The Effect of Locally Made Nutritional Supplementation on Cancer Cachexia in Bangladesh: A Quasi-experimental Study.

Background (brief): Burden: Cancer is the sixth leading cause of death in Bangladesh, posing a significant public health challenge. Among the major complications associated with cancer, cachexia remains a critical concern. Cancer cachexia is a multifactorial syndrome characterized by severe and progressive weight loss, muscle wasting, and metabolic dysfunction, significantly impacting patient's overall health. It not only leads to a decline in quality of life but also contributes to poor treatment outcomes and reduced overall survival. Despite its profound clinical implications, effective therapeutic strategies for managing cancer cachexia remain limited. Addressing this condition is essential for improving the prognosis and well-being of cancer patients, highlighting the urgent need for further research and targeted interventions. Knowledge gap: It has been reported that a single nutritional supplement alone is not enough to combat cancer related cachexia. Many commercial formulas are available in the market, but these are costly and out of reach for the people of low- and middle-income countries. Hypothesis (if any): Egg-enriched rice starch water fortified with multivitamins and multimineral is efficient in managing cancer cachexia. Objectives: Our primary objective is to observe the effects of locally developed nutritional supplement on cancer cachexia. Methods: This will be a prospective study with quasi-experimental design to be conducted among the patients with cancer cachexia admitted to a tertiary hospital. Patients will be recruited from the department of surgical oncology, National Institute of Cancer Research \& Hospital (NICRH). Patients in intervention group will receive cooked rice starch water mixed with egg and multivitamin multimineral pre-mix for 14 days, in addition to conventional treatments for cancer. The control group will receive the conventional diet provided from hospital. Outcome measures/variables: Primary: Improvement in serum albumin and haemoglobin after nutritional supplementation Secondary: Change in quality of life, change is basal metabolic index (BMI)

Sex

All

Minimum age

18 Years

Inclusion Criteria:

1. Age- ≥18 years.
2. Either sex
3. Diagnosed case of cancer who met Fearon et al's criteria for cancer cachexia.
4. Informed written consent.

Exclusion Criteria:

1. Patients with severe organ dysfunction, such as: renal failure (chronic kidney disease stage 4 and above), advanced hepatic failure (child-pugh score class B or C), severe cardiac dysfunction (heart failure, arrythmia, acute coronary syndrome).
2. Patient with stage 4 (metastasis) cancer
3. Patients with active gastrointestinal obstruction or any complication that will interfere with oral and tube feeding.
4. Patient who are already getting commercially available nutritional formula or multivitamin, multimineral therapy.
5. Patients with a recent history (e.g., \<3 months) of participation in another nutritional intervention study.
6. Patients who require exclusive parenteral feeding.
7. Patients with a known allergy to egg protein