Multimodal Intervention for Cachexia in Advanced Cancer Patients Undergoing Chemotherapy
- Conditions
- CachexiaNeoplasms
- Interventions
- Other: standard careOther: nutritional supplements and adviceOther: home-based self-assisted exercise program
- Registration Number
- NCT02330926
- Lead Sponsor
- Norwegian University of Science and Technology
- Brief Summary
Cancer cachexia is a multi-factorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.
There is an urgency for improving management, but there is no consensus on the optimal treatment for cancer cachexia. Several single therapies for cancer cachexia have been examined in clinical trials, with disappointing overall results. As multiple factors are responsible for the development of cachexia, it has been argued that optimal cachexia interventions should target all components: multimodal therapy for a multimodal problem.
The overall aim of this study is to early prevent the development of cachexia rather than treatment late in the disease trajectory. From a patient perspective a short term effect will be to improve physical and psychological function, to reduce symptom burden and to improve survival. In other words live a longer and better life during and after chemotherapy. Direct effects of the cachexia intervention are expected to be reduction of weight and muscle loss, and improved physical activity and quality of life.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 221
- Diagnosis of lung cancer, pancreatic cancer or cholangiocarcinoma where the diagnosis is based on histological, radiological or multidisciplinary team (MDT) evaluation
- non-small cell lung cancer (stage III or IV), pancreatic adenocarcinoma (stage III or IV), due to commence first or second line anticancer treatment (defined as chemotherapy, chemo-radiotherapy, targeted therapy or immunotherapy)
- staging CT within 4 weeks of commencement of anti-cancer therapy (in patients where staging CT is out-with this period, further CT scanning will be undertaken. PETCT's are also appropriate)
- completed all other baseline assessments within one week prior to first course of anti-cancer treatment
- written informed consent
- able to comply with trial interventions (in the opinion of referring clinician) e.g. willing and able to do light exercise and take oral nutritional supplements as well as no major contraindications against ibuprofen.
- Karnofsky Performance Status >70
- Neuro-endocrine pancreatic cancer
- Creatinine clearance <30ml/min
- Receiving parenteral nutrition or enteral nutrition via feeding tube
- receiving neo-adjuvant anti-cancer therapy
- BMI >30 kg/m2
- Use of appetite stimulants or anabolic/anti-catabolic agents (such as megestrol acetate, progestational agents, marijuana growth hormone, dronabinol, or other anabolic agent) within 30 days prior to study baseline
- Concomitant steroid (>10mg/d prednisolone or equivalent) treatment for less than three months prior to inclusion (inhaled, optical or pulsed oral steroids (up to 10 days use) are permitted)
- Concomitant long term (>1 week) nonsteroidal anti-inflammatory drugs (NSAID) or aspirin treatment
- pregnancy, breast-feeding or of child bearing potential (that is not postmenopausal or permanently sterilised) age and not using adequate contraception (oral, injected, implanted or hormonal methods of contraception, intrauterine device and barrier method)
- Concomitant anti-coagulant treatment (e.g. warfarin or heparin)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description standard care standard care standard palliative care multimodal intervention standard care standard care plus multimodal intervention consisting of nutritional supplements and advice, home-based self-assisted exercise program, and anti-inflammatory medication (ibuprofen) multimodal intervention nutritional supplements and advice standard care plus multimodal intervention consisting of nutritional supplements and advice, home-based self-assisted exercise program, and anti-inflammatory medication (ibuprofen) multimodal intervention home-based self-assisted exercise program standard care plus multimodal intervention consisting of nutritional supplements and advice, home-based self-assisted exercise program, and anti-inflammatory medication (ibuprofen) multimodal intervention Ibuprofen standard care plus multimodal intervention consisting of nutritional supplements and advice, home-based self-assisted exercise program, and anti-inflammatory medication (ibuprofen)
- Primary Outcome Measures
Name Time Method change in body weight 6 weeks
- Secondary Outcome Measures
Name Time Method change in muscle mass 6 weeks change in physical activity 6 weeks
Trial Locations
- Locations (17)
St Olavs Hospital
🇳🇴Trondheim, Norway
Queen Margaret Hospital
🇬🇧Dunfermline, Fife, United Kingdom
Cross Cancer Insitute
🇨🇦Edmonton, Canada
Jewish General Hospital
🇨🇦Montréal, Canada
CA4 Brampton Civic Hospital
🇨🇦Brampton, Canada
Ottawa Regional Cancer Centre
🇨🇦Ottawa, Canada
Universitätsklinikum Bonn
🇩🇪Bonn, Germany
Oslo University Hospital
🇳🇴Oslo, Norway
Cantonal Hospital
🇨🇭St. Gallen, Switzerland
Tumor Zentrum
🇨🇭Aarau, Switzerland
NHS Forth Valley
🇬🇧Larbert, Falkirk, United Kingdom
Llandough Hospital
🇬🇧Cardiff, United Kingdom
Edinburgh Cancer Centre
🇬🇧Edinburgh, United Kingdom
Beatson West of Scotland Cancer Centre
🇬🇧Glasgow, United Kingdom
Chelsea and Westminister Hospital NHS
🇬🇧London, United Kingdom
Guys and St Thomas
🇬🇧London, United Kingdom
Cedars-Sinai Medical Center
🇺🇸Los Angeles, California, United States