including a discussion of study quality, this presentation will outline the opportunities that currently exist for advancing naturopathic oncology care during the surgical period due to recent hospital ERAS protocols.
Learning Objectives
Evaluate the evidence base for the safety and efficacy of branched-chain amino acids use during the oncology surgical period.
Appreciate the clinical application of branched-chain amino acids for patients undergoing cancer surgery.
Analyze the opportunities for advancing the integration of naturopathic oncology within the context of recent hospital Enhanced Recovery After Surgery guidelines.
Background: The Patterson Institute for Integrative Cancer Research was established at CCNM 4 years ago. Our mission is to support further integration of naturopathic and whole person care with conventional oncology care, providing the people living with cancer the opportunity to make informed choices about their care. High-quality systematic reviews can facilitate our goal of integrating patient care. We previously mapped evidence from over 200 reviews of human controlled trials in integrative oncology to focus our research agenda. We are conducting a series of systematic reviews to inform the development of evidence-informed best practice guidance in integrative oncology care.
A unique opportunity currently exists for integrating naturopathic care during the surgical period due to recent significant changes in many hospitals from the gradual implementation of new Enhanced Recovery After Surgery (ERAS©) guidelines. Among several recommendations related to nutrition, ERAS liver guidelines (2016) advise early oral intake of solid foods post-operatively, with oral nutritional supplementation being reserved for malnourished patients or those with prolonged fasting due to complications and preference in these cases is given to enteral over parenteral nutrition. However, current conventional recommendations for the optimal specific types of oral nutritional supplements are unclear.
The branched-chain amino acids (BCAAs) leucine, isoleucine and valine are essential amino acids involved in protein synthesis and immune responses. Patients undergoing cancer surgery are often protein malnourished or at risk of malnutrition, and can be in a catabolic state, thus increasing the demand for BCAAs. Furthermore, patients with liver cancer can have a decreased ratio of BCAAs to aromatic amino acids (Fischer’s ratio), and BCAAs administration may help correct this imbalance. A comprehensive systematic review of BCAAs use during the oncology peri-operative period has not been published.
Research Objectives: To evaluate and synthesize the evidence base on the safety and efficacy of BCAAs use in patients with cancer undergoing surgery.
Methods: A rigorous systematic review with meta-analysis was conducted following an a priori protocol. Detailed methods were registered on the PROSPERO website (CRD42018086168).
Results: 20 articles were included comprising 13 RCTs and 6 observational cohort studies (in 7 reports) and 2019 total participants. 77% of RCTs involved liver cancer. 69% of RCTs evaluated oral intake of BCAAs, while 31% administered them intravenously. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analyses found BCAAs had several significant beneficial effects compared to controls, including 38% decreased risk of post-operative infections (p=0.006), 45% reduction in the risk of ascites (p=0.008), 3 kg greater body weight (p=0.02), and 2-day shorter hospital stay (p=0.03). No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns were identified from observational studies.
Conclusions: BCAAs during the oncological surgical period demonstrated promise in reducing important post-operative morbidity. In addition to summarizing the main systematic review and meta-analysis methods, results and conclusions, including a discussion of study quality, this presentation will outline the opportunities that currently exist for advancing naturopathic oncology care during the surgical period due to recent hospital ERAS protocols.
Learning Objectives
Evaluate the evidence base for the safety and efficacy of branched-chain amino acids use during the oncology surgical period.
Appreciate the clinical application of branched-chain amino acids for patients undergoing cancer surgery.
Analyze the opportunities for advancing the integration of naturopathic oncology within the context of recent hospital Enhanced Recovery After Surgery guidelines.