Oncology · Medical Literature
Impact of oral nutritional supplements on chemotherapy tolerance and overall survival in postoperative colorectal cancer patients undergoing chemotherapy.
Abstract
The primary objective of this study was to evaluate the efficacy of oral nutritional supplements (ONS) on chemotherapy tolerance and long-term survival outcomes in postoperative colorectal cancer patients undergoing chemotherapy. This study was a secondary analysis based on a randomized controlled trial, and patients undergoing chemotherapy after hospital discharge were included. Patients in the ONS group received dietary advice as well as ONS for three months, while the control group received only dietary advice. Clinical characteristics and nutritional indicators were collected at baseline and three months after hospital discharge to assess nutritional status. These included body weight, body mass index, skeletal muscle index, serum albumin, and hemoglobin levels. Chemotherapy modifications including dose reduction, delay, and discontinuation were recorded to represent chemotherapy tolerance. The survival information within 5 years was collected and analysed. There were 157 patients included in this study, with 80 patients in the ONS group and 77 in the control group. At three months after hospital discharge, nutrition-related parameters showed no significant differences between the two groups. However, the ONS group demonstrated a significant improvement in chemotherapy tolerance comparing to the control group (17.5% vs. 35.1%, p = 0.01). Additionally, the ONS group exhibited a lower 5-year all-cause mortality rate and significantly improved survival outcomes compared to the control group (hazard ratio 0.58, 95%CI: 0.34-0.98, p = 0.04). The administration of ONS after hospital discharge can improve chemotherapy tolerance and long-term survival rates in colorectal cancer patients under-going chemotherapy, highlighting the importance of nutritional support during postoperative chemotherapy. Further studies are warranted to validate the underlying mechanisms and other long-term effects.
Clinical relevance
Malnutrition and chemotherapy intolerance are major clinical challenges in postoperative colorectal cancer patients, frequently leading to dose modifications that may compromise oncologic outcomes. This secondary analysis of an RCT addresses the underexplored question of whether structured oral nutritional supplementation (ONS) during the post-discharge chemotherapy period can meaningfully improve both treatment delivery and long-term survival. Given the high global burden of colorectal cancer and the practical feasibility of ONS as an intervention, these findings are immediately relevant to oncology and surgical teams managing this population.
Key findings
1. Chemotherapy modification rate (dose reduction, delay, or discontinuation combined) was significantly lower in the ONS group compared to controls (17.5% vs. 35.1%, p = 0.01), representing a clinically meaningful improvement in chemotherapy tolerance. 2. Five-year all-cause mortality was significantly reduced in the ONS group, with a hazard ratio of 0.58 (95% CI: 0.34–0.98, p = 0.04), indicating a 42% relative reduction in mortality risk. 3. The study enrolled 157 postoperative colorectal cancer patients (ONS group n = 80; control group n = 77), with ONS administered for three months post-hospital discharge alongside dietary counseling, versus dietary counseling alone in controls. 4. At three months post-discharge, nutritional parameters — including body weight, BMI, skeletal muscle index, serum albumin, and hemoglobin — showed no statistically significant differences between the two groups, suggesting the survival and tolerance benefits may be mediated by mechanisms beyond measurable macro-nutritional indices. 5. The intervention was time-limited (three months) and initiated at hospital discharge, highlighting a specific and actionable therapeutic window during which ONS may exert its greatest impact on downstream oncologic outcomes.
Practice implications
Oncology and surgical teams should consider prescribing structured ONS for a minimum of three months at hospital discharge for postoperative colorectal cancer patients initiating adjuvant or palliative chemotherapy, particularly those at nutritional risk, given the significant reduction in chemotherapy modification rates and improved 5-year survival. Patient selection should prioritize those with evidence of or risk for malnutrition in the post-discharge period, and ONS should be combined with individualized dietary counseling as part of a multimodal nutritional support strategy. As the specific ONS formulation, dosing, and mechanistic pathways were not fully delineated in this analysis, clinicians should await confirmatory prospective trials while applying these findings as supportive evidence for integrating formal nutrition support into standard postoperative chemotherapy protocols.