April 2003

Dear Readers: Here's the Article for this Month:

Name of article:

Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study

Author(s): Bruera E, Strasser F, Palmer JL, Willey J, Calder K, Amyotte G, Baracos V
Reference: J Clinical Oncology 2003; 21: 129-134

Abstract: 

Cachexia occurs in more than 80% of patients with advanced cancer. These patients present loss of appetite, chronic nausea, fatigue, and changes in body weight, lean body mass, and total body fat. Fish oil capsules are frequently used as a form of complementary, or alternative medicine, by cancer patients. In a previous controlled study carried out on 60 cancer patients (Gogos et al. Cancer 1998; 82: 395-402) who were treated with fish oil till death, an advantage on survival and an increase in performance status was noted, but no changes in body weight or albumin level were observed. No data were collected as to the assessment of subjective symptoms referred to by the patients.

The aim of the present study (Bruera et al. 2003) was to determine whether high doses of fish oil, administered over 2 weeks, improved symptoms in patients with advanced cancer who presented a decrease in weight and appetite. Sixty patients were randomized to receive a daily dose of 18 gelatin capsules containing either 1,000 mg of fish oil ( containing 180 mg of EPA, 120 mg of docosahexaenoic acid, and 1 mg of vitamin E) or 1,000 mg of a placebo (olive oil).

At baseline and on day 14 the following subjective and objective symptoms were measured:

-appetite, nausea, tiredness, and patients’ overall sensation of well-being (using a Visual analogue scale)

-anthropometric measurements (weight, body composition by means of multiple-frequency bioimpedance analysis, arm muscular circumference, arm triceps and subscapular skinfold)

-patients’ function level (using the Karnofsky performance scale and Edmonton Functional Assessment Test)

-food intake was recorded by estimating food quantities with reference to standard portions.

The mean daily dose was 10 +/- 4 (fish oil group) (which provided 1.8 g of EPA and 1.2 g of docosahexaenoic acid) and 9 +/- 3 (placebo group) capsules.

The authors did not find significant improvement in appetite, other symptoms, nutritional status, performance status after the administration of fish oil for 2 weeks compared with placeboThey did not observe any correlation between most subjective and objective outcomes between days 1 and 14 in the fish oil group. The majority of patients were not able to swallow more than 10 fish oil capsules per day because of burping and fish oil aftertaste.

Why I chose this Article: 

Cachexia/anorexia are very common in advanced cancer patients and are among the causes of worsening of quality of life. This study shows that the assessment of subjective symptoms such as appetite, nausea, tiredness, asthenia and patients’ overall sensation is paramount in RCTs carried out to evaluate the efficacy of a drug in cachectic advanced cancer patients.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC