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A retrospective study of the effect of oral supplementation with immunonutrients on radiation-induced hematologic toxicity in cancer patients: a preliminary study

A. Gaerlan, M. C. Saniel, F. Moog, F. Llido, M. Calaguas. M.D

Purpose/Objective(s): Radiation therapy in cancer patients causes hematologic abnormalities mainly resulting to decrease in the blood counts induced by radiation toxicity. The current availability of immunonutrients holds promise of modulating these adverse effects. Objective: To determine the effect of oral supplementation with immunonutrients on patients with cancer un- dergoing radiation therapy on the following hematologic indices: hemoglobin, total WBC, neutrophil, lymphocyte, and platelet counts.

Materials/Methods: Cancer patients who underwent radiotherapy from year 2007 to 2009 were grouped according to their diet: Study Group (n = 24) which received standard diet plus oral nutritional supplements composed of an immunonutrition regimen and a Control Group (n = 32) which only had standard diet. The oral supplement is a 200 ml drink given twice per day providing 600 kcal, 40 g protein, 40% fat for energy, MCT = 6.4 g, EPA (eicosapentanoic acid) = 2 g, antioxidants (Vit A = 600 ug, Vit C = 75.2mg, Vit E = 15 mg, B-carotene = 1500 ug), zinc = 8 mg, selenium = 54 ug, and Fiber = 6 g). The hematologic data: hemoglobin, total WBC count, neutrophil count, lymphocyte count, and platelet count, were taken at the start and after the completion of the prescribed radiation dose. The results were analyzed using unpaired t-test.

Results: In the study group the following blood indices were higher compared to the control group at the end of radiation therapy: hemoglobin in gm% (12.8 . 11.8, p = 0.002), total WBC (7276 . 4877, p = 0.0005), and neutrophil count (5363 . 3315, p = 0.0007). The platelet pattern in the control group showed a significant decreasing pattern (265 / 231, p = 0.003) while in the study group the decrease was not significant (278 /254 p = 0.098). There was no difference in the lymphocyte count.

Conclusions: Oral supplementation with immunonutrients in cancer patients undergoing radiation therapy resulted to lesser hematologic toxic changes in hemoglobin, total WBC, and neutrophil count. This advantage is possibly due to the high calorie, high protein, high fat (omega 3-fatty acids) and low carbohydrate diet together with the antioxidants and vitamins and minerals (e.g. selenium, vitamin C, vitamin B12 and folic acid) known to help increase these blood components.