Introduction
Methods
Inclusion and exclusion criteria
Inclusion criteria | Exclusion criteria |
---|---|
Cancer patients (all types) Intervention: fasting, caloric restriction patient-reported outcomes, adverse events randomized controlled trial, controlled trial, systematic review, one-armed studies, case series | Healthy patients, patients with precancerous lesions primary prevention, preclinical study (in vivo, in vitro) multimodal interventions without separate evaluation laboratory data grey literature (abstracts, letters, ongoing trials) Reviews without systematic research |
Study selection
Database | Searchstring |
---|---|
Ovid Medline | 1 exp Fasting/ OR ((Exp diet therapy/ OR diet.mp.) AND (fasting).mp.) |
2 exp neoplasms/ or neoplasm$.mp or cancer$.mp. or tumo?r$.mp. or malignan$.mp. or oncolog$.mp. or carcinom$.mp. or leuk?emia.mp. or lymphom$.mp. or sarcom$.mp | |
3 1 AND 2 | |
4 limit 3 to english or limit 3 to german | |
5 (4 and humans/) or (4 not animals/) | |
6 ((((comprehensive* or integrative or systematic*) adj3 (bibliographic* or review* or literature)) or (meta-analy* or metaanaly* or "research synthesis" or ((information or data) adj3 synthesis) or (data adj2 extract*))).ti,ab. or (cinahl or (cochrane adj3 trial*) or embase or medline or psyclit or (psycinfo not "psycinfo database") or pubmed or scopus or "sociological abstracts" or "web of science" or central).ab. or ("cochrane database of systematic reviews" or evidence report technology assessment or evidence report technology assessment summary).jn. or Evidence Report: Technology Assessment*.jn. or (network adj1 analy*).ti,ab.) or (((review adj5 (rationale or evidence)).ti,ab. and review.pt.) or meta-analysis as topic/ or Meta-Analysis.pt.) | |
7 Randomi?ed controlled trial?.pt. or controlled clinical trial?.pt. or randomi?ed.ti,ab.or placebo.ti,ab. or drug therapy.sh. or randomly.ti,ab. or trial?.ti,ab. or group?.ti,ab | |
8 5 AND (6 OR 7) | |
9 5 NOT 8 | |
Ovid Embase | 1 exp diet restriction OR ((exp diet / OR exp diet therapy/ OR diet.mp.) AND (fasting).mp.) |
2 exp neoplasm/ or neoplasm$.mp or cancer$.mp. or tumo?r$.mp. or malignan$.mp. or oncolog$.mp. or carcinom$.mp. or leuk?emia.mp. or lymphom$.mp. or sarcom$.mp | |
3 1 AND 2 | |
4 limit 3 to english or limit 3 to german | |
5 (4 and humans/) or (4 not animals/) | |
6 ((((comprehensive* or integrative or systematic*) adj3 (bibliographic* or review* or literature)) or (meta-analy* or metaanaly* or "research synthesis" or ((information or data) adj3 synthesis) or (data adj2 extract*))).ti,ab. or (cinahl or (cochrane adj3 trial*) or embase or medline or psyclit or (psycinfo not "psycinfo database") or pubmed or scopus or "sociological abstracts" or "web of science" or central).ab. or ("cochrane database of systematic reviews" or evidence report technology assessment or evidence report technology assessment summary).jn. or Evidence Report: Technology Assessment*.jn. or (network adj1 analy*).ti,ab.) or (exp Meta Analysis/ or ((data extraction.ab. or selection criteria.ab.) and review.pt.)) | |
7 crossover procedure/ or double blind procedure/ or randomized controlled trial/ or single blind procedure/ or (random$ or factorial$ or crossover$ or (cross adj1 over$) or placebo$ or (doubl$ adj1 blind$) or (singl$ adj1 blind$) or assign$ or allocat$ or volunteer$).ti,ab,de | |
8 5 AND (6 OR 7) | |
9 5 NOT 8 | |
Cochrane | #1 [mh fasting] or ([mh “diet therapy”] OR diet) AND fasting |
#2 [mh neoplasms] or neoplasm* or cancer? or tum*r? or malignan* or oncolog* or carcinom* or leuk*mia or lymphoma? or sarcoma? | |
#3 #1 AND #2 | |
Ebsco—PsychINFO | S1 (DE “Diet” OR TX diet) AND TX (fasting) |
S2 ((DE "Neoplasms" OR DE "Benign Neoplasms" OR DE "Breast Neoplasms" OR DE "Endocrine Neoplasms" OR DE "Leukemias" OR DE "Melanoma" OR DE "Metastasis" OR DE "Nervous System Neoplasms" OR DE "Terminal Cancer") OR (TX neoplasm* OR TX cancer OR TX tumo#r OR TX malignan* OR DE „oncology “ OR TX oncolog* OR TX carcinom* OR TX leuk#emia OR TX lymphoma OR TX sarcoma)) | |
S3 (LA German OR LA English) | |
S4 S1 AND S2 AND S3 | |
S5 ((comprehensive* OR integrative OR systematic*) N3 (bibliographic* OR review* OR literature)) OR (meta-analy* or metaanaly* or "research synthesis" OR ((information OR data) N3 synthesis) OR (data N2 extract*)) OR ((review N5 (rationale OR evidence)) AND DE "Literature Review") OR (AB(cinahl OR (cochrane N3 trial*) OR embase OR medline OR psyclit OR pubmed OR scopus OR "sociological abstracts" OR "web of science" OR central)) OR DE "Meta Analysis" OR (network N1 analy*) | |
S6 DE "Treatment Effectiveness Evaluation" OR DE "Treatment Outcomes" OR DE "Psychotherapeutic Outcomes" OR DE "Placebo" or DE "Followup Studies" OR placebo* OR random* OR "comparative stud*" OR (clinical N3 trial*) OR (research N3 design) OR (evaluat* N3 stud*) OR (prospectiv* N3 stud*) OR ((singl* OR doubl* OR trebl* OR tripl*) N3 (blind* OR mask*) | |
S7 S4 AND (S5 OR S6) | |
S8 S4 NOT S7 | |
Ebsco- CINAHL | S1 MH “Fasting” OR ((MH “Diet + ” OR TX diet) AND TX (fasting) |
S2 (MH "Neoplasms + " OR TX neoplasm* OR TX cancer OR TX tumo#r OR TX malignan* OR TX oncolog* OR TX carcinom* OR TX leuk#emia OR TX lymphoma OR TX sarcoma) | |
S3 (LA German OR LA English) | |
S4 S1 AND S2 AND S3 | |
S5 (TI (systematic* n3 review*)) or (AB (systematic* n3 review*)) or (TI (systematic* n3 bibliographic*)) or (AB (systematic* n3 bibliographic*)) or (TI (systematic* n3 literature)) or (AB (systematic* n3 literature)) or (TI (comprehensive* n3 literature)) or (AB (comprehensive* n3 literature)) or (TI (comprehensive* n3 bibliographic*)) or (AB (comprehensive* n3 bibliographic*)) or (TI (integrative n3 review)) or (AB (integrative n3 review)) or (JN “Cochrane Database of Systematic Reviews”) or (TI (information n2 synthesis)) or (TI (data n2 synthesis)) or (AB (information n2 synthesis)) or (AB (data n2 synthesis)) or (TI (data n2 extract*)) or (AB (data n2 extract*)) or (TI (medline or pubmed or psyclit or cinahl or (psycinfo not “psycinfo database”) or “web of science” or scopus or embase)) or (AB (medline or pubmed or psyclit or cinahl or (psycinfo not “psycinfo database”) or “web of science” or scopus or embase or central)) or (MH “Systematic Review”) or (MH “Meta Analysis”) or (TI (meta-analy* or metaanaly*)) or (AB (meta-analy* or metaanaly*)) or network n1 analy* | |
S6 (MH "Clinical Trials + ") or PT Clinical trial or TX clinic* n1 trial* or TX ( (singl* n1 blind*) or (singl* n1 mask*)) or TX ((doubl* n1 blind*) or (doubl* n1 mask*)) or TX ( (tripl* n1 blind*) or (tripl* n1 mask*)) or TX ((trebl* n1 blind*) or (trebl* n1 mask*)) or TX randomi* control* trial* or (MH "Random Assignment") or TX random* | |
allocat* or TX placebo* or MH "Placebos") or MH "Quantitative Studies") or TX allocat* random* | |
S7 S4 AND (S5 OR S6) | |
S8 S4 NOT S7 |
Assessment of risk of bias and methodological quality
Data extraction
Reference | Study type | n/drop-out | Intervention/duration | Endpoints | Outcomes |
---|---|---|---|---|---|
Bauersfeld [16] | RCT | n = 50 Drop-Out = 16 | Arm A: Fasting (36 h before, 24 h after) for 1st 3 chemotherapy cycles (T1) & normocaloric diet for 2nd 3 chemotherapy cycles (T2) | T0: Baseline day 0 cycle 1 | |
T1: Cycle 1–3 (Group A fasting, Group B normocaloric) | |||||
T2: Cycle 4–6 (Group A normocaloric, Group B fasting) | |||||
Arm B: Normocaloric diet for 1st 3 chemotherapy cycles (T1) & fasting (36 h before, 24 h after) for 2nd 3 chemotherapy cycles (T2) | 1. Quality of Life FACT-G scale | 1: Significant increase in QOL in Arm A during T1, no significant changing in Arm B, no group comparison was conducted | |||
QOL: mean (SD): Arm A pretest: 71.1 (18.7), posttest: 61.9 (18.5), p = 0.04, Arm B pretest: 76 (17.2), posttest: 74 (17.6), p > 0.05 | |||||
2. Quality of Life FACIT-F scale | 2: Significant increase of QOL in Arm A during T1, no significant changing in Arm B, no group comparison was conducted | ||||
Arm A pretest: 33.9 (13.4), posttest: 24.8 (13.7), p = 0.006, Arm B pretest: 33.4 (14), posttest: 31.7 (12.6), p > 0.05 | |||||
3. Quality of Life FACIT-F TOI scale | 3: Significant increase in QOL in Arm A during T1, no significant changing in Arm B, no group comparison was conducted | ||||
Duration: Fasting for 60 h during each chemotherapy cycle | Arm A pretest: 66 (25), posttest: 49.8 (26.4), p = 0.009, Arm B pretest: 68 (25.2), posttest: 63.8 (23.9), p > 0.05 | ||||
4. Quality of Life FACIT-F Total | 4: Significant increase in QOL in Arm A during T1, no significant changing in Arm B, no group comparison was conducted | ||||
Arm A Mean Difference: 18.3, p = 0.013, Arm B Mean Difference: 4.2, p > 0.05 | |||||
5. Bodyweight/BMI | 5: No significant changing in bodyweight from T1 to T2 in Arm A, no significant changing in bodyweight from T1 to T2 in Arm B, no group comparison was conducted | ||||
Bodyweight in kg: Arm A pretest: 73, posttest: 72.3, p > 0.3, Arm B pretest: 67.9, posttest: 68.5, p > 0.3 | |||||
De Groot [28] | RCT | n = 13 | Arm A: Fasting (24 h before, 24 h after) chemotherapy for 6 cycles | 1. Chemotherapy-induced side effects Grade I/II (fatigue, infection, mucositis, neuropathy, diarrhea, dizziness, nausea, eye complaints, constipation) | 1: No significant differences between both groups, p not stated |
Drop-Out = 2 | Arm B: Eating according to guidelines for healthy nutrition | 2. Chemotherapy-induced side effects Grade III/IV (neutropenic fever, fatigue, infection) | 2: No significant differences between both groups, p not stated | ||
Duration: Fasting for 48 h for 6 cycles of chemotherapy, 3 weeks each (18 weeks in total) | |||||
De Groot [23] | RCT | n = 131 | Arm A: Fasting mimicking diet 3 days prior to and during the day of each cycle of chemotherapy | 1. Chemotherapy-related toxicities CTCAE (Grade III/IV) | 1: No significant difference between Arm A & Arm B |
Drop-Out = 50 | Arm A: 31 patients (47.7%), Arm B: 36 patients (56.3%), p > 0.05 | ||||
2. pathological complete response | 2: No significant difference between Arm A & Arm B | ||||
Arm B: Consuming regular diet | (%): Arm A: 10.8, Arm B: 12.7, p > 0.05 | ||||
Duration: 6–8 cycles of chemotherapy | 3. radiological response RECIST scala | 3: Significant higher radiological response in Arm A | |||
(%): Arm A: 47, Arm B: 38, p = 0.039 | |||||
4. pathological response Miller & Payne Score 4/5 | 4: No significant difference between Arm A & Arm B | ||||
(%): Arm A: 20, Arm B: 14, p > 0.05 but compliant patients in Arm A significant higher pathological response | |||||
(%): Arm A: 10, Arm B: 12, p = 0.016 | |||||
5. Quality of Life EORTC QLQ-C30 | 5: No significant difference between Arm A & Arm B, p > 0.05 | ||||
6. Psychological distress thermometer | 6: No significant difference between Arm A & Arm B, p > 0.05 | ||||
7. DNA Damage | 7: Significant less DNA Damage in Arm A in CD45/CD3 + T-Lymphocytes | ||||
(%): Arm A: 16, Arm B: 11, p = 0.045 | |||||
RCT | n = 131 | Arm A: Fasting mimicking diet 3 days prior to and during the day of each cycle of chemotherapy | 1. Quality of Life Baseline (EORTC-QLQ-C30/EORTC BR23/BIPQ/Distress Thermometer) | 1: No significant difference between Arm A & Arm B, p > 0.05 | |
Drop-out = 50 | 2. Quality of Life Halfway Therapy (EORTC-QLQ-C30/EORTC B23/Distress Thermometer) | 2: No significant difference between Arm A & Arm B, p > 0.05 | |||
Arm B: Consuming regular diet | |||||
Duration: 6–8 cycles of chemotherapy | 3. Quality of Life before last cycle of chemotherapy (EORTC-QLQ-C30/EORTC b23/ Distress Thermometer) | 3: No significant difference between Arm A & Arm B, p > 0.05 | |||
4. Quality of Life 6-month-Follow-Up (EORTC-QLQ-C30/EORTC B23/ Distress Thermometer) | 4: No significant difference between Arm A & Arm B, p > 0.05 | ||||
5. Global Health Status (EORTC-Qol-C30) | 5: During Treatment significant reduction in Global Health in each Arm returning to Baseline during Follow-Up, p < 0.01 | ||||
6. Illness perception (BIPQ) | 6: No significant difference between Arm A & Arm B, but Arm A seems to understand toxicities better (p = 0.01) and has significant less worries (p < 0.01) | ||||
Lende [27] | RCT | n = 80 | Arm A: Fasting before breast cancer surgery (standard fasting procedure) | 1. Quality of life patient-recorded outcome measures (nausea, pain, mobilization, dizziness, insecurity, bleeding) | 1: Significant more reports of mild & moderate pain 7 days post-OP in Arm A, p < 0.001 |
in post-hoc analysis significant on day 5 ( Arm A: 47%, Arm B: 28%, p = 0.038) & day 6 (Arm A: 50%, Arm B: 28%, p < 0.001) | |||||
Drop-Out = 19 | Arm B: 2 × Pre-operative carbohydrates (400 ml pre-OP Nutricia 18 h before & 2-3 h before surgery) | 2. Relapse-free survival (surgery until diagnosis of relapse) in whole cohort | 2: Significant higher chance of relapse-free survival in Arm A | ||
Event at risk (% survival), p value: Arm A: 2/35 (94), Arm B: 6/26 (77), p = 0.049 | |||||
3. Relapse-free survival in ER + patients (endocrine resistant tumours to Insulin/IGF1-pathway) | 3: Significant higher chance of relapse-free survival in Arm A | ||||
Arm A: 1/29 (97), Arm B: 6/21 (71), p = 0.012 | |||||
Duration: standard fasting procedure, exact length not stated in study | 4. Breast cancer-specific survival (surgery until death due to breast cancer) in whole cohort | 4: No significant differences between the two groups | |||
Arm A: 1/35 (97), Arm B: 4/26 (85), p = 0.08 | |||||
5. Breast cancer-specific survival in ER + patients | 5: Significant higher chance of breast cancer-specific survival in Arm A | ||||
Arm A: 0/29 (100), Arm B: 4/21 (81), p = 0.015 | |||||
6. Overall survival (surgery until death from any cause) | 6: no report, Cox model was considered too unstable | ||||
Riedinger [25] | RCT | n = 24 | Arm A: Fasting 24 h before and 24 h following chemotherapy | 1. Quality of life NCCN FACT FOSI-18 score | 1: No significant difference between Arm A & Arm B |
Mean, p value: Arm A: 58.38, Arm B: 57.1, p = 0.71 | |||||
but Arm A significant higher score during one cycle compared to baseline compared to Arm B | |||||
Drop-Out = 4 | Arm B: Eating a normocaloric diet | Score, p value: Arm A: + 5.1, Arm B: + 0.22, p = 0.015 | |||
Duration: Chemotherapy cycles 3-week intervals fot a minimum of 6 cycles, in total 120 cycles | 2. Chemotherapy-related side effects (a: CTCAE toxicity Grade 3 or 4, b: Anemia Grade 2, c: Thrombocytopenia Grade 2, d: Neutropenia Grade 2 / 3) | 2a: No significant difference between Arm A & Arm B | |||
Arm A 0 patients, Arm B 2 patients, p > 0.05 | |||||
2b: No significant difference between Arm A & Arm B | |||||
Arm A 1 patient, Arm B 3 patients, p > 0.05 | |||||
2c: No significant difference between Arm A & Arm B | |||||
Arm A 0 patients, Arm B 1 patient, p > 0.05 | |||||
2d: No significant difference between Arm A & Arm B | |||||
Arm A: 4 patients / 0 patients, Arm B: 2 patients / 1 patient, p > 0.05 | |||||
3. Hematologic parameters (a: Hemoglobin, b: Neutrophil count, c: Platelet count, d: Serum glucose) | 3a: No significant difference between Arm A & Arm B | ||||
Mean (SD), p value: Arm A: 10.8 (1.3), Arm B: 10.9 (1.5), p > 0.05 | |||||
3b: No significant difference between Arm A & Arm B | |||||
Mean (SD), p value: Arm A: 4.7 (3.3), Arm B: 4 (2.2), p > 0.05 | |||||
3c: Significant higher Platelet count in Arm A | |||||
Mean (SD), p value: Arm A: 246.5 (96.5), Arm B: 203.5 (82.5), p = 0.009 | |||||
3d: Significant less Serum glucose in Arm A | |||||
Mean (SD), p value: Arm A: 97.2 (17.8), Arm B: 120 (25.6), p < 0.001 | |||||
4. Change in bodyweight | 4: No significant difference between Arm A & Arm B | ||||
Mean (SD), p value: Arm A: 0.84 (2.33), Arm B: 1.1 (3.55), p > 0.05 | |||||
Safdie [15] | Case report | n = 10 | Fasting before/after chemotherapy | Side effects of fasting | 1: loss of 7 pounds (recovered after treatment), mild fatigue, dry mouth, hiccups |
2: loss of 7 pounds (regained 4), less severe side effects compared to cycles with calories, mild diarrhea, abdominal cramps | |||||
3: lower side effects compared to previous cycles with calories, PSA reduced from 34 to 6 | |||||
4: loss of 6 pounds (recovered), mild fatigue, weakness, acute toxic side effects reduced, quick regain of strength | |||||
Duration: fasting for 48–140 h before and/or 5–56 h after | 5: reduced side effects | ||||
6: faster recovery of blood cell counts | |||||
7: lightheadedness, drop in blood pressure, neuropathy | |||||
8: mild weakness, short-term memory impairment | |||||
9: mild weakness, alopecia | |||||
Zorn [26] | Controlled Cross Over Study | n = 51 | Double-Intervention Fasting in combination with ketogenic diet | 1. Chemotherapy-related toxicities CTCAE Grade I/II (Infection, Fatigue, Insomnia, Headaches; Dizziness, Depression, Nausea, Vomiting, Diarrhea, Obstipation, Stomach pains, Reduced appetite, Hunger, Stomatitis, Esophagitis, Neuroses, Arthralgia, Pain, Dyspnea, Oedemas) | 1. No significant difference between the groups except for Stomatitis |
Stomatitis Mean (%), p value: Normocaloric Cycles: 15 (25.9); Fasted Cycles: 3 (5.5), p = 0.013 | |||||
Drop-Out = 21 | Arm A: 2–3 chemotherapy cycles modified short-term fast 3 days prior & 1 day after chemotherapy, followed by 2–3 chemotherapy cycles on a normocaloric diet | 2. Chemotherapy-related toxicities 1 week after chemotherapy, patient-reported (Reduced appetite, Hunger, Nauseam Vomiting, Stomach pains, Diarrhea, Obstipation, Fever, Headaches, Insomnia, Fatigue, Dizziness, Weakness, Exhaution, frequency & score of total toxicities) | 2: No significant difference between the groups except for headaches, weakness & total toxicities | ||
Headaches Mean (SD), p value: Fasted Cycles: 1.18 (2.06), Normocaloric Cycles: 2.74 (4.3), p = 0.002 | |||||
Weakness Mean (SD), p value: Fasted Cycles: 2.84 (4.25), Normocaloric Cycles: 7.11 (5.4), p = 0.024 | |||||
Total Toxicities Mean (SD), p value: Fasted Cycles: 47.52 (33.21), Normocaloric Cycles: 56.36 (32.14), p = 0.023 | |||||
Arm B: 2–3 chemotherapy cycles normocaloric diet followed by 2–3 modified short-term fast | 3. Blood parameters (MCV, MCH, Erythrocytes, Sodium, fT3/fT4) | 3: No significant difference between the groups except for MCV, MCH, sodium & fT3/fT4 | |||
Arm C: 2–3 cycles modified short-term fast with a normocaloric ketogenig diet 6 days prior to fasting, followed by 2–3 cycles normocaloric diet | MCV Mean (SD), p value: Fasted Cycles: 84.1 (3.4), Normocaloric Cycles: 85.7 (4), p < 0.001 | ||||
MCH Mean (SD), p value: Fasted Cycles: 29.5 (1.6), Normocaloric Cycles: 29.9 (1.5), p = 0.004 | |||||
Sodium Mean (SD), p value: Fasted Cycles: 137.9 (3.3), Normocaloric Cycles: 139.2 (2.2), p = 0.007 | |||||
fT3 Mean (SD), p value: Fasted Cycles: 3.75 (0.76), Normocaloric Cycles: 4.21 (0.81), p < 0.001 | |||||
fT4 Mean (SD), p value: Fasted Cycles: 16.4 (2.9), Normocaloric Cycles: 15.5 (2.7), p = 0.028 | |||||
Arm D: 2–3 chemotherapy cycles normocaloric diet followed by 2–3 cycles modified short-term fast with a normocaloric ketogenic diet 6 days prior to fasting | |||||
4. Quality of Life, CIPN, Fatigue | 4: No significant difference between the groups, p not stated | ||||
5. Number of days postponing chemotherapy due to toxicities | 5: Significant less postponements during Fasted Cycles | ||||
Duration: 56 cycles fasted, 62 cycles normocaloric diet | Mean (SD), p value: − 0.8 (0.37), p = 0.034 | ||||
Dorff [29] | Cohort study | n = 13 | Arm A: Fasting 24 h before platinum-based chemotherapy | 1. Chemotherapy-related toxicities (a: fatigue, b: alopecia, c: nausea, d: vomiting, e: constipation, f: diarrhea) | 1a: Arm A: 6/6 (100%), Arm B: 5/7 (71%), Arm C: 6/7 (86%) |
1b: Arm A: 6/6 (100%), Arm B: 5/7 (71%), Arm C: 7/7 (100%) | |||||
Drop-out = 3 | Arm B: Fasting 48 h before p.b.-chemotherapy | 1c: Significant more patients nauseous in Arm A > Arm B > Arm C | |||
Arm C: Fasting 48 h before & 24 h after p.b.-chemotherapy | Arm A: 6/6 (100%), Arm B: 6/7 (86%), Arm C: 3/7 (43%), p = 0.019, test for trend | ||||
1d: Significant more patients vomited in Arm A > Arm B > Arm C | |||||
Duration: 24 h/48 h/72 h of fasting | Arm A: 5/6 (83%), Arm B: 3/7 (43%), Arm C: 0/7 (0%), p = 0.003, test for trend | ||||
1e: Arm A: 3/6 (50%), Arm B: 2/7 (28%), Arm C: 3/7 (43%) | |||||
1f: Arm A: 2/6 (33%), Arm B: 1/7 (14%), Arm C 4/7 (57%) |
Results
Author | Year | Title | Exclusion criteria |
---|---|---|---|
Lv | 2014 | Roles of caloric restriction, ketogenic diet and intermittent fasting during initiation, progression and metastasis of cancer in animal models: a systematic review and meta-analysis | Animal studies included |
Sun | 2017 | Effect of fasting therapy in chemotherapy-protection and tumorsuppression: A systematic review | Animal studies included |
Bertz | 2018 | MOFAX Impact of short-term modified fasting and the combination with a fasting supportive diet during chemotherapy on the incidence and severity of chemotherapy-induced toxicities in cancer patients-a randomised controlled cross-over pilot study | Final results not published, single parts of these interventions were not analyzed separately |
Dorff | 2018 | A randomized phase II clinical trial of a fasting-mimic diet prior to chemotherapy to evaluate the impact on toxicity and efficacy | Grade of evidence/publication, only clinical trial |
Shingler | 2019 | A feasibility randomised controlled trial of short-term fasting prior to CAPOX chemotherapy for stage 2/3 colorectal cancer: sWiFT protocol | Publication, only protocol |
De Braud | 2018 | Safety and metabolic effects of cyclic fasting mimicking diet (FMD) in cancer patients | Final results not published, single parts of these interventions were not analyzed separately |
Excluded studies
Risk of bias in included studies
Reference | Study type | Standardized rating of risk of bias | Additional comments on methodology | Evidence Level (Oxford) |
---|---|---|---|---|
Bauersfeld [16] | RCT | SIGN | PRO: poweranalysis was conducted; structured explanation of statistical analysis; use of different scales for validation of outcome | 1b |
Positive: 5 | ||||
Uncertain: 2 | ||||
Negative: 1 | CONTRA: | |||
Overall quality: Acceptable | Patients & blinding: very small sample size (n=34) analysed; patients not blinded; not placebo-controlled methods: significant differences between the groups not statistically documented (confusing report in text, partially not proven with numbers), multiple testing | |||
De Groot [28] | RCT | SIGN | CONTRA: | 2b |
Positive: 4 | Patients & blinding: very small sample size (n = 11); patients not blinded | |||
Uncertain: 2 | ||||
Negative: 1 | Methods: no poweranalysis was conducted; randomization not specified | |||
Overall quality: Acceptable | ||||
De Groot [23] | RCT | SIGN | PRO: poweranalysis was conducted; structured explanation of randomization | 2b |
Positive: 5 | CONTRA: | |||
Uncertain: 3 | Patients & blinding: small sample size (n = 131); patients not blinded; not placebo-controlled; high rate of Drop-Out because of non-compliance | |||
Negative: 1 | Methods: not all outcomes measured in numbers (e.g. psychological distress); diet of control group not further explained | |||
Overall quality: Acceptable | ||||
Lende [27] | RCT | SIGN | PRO: poweranalysis was conducted; structured explanation of randomization, structured explanation of Follow-Up | 1b |
Positive: 5 | CONTRA: | |||
Uncertain: 1 | Patients & blinding: high rate of Drop-Out; patients not blinded | |||
Negative: 2 | Methods: treatment (OP) individually different (different outcome possible); no numbers given about adverse events | |||
Overall quality: Acceptable | ||||
RCT | SIGN | PRO: detailed examination of side effects of fasting | 2b | |
Positive: 4 | CONTRA: | |||
Uncertain: 4 | Patients & blinding: small sample size (n = 131); patients not blinded; not placebo-controlled; high rate of Drop-Out because of non-compliance | |||
Negative: 1 | Methods: ITT & PP-analysis do not agree (no explanation given); diet of control group not further explained | |||
Overall quality: Acceptable | ||||
Riedinger [25] | RCT | SIGN | PRO: structured explanation of statistical analysis; homogeneity in treatment (chemotherapy drugs) | 2b |
Positive: 4 | CONTRA: | |||
Uncertain: 3 | Patients & blinding: very small sample size (n = 24); only women; patients not blinded; not placebo-controlled | |||
Negative: 2 | Methods: study based on honesty of patients (compliance), no bloodwork was drawn during intervention | |||
Overall quality: Acceptable | ||||
Zorn [26] | Cross-over | SIGN | PRO: good comparison of the groups due to cross-over; bloodwork was drawn to measure compliance; authors discuss other studies with the same key question | 2c |
Positive: 3 | CONTRA: | |||
Uncertain: 4 | Patients & blinding: small sample size (n = 51); patients not blinded; not placebo-controlled | |||
Negative: 2 | Methods: double intervention with ketogenic diet; no randomization; QoL-data based on patient records; primary endpoint was not met | |||
Overall quality: | ||||
Dorff [29] | Cohort | SIGN | CONTRA: | 2b |
Positive: 6 | Patients & blinding: very small sample size (n = 13); patients not blinded; no control group | |||
Uncertain: 2 | Methods: study based on honesty of patients (compliance); different types of chemotherapy; randomization not specified; blood work was drawn at different times between the groups | |||
Negative: 3 | ||||
Overall quality: Acceptable | ||||
Safdie [15] | CS | IHE | CONTRA: | 4 |
Positive: 5 | Patients & blinding: very small sample size (n = 10); inclusion/exclusion criteria not defined; patients not comparable; data based on subjective questionnaire | |||
Uncertain: 2 | ||||
Negative: 2 | ||||
Overall quality: Acceptable |