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Nutritional Support Indications in Gastroesophageal Cancer Patients: From Perioperative to Palliative Systemic Therapy. A Comprehensive Review of the Last Decade.

ABSTRACT: Gastric cancer treatments are rapidly evolving, leading to significant survival benefit. Recent evidence provided by clinical trials strongly encouraged the use of perioperative chemotherapy as standard treatment for the localized disease, whereas in the advanced disease setting, molecular characterization has improved patients' selection for tailored therapeutic approaches, including molecular targeted therapy and immunotherapy. The role of nutritional therapy is widely recognized, with oncologic treatment's tolerance and response being better in well-nourished patients. In this review, literature data on strategies or nutritional interventions will be critically examined, with particular regard to different treatment phases (perioperative, metastatic, and palliative settings), with the aim to draw practical indications for an adequate nutritional support of gastric cancer patients and provide an insight on future directions in nutritional strategies. We extensively analyzed the last 10 years of literature, in order to provide evidence that may fit current clinical practice both in terms of nutritional interventions and oncological treatment. Overall, 137 works were selected: 34 Randomized Clinical Trials (RCTs), 12 meta-analysis, 9 reviews, and the most relevant prospective, retrospective and cross-sectional studies in this setting. Eleven ongoing trials have been selected from clinicaltrial.gov as representative of current research. One limitation of our work lies in the heterogeneity of the described studies, in terms of sample size, study procedures, and both nutritional and clinical outcomes. Indeed, to date, there are no specific evidence-based guidelines in this fields, therefore we proposed a clinical algorithm with the aim to indicate an appropriate nutritional strategy for gastric cancer patients.

SUBMITTER: Mulazzani GEG

PROVIDER: S-EPMC8400027 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAs palliative care research continues to expand across Europe, and the world, questions exist about the nature and type of research undertaken in addition to the research priorities for the future. This systematic review, which is the first stage of a larger scale study to identify the research priorities for palliative care on the island of Ireland, examined palliative care research conducted on the island over the last decade.MethodsA comprehensive search strategy was implemented and strict eligibility criteria were applied in order to identify relevant peer-reviewed journal articles. Inclusion criteria were all of the palliative care studies undertaken on the island of Ireland and published between January 2002 and May 2012. These were assessed in relation to year, setting, sample size, research methodology, and relevant findings.Results412 publications were identified for screening and their abstracts obtained. After eliminating articles that did not meet the inclusion criteria, 151 remained for further analysis. A thematic analysis of 128 studies published between 2006 and 2012 revealed eight core themes: (1) specific groups/populations; (2) services and settings; (3) management of symptoms (physical, psychological, social); (4) bereavement; (5) communication and education; (6) death and dying; (7) spirituality; and (8) complementary and alternative medicine/intervention (CAM). There was an upward trend in the number of publications in palliative care research over the last ten years with over 72% of studies being published within the previous four years. A slightly higher number of studies were quantitative in nature (surveys, questionnaires, standardised assessments) followed by qualitative (individual and focus group interviews, case studies, documentary analysis and retrospective case note reviews), mixed methods, and systematic reviews.ConclusionsWhilst there has been a welcome growth in palliative care research across Ireland, this has largely been needs-based and small scale studies. In contrast, international researchers and decision makers recommend the need for more outcomes focused multidisciplinary research. An examination of palliative care research is an essential first step in seeking to develop future priority areas for further research, highlighting opportunities for future collaboration both nationally and internationally.

Project description:This paper reviewed the published data on the levels of different pesticide residues in vegetables (tomato, eggplant, beans, gourds, cauliflower, cabbage, cucumber, potato, carrot, onion, red chilli, red amaranth, lady's finger, spinach, coriander, and lettuce) from Bangladesh in the last decade. Vegetable production in Bangladesh has increased tremendously (37.63%) compared to the last decades, along with its pesticide use. The most observed pesticide groups used in vegetable production were organophosphorus, pyrethroids, carbamate, organochlorine, nereistoxin analogue group, and neonicotinoids. More specifically, chlorpyrifos, dimethoate, diazinon, and malathion were the most used pesticides. More than 29% of the vegetable samples (1577) were contaminated with pesticide residue; among the contaminated samples (458), most cases (73%) exceeded the maximum residue limits (MRLs). The pesticide-contaminated vegetables were cucumber (51%), tomato (41%), cauliflower (31%), miscellaneous vegetables (36%), eggplant (29%), beans (23%), cabbage (18%), and gourds (16%). Among the pesticide-contaminated samples, vegetables with above MRL were gourds (100%), beans (92), tomato (78%), eggplant (73%), miscellaneous vegetables (69%), cucumber (62%), cabbage (50%), cauliflower (50%) (p < 0.05). It was also observed that a single vegetable was often contaminated with multiple pesticides, and farmers did not follow a proper withdrawal period while using pesticides. Hazard quotation (HQ>1) was observed in adolescents and adults in tomato, eggplant, beans, cauliflower, cabbage, cucumber, lady's finger, lettuce, and coriander. There was no health risk observed (HQ<1) in gourds, potato, carrot, onion, red chilli, red amaranth, spinach, and okra. The highest acute and chronic HQ (aHQ, cHQ) was observed for cypermethrin (bean) in adolescents (aHQ=255, cHQ= 510) and adults (aHQ=131, cHQ=263). It was also observed that these pesticides harmed air, soil, water, and non-target organisms. Nevertheless, the review will help the government develop policies that reduce pesticide use and raise people's awareness of its harmful effects.

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Nutritional Support Indications in Gastroesophageal Cancer Patients: From Perioperative to Palliative Systemic Therapy. A Comprehensive Review of the Last Decade.

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