To assess the effectiveness of tailored food recipe in attenuating the progression of cancer cachexia to refractory cachexia in adult female patients undergoing palliative care in India

Cancer cachexia negatively impacts patients’ capability to undergo chemotherapy and fight infection. Increased energy expenditure and anorexia are key clinical features among cachexia patients leading to body weight loss. Therefore, it is imperative to assess all cancer patients for early signs of undernourishment. Nutrition intervention with counseling may ameliorate undernutrition and metabolic alterations. The aim of this study was to attenuate the progression to refractory cachexia, improve nutritional status and quality of life of female palliative care patients by providing nutrient rich natural food along with counseling. Female cancer patients with symptoms of cachexia were randomly distributed into control and intervention group. Patients were recruited from the Palliative clinic, Oncology department in AIIMS, New Delhi, India; control/placebo groups (for pilot n= 30 and scale-up n=75) and intervention groups (for pilot n= 33 and scale-up n=75). In addition to nutritional and physical activity counseling, intervention patients were instructed to consume 100g nutritional supplement (IAtta) on a daily basis with their normal dietary intake for a six month period, during the pilot study. Moreover, during the scale-up study, the intervention group received 100g of IAtta while the placebo group received 100g of whole wheat flour for daily consumption. Anthropometric measurements, physical activity level (PAL), dietary intake, quality of life (QoL) and biochemical indices were assessed at baseline, three-month and after six-month period. Study variables were analysed using repeated-measures ANOVA and the Friedman test for multi–comparisons to determine the changes within the groups at different time points (i.e. baseline, mid-intervention and post-intervention). Student t-test/ Wilcoxon ranksum tests were performed on the variables to assess the difference between the intervention and control/placebo groups at baseline (P- value ≤0.05; 95% confidence interval). After six months, patients in intervention group (IAtta group) had significant improvement in PAL (p<0.001) and QoL domain (global health status, p<0.001 and fatigue, p=0.001). Conversely, the QoL in the placebo group did not improve (global health status, p=0.74) nor did PAL (p=0.49). Body mass index was maintained in both groups (IAtta, p-value 0.121; Placebo, p-value 0.35). Serum albumin levels were significantly reduced (p = 0.005) in placebo group patients after six months of intervention.

Nutrition sensitive intervention (IAtta meal) along with counseling (tailored nutrition and physical activity) improves quality of life and nutritional status as well as delays progression of cachexia among female palliative care patients. These findings highlight the need to ascertain the nutritional status of cancer patients and underpin the pivotal role of IAtta as intervention tool to compensate for deficient nutrients. It is therefore suggested to embed IAtta into the Indian palliative care framework to modulate cancer progression.