Presentation Authors: Janet Baack Kukreja*, Denver, CO, Mohamed Seif, Marisa Lozano, Xuemei Wang, Hyunsoo Hwang, Ashish Kamat, Colin Dinney, Neema Navai, Houston, TX
Introduction: Patients undergoing cystectomy continue to have poor outcomes despite multiple interventions to enhance recovery. Risk factors for poor recovery are limited and patients often place a low priority for meaningful interventions such as nutrition, compliance rates previously have been reported around 60%. Immunonutrition with high dose omega-3 fatty acids and arginine has been found to improve recovery in patients undergoing procedures often associated with poor recovery. However, the volume of some of the immunonutrition supplements is large (over 600ml/day) and can be hard for patients to tolerate. Our objective was to test a novel immunonutrition regimen to see if it was acceptable and tolerable for patients to take in the perioperative period.
Methods: We performed a pilot study as a randomized controlled clinical trial. The study was powered to detect a compliance of 75%, thus 23 patients were needed to take immunonutrition and 23 controls. Patients were enrolled between 9/2017 and 5/2018. Patients were given a high dose arginine supplement four times daily (120ml/day) and omega-3 fatty acid capsules (4 grams/day). Supplementation was started 5 days before surgery and continued 14 days after surgery. Doses were prospectively recorded. A total of 76 doses was the maximum number of doses taken. Patients were followed for total consumption of the prescribed doses as well as queried about the acceptability and attributes of the supplement. Patients were asked to rank the supplements on a scale of 0 to 10, 0 being not acceptable and 10 being very acceptable. The supplement characteristics were rated on a scale of 0 to 10 (0 being not sweet and 10 being very sweet, etc)
Results: A total of 46 participants enrolled in the study. The mean number of supplements taken was 58, 60 for omega-3 and 56 for the high arginine supplement, thus 76% of the total doses were consumed by the patients. Patients rated the supplement as mildly bitter (2), fairly thick (7), mildly sour (2), not salty, having a metallic taste or being gritty (0, 1, 0). Patients did rate the supplement as sweet (9). Patients did find the supplement acceptable (5).
Conclusions: The novel immunonutrition regimen was found to be acceptable to patients with a high compliance rate of taking the prescribed doses. This regimen may serve as an alternative to high volume supplements in the future. Further work is needed on the equivalency to other immunonutrition regimens for the effectiveness of reducing complications.
Source of Funding: The University of Texas MD Anderson SPORE in Genitourinary Cancer