AbstractAim To determine if activelytreated cancerpatients developi - PDF document

Abstract.Aim: To determine if actively-treated cancerpatients developing cachexia could benefit from participationto mindfulness workshops. Patients and Methods: Subjectsdeveloping cachexia signs while treated for cancer wererandomized in a trial aiming to compare an experimentalgroup that would participate to specific workshops based onmindfulness alternating dietetic and psychologicalapproachesand a control group managed in accordance to 6311 Correspondence to:Christian Focan, MD, Ph.D., CHC; CliniqueSaint-Joseph, 75, rue de Hesbaye, B-4000-LIEGE, Belgium. Tel:+32 42248990, Fax: +32 42248991, e-mail: christian.focan@chc.beKey Words: Cachexia, dietetics, mindfulness. Dietetic and Psychological Mindfulness Workshops for the Management of Cachectic Cancer Patients. 0250-7005/2015 $2.00+.40 specifically structured on the concept of mindfulness,workshops developed not only on a psychological dimensionas previously proposed by some authors (6) but also for thefirst time on a dietetic dimension. This type of managementheld as a pilot-project having benefited from a grant from theCancer-Plan Belgium Patients and Methods The study protocol received approval from Clinique Saint-Joseph/597). It was held according to the good clinical practiceregarding human respect and rights.Cancer patients treated in our oncology department developingevidence of cachexia (1, 2) (unw�anted body weight loss =2%) wered rate of albumin and pre-albumin;for the study. They were proposed to be included in a randomizedtrial aiming to compare standard management of cachexia (standarddietetics support; eventual nutritional complements according toversusvoluntary participation to psychological and dietetics workshopsoffering a cognitivo-behavioural approach based on full bodymindfulness philosophy.Mindfulness workshops of maximum 10 patients were animatedalternatively by dedicated psychologists and dieticians. Four doubleworkshops were programmed every 2 weeks. In diets workshops,technics and tasting of particular dishes at the level of the taste, ofthe sense of smell and the texture (touch) were developed. Detailson the coverage proposed in these dietary and psychologicalspecialized workshops is available on request. between the workshops group (group A) and the control group(group B). All subjects benefited from the same clinical andbiological evaluation as well as from the same detailed quantitativeand qualitative food anamnesis (daily ingested total calories anddistribution of calorie intakes in carbohydrates / lipids / proteins).These assessments were proposed before the beginning ofworkshops (time 0; T0), one month later or after 2×2 workshops (T1 month; T1) and 2 months later or after 4×2 workshops (T 2Questionnaires. Furthermore, questionnaires aiming to evaluateadministered to all patients

at the 3 experimental times. For qualityof life, the EORTC-QLQ-C30 well known and largely validatedquestionnaire was elected (7-10) while for mindfulness approach,the FFMQ (Five facet Mindfulness Questionnaire) validated invarious languages (i.e.in french) was applied (11-13). EORTCquestionnaire comprises 30 randomly distributed questions (withquotation from 0 to 4) allowing after grouping to obtain scoring forGlobal Health, Physical, Emotional, Cognitive and Socialfunctioning; also some scorings are centered on symptoms (fatigue;pain; sleep disturbances; appetite) and treatments side-effects (GI-also randomly applied, allowed after grouping to assesspsychological behaviour in terms of Observation, Description,Action, no Judgment and lack of Reactivity (11-13). Data collectedby both questionnaires with the aim of a comparative analysis had tothe value between 0.0 and 100.0%, the more positive for the patientwas the estimated variable (9-11). Finally a satisfaction questionnaire was proposed to subjects at theend of their management. All data, recorded and encoded after eventualnormalization (standardization) and transformation, were statisticallycompared at the 3 experimental times (T0; T 1 month; T 2 months) andthis, for both groups A and B as well as inside each group (comparisonT0 vs other experimental times). All analyses were processed throughthe software SAS v9.2. Continuous data were compared by Student-T,Wilcoxon and Kuskall-Wallis non-parametric tests. Categorical datawere compared by chi-square and exact Fisher tests.Results Screening and recruitment. Between november 2011 and july2013, 551 patients were screened regarding a possiblecachexia. Among them, 429 (77.8%) were fulfilling inclusioncriteria. However only 53 subjects, thus 12.3% of thecandidate population and a majority of women, finally6.5%) or even early deaths (62; 14.5%) or medical refusal(17; 3.9%). Figure 1 presents the flow-chart of the study.Patients characteristics.Patients detailed characteristics arepresented in Tables I and II. Upon inclusion, no statisticaldifference appeared between groups A and B, followingclinical and biological evaluations. Control B group hadmore grade 2 and 3 anorexia (lower rate of metastases (0.06). Similarly no difference ininitial quantitative or qualitative calory intake could beobserved (Table III) . Eight and 10 patients in groups A andB, respectively were receiving nutritional support; onepatient in each group also benefited from an enteral feeding.Compliance of workshops (Group A). the 28 included cases followed the totality of the 8 sessionswhich were re-grouped in 4 sessions of 2 workshops. Thislack of adhesion was surprising although enrolled patientshad given a clear informed and signed consent. Howeverapplied satisfaction questionnaires showed a positive

appreciation of workshops with a satisfaction rate of 75%. Evolution of patients. No difference was observed betweendata recorded at experimental times T1 and T2. Subjectshaving participated to workshops (group A) ultimately had afavourable evolution regarding weight (average weight gain(improvement of +0.31 clinical WHO/ECOG indices (14) (improved in 57.1%only 5.5% in other group, 0.004) (Table IV). On thecontrary no difference could be detected (either betweengroups A and B or insides groups at T0T1/T2 levels)with regards to biological parameters, quantitative or relativequalitative calories intakes (Table III) or nutritional indices(NRS) (15). Similarly, in terms of complementary nutritionalno difference appeared at the 3 experimental times: one caseof enteral feeding in each group at T0; one case of parenteralnutrition at T2 in group A and at T1 in group B and one caseof enteral support at T1 in the same group. Questionnaires of quality of life (EORTC- QLQC-30) and ofgroups A and B at the 3 experimental points (T0; T1 month;T2 months) but also within each group (T0month/T2 - 2 months; also T1T2). The only variables thatsignificantly improved were observed in the experimentalgroup; emotional function, fatigue and digestive disturbances(nausea; vomiting; constipation) (questionnaire EORTC) aswell as faculty of observation (questionnaire FFMQ) (In the control group, only a slight improvement of fatigue andsocial activities were noted (questionnaire EORTC).Discussion To the best of our knowledge, a pluri-disciplinarymanagement involving both psychological and dieteticianteams, proposed to cancer patients, actively treated anddeveloping evolutive cachexia, has never been reported in theliterature. The aim of our approach was to allow patients tobenefit from the mindfulness concept applied both at thepsychological and at the dietary level in dedicatedworkshops. Also at the dietary level, patients were invited toevaluate various aliments by appealing to their 5 senses. Themindfulness psychological method is a cognitivo-behaviouralbuddhism philosophy. Its contribution for the managementof cancer patients has been recently acknowledged (16). Itcomparison to more traditional initiatives, sometimes withpositive outcomes expressed on stress reduction (17, 18).This was evidenced especially within cancer patients insearch of meaning (19). However, by now, it had never beenespecially for cancer patients groups in peculiar difficulty,such as those suffering from evolutive cachexia.difficulties in terms of feasibility as well as at the level ofpatients having finally accepted to participate) or at the levelof general compliance in workshops.Hospital routine. However despite difficulties and hazards,our randomized trial has shown that it was possible to allowsmall groups of cachectic ca

ncer patients to benefit frompsychological and dietary mindfulness workshops. Despite adifficult follow-up with aleatory compliance, it was evidentthat subjects from the experimental group, though presentingat initial assessment with less favourable clinical items (trendFocan : Mindfulness for Cancer Cachexia 6313 Trial flow-chart. to more frequent metastases and more important anorexia),were generally satisfied from their peculiar management.They could enjoy significant weight gain and had an evidentimprovement of their general status. Also their quality of lifewas improved with regard to emotional function, observationfaculty, fatigue and digestive problems.For the future, this type of specialized management couldonly be proposed to especially-motivated patients withneoplastic cachexia. Questions regarding the eventualindividualization of this type of complementary care and thepossibility to implement the initiative earlier in the course oftreatment or disease, thus allowing an eventual prevention ofcachexia, are raised.Conflicts of Interest The Authors have nothing to disclose and indicated no potentialReferences1 Tuca A, Jimenez-Fonseca P and Gascon P: Clinical evaluationand optimal Management of cancer cachexia. Crit Rev Oncol2 Argiles JM, Lopez-Soriano FJ, Toledo M, Betancourt A, Serpe Rand Busquets S: The cachexia score (CASCO): a new tool forstaging cachectic cancer patients. J Cachexia Sarcopenia Muscle Table I. Patients characteristics. NBGroup AGroup B-Value (n=27)(n=26)Limits31-7937-76NSMean 55.456.3M/F5/226/20NSTumor typeBreast98GI-tract66Head & neck 24NSHematology 21NSCLC2…Genito-urinary 64Various0 3 Nb23/2717/260.06 %85.2 65.4No significant difference was observed between groups. A trend to lessmetastases was seen in control group B (Table II.Clinical and biological characteristics of patients. VariableGroup AGroup B-Value Weight (kg)Limits36.2-88.541-91NSMean58.961.6Limits14-3117.7-34.2NSMean 20.922.82 + 3 (%)86.7 80.0 NSAnorexiaGrades 2+3 (%)72.2 40.0 0.02Albumin (gr/l)Limits 29-4428.2-47.5 NS Mean 39.4739.44Pre-albumin (gr/l)Limits0.07-0.280.09-0.40 NSMean 0.190.22Limits0.1-243.10.1-54 NS Mean 30.06 9.84 Less severe anorexia was observed in control group B. Table III.Total daily calory intake at the three experimental times. Experimental timeGroup A Group B-Value Mean 15921713 NSLimits1168-2174 965-3260Mean15131702NSLimits1100-2065419-3341Mean14711562NS Limits1085-1768800-2970No difference was observed between groups at either evaluationTable IV.Weight BMI and clinical indices evolution. VariableGroup AGroup B-Value WeightMean variation (kg)+1.32…1.470.01Limits (kg)…1.4-+5.8…10-+1.0Mean variation +0.31 …0.570.04Limits …1.1-+1.2 …4.8-+2.4 % improvement 57.1 5.5 0.004No difference was observed between T1 and T2 assessment times. 3 Kabat-Zinn J: An out-

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