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. 2024 Jul 1;116(7):1026-1034.
doi: 10.1093/jnci/djae051.

Dietary interventions in cancer: a systematic review of all randomized controlled trials

Nosakhare Paul Ilerhunmwuwa  1 , Abul Hasan Shadali Abdul Khader  2 , Calvin Smith  3 , Edward R Scheffer Cliff  4 , Christopher M Booth  5 , Evevanne Hottel  6 , Muhammad Aziz  7 , Wade Lee-Smith  8 , Aaron Goodman  9 , Rajshekhar Chakraborty  10 , Ghulam Rehman Mohyuddin  6
Affiliations

Dietary interventions in cancer: a systematic review of all randomized controlled trials

Nosakhare Paul Ilerhunmwuwa et al. J Natl Cancer Inst. .

Abstract

Background: Prior systematic reviews addressing the impact of diet on cancer outcomes have focused on specific dietary interventions. In this systematic review, we assessed all randomized controlled trials (RCTs) investigating dietary interventions for cancer patients, examining the range of interventions, endpoints, patient populations, and results.

Methods: This systematic review identified all RCTs conducted before January 2023 testing dietary interventions in patients with cancer. Assessed outcomes included quality of life, functional outcomes, clinical cancer measurements (eg, progression-free survival, response rates), overall survival, and translational endpoints (eg, inflammatory markers).

Results: In total, 252 RCTs were identified involving 31 067 patients. The median sample size was 71 (interquartile range 41 to 118), and 80 (32%) studies had a sample size greater than 100. Most trials (n = 184, 73%) were conducted in the adjuvant setting. Weight or body composition and translational endpoints were the most common primary endpoints (n = 64, 25%; n = 52, 21%, respectively). Direct cancer measurements and overall survival were primary endpoints in 20 (8%) and 7 (3%) studies, respectively. Eight trials with a primary endpoint of cancer measurement (40%) met their endpoint. Large trials in colon (n = 1429), breast (n = 3088), and prostate cancer (n = 478) each showed no effect of dietary interventions on endpoints measuring cancer.

Conclusion: Most RCTs of dietary interventions in cancer are small and measure nonclinical endpoints. Although only a small number of large RCTs have been conducted to date, these trials have not shown an improvement in cancer outcomes. Currently, there is limited evidence to support dietary interventions as a therapeutic tool in cancer care.

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Conflict of interest statement

Dr Rajshekhar Chakraborty: Consults for Janssen, Sanofi, and Adaptive.

Dr Edward R. Scheffer Cliff: Research funding from Arnold Ventures.

Dr Ghulam Rehman Mohyuddin: Royalties for writing from MashupMD.

Dr Nosakhare Paul Ilerhunmwuwa: Research funding from American Society of Hematology as part of the Minority Hematology Resident Program Initiative.

Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram.
Figure 2.
Figure 2.
Primary endpoints of dietary intervention trials.
Figure 3.
Figure 3.
Percentage of RCTs with achieved primary endpoint by endpoint categorization. Endpoints from RCTs testing dietary interventions in cancer patients were categorized into the following categories: Compliance or feasibility, Translational or preclinical, measurements of Weight or composition or muscle mass, Nonstandard quality-of-life, Various postoperative endpoints, Quality-of-life, Cancer measurements, and Overall survival. Quality-of-life endpoints were defined as validated measurements such as the EORTC QLQ-C30, FACIT-F, FACIT-G, and SF-36 health questionnaires. Nonstandard quality-of-life were measurements of symptom burden without the use of standardized scales, such as chemotherapy or radiation-induced adverse events, infection rates, unspecified measurement scales of QoL, and functional outcomes (such as fatigue). Cancer measurement endpoints were defined as response rates, clinical/biochemical recurrences, progression-free survival, relapse-free survival, and time until cancer recurrence.
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