The Effect of Special Diets in Hematological Cancer Patients
The Effect of Special Diets in Hematological Cancer Patients
Major weight loss and taste changes are well documented in patients with hematological cancer
 during chemotherapy. It has previously been documented, that such patients have preferences
 for much umami, a little sweet, sour and salt, and no bitter. The purpose of the study was to
 convert these results into real diets. Patients participated in two sensory pilot studies
 (n=10), where dishes were tested for preferences before and after chemotherapy. From these
 results four dishes were selected and tested on 32 patients in 30 days in a cross-over
 design. The diets resulted in a beneficial and statistical significant difference in weight
 development (p= 0.0008), with 1.2 ± 1.9 kg (+2%) in the intervention period and -2.8 ± 5.2 kg
 (-4%) in the control period. This difference persisted after sensitivity analysis (± 10%) p=
 0.005. However, the nutritional intake was still low in both periods, and the treatment with
 cytarabin turned out to be a major confounder as dosage was significantly higher in the
 control period.
The study was approved by the regional scientific ethical committee, and was registered in
 ClinicalTrial.gov NTC no………...

 Patients were selected consecutively with acute and chronic leukemia and lymphoma, Hodg-kin's
 lymphoma, and Non-Hodgkin's lymphoma in treatment with chemotherapy.

 Eligible patients were aged >18 years, and only patients who were able to com-municate and
 understand written and oral information and receive food orally were included. The special
 diets were developed at the Central Kitchen at Rigshospitalet Initially, two single blinded
 pilot studies of five patients were performed, with the same inclusion and exclusion criteria
 as the main study. In the first study patients tested 17 dishes with a taste-mix of
 dominating umami, a little sweet, sour and salt, and no bitter. In the second round six
 dishes were selected based on the results from the first round. All dishes had a high
 energy-density, with a protein content of at least 5 g/100 g. Every dish was tested both
 before and after chemotherapy. Patients rated acceptability on 9-point scales.

 The clinical controlled cross-over design with two periods of four weeks, intervention and
 control, tested four dishes selected after the second pilot study. 32 patients were included
 in that trial, and they started with their habitual diet as control and then switched to
 recommendation of introduction of the four dishes selected.

 The patients registered their weight every time they were at the hospital. During the
 intervention period the patients received a recipe booklet with the four dishes and a noted
 every time they ingested one of these. Compliance measurements were based on this
 registration. Patients had access to the dishes when in-patients, but they did their own
 cooking at home. It was possible to buy the similar dishes as pre-prepared meals in the
 supermarkets. The dishes in the final study were: Chili con Carne, Chicken in Curry, Curry
 Soup and Pasta Carbonara with added curry.

 Data were analyzed with R (version 2.15.3). In histograms used to show the degree of
 acceptability for the dishes in the pilot studies, answers above 5 were graded as high grade
 of acceptance. To present descriptive statistics, the results were expressed as mean ±
 standard deviation (SD), median (interquartile range (IQR)) and range. As the data did not
 show a normal distribution, Wilcoxon rang-sum tests (paired and unpaired) were used. Analyses
 were carried out both according to intention-to- treat (ITT) and per-protocol (PP)
 principles. As many of the data sampled, especially the subjective ones, sensitivity analysis
 (± 10% correction of the results) were performed.
Inclusion Criteria:

 -  Hematological cancer

 -  Ongoing chemotherapy

 -  Ability to eat by mouth

 -  Informed consent

 Exclusion Criteria:

 -  Lack of the ability to understand the informations given

 -  Lack of the ability to understand the conditions of the experiment