Article: Klassen PN, Goldenberg BA, Lambert P, Vagianos K, Kim CA. Ketogenic and low-sugar diets for patients with cancer: perceptions and practices of medical oncologists in Canada. Support Care Cancer. 2020 Nov;28(11):5243-5249. doi: 10.1007/s00520-020-05361-9. Epub 2020 Feb 23. PMID: 32090285.

Abstract: Purpose: Many patients with cancer are interested in complementary therapies, including strategies such as reduced carbohydrate diets. Guidelines regarding the use of these diets during cancer treatment are lacking; therefore, we aimed to explore the perceptions and practices of medical oncologists in Canada regarding low-sugar and ketogenic diets.
Method: A cross-sectional, online multiple-choice survey was distributed to 206 Canadian medical oncologists. Questions explored frequency of patient interactions, oncologist perceptions of efficacy, advice given to patients, and concerns about side effects related to reduced carbohydrate diets. Results: Responses were received from 57 medical oncologists in seven of thirteen provinces and territories, with an overall response rate of 28%. Forty-nine percent of respondents were asked at least weekly about a low-sugar diet, and 9% about the ketogenic diet. Eighty-five percent supported the use of a low-added sugar diet in patients with diabetes or hyperglycemia, while conversely 87% did not support the use of a ketogenic diet for any of their patients undergoing active cancer treatment. Respondents felt either that a ketogenic diet was not effective (31%) or that the effect on cancer outcomes was unknown (69%). Ninety-six percent of respondents had concerns about a ketogenic diet for patients receiving active cancer treatment. Conclusion: The role of reduced carbohydrate diets during cancer treatment is topical. Canadian oncologists are particularly reluctant to support a ketogenic diet for patients on active cancer treatment, with concerns about side effects and unknown efficacy. There may be a role for continuing medical education and institutional guidelines to inform these discussions with patients.

Review: Low-sugar and ketogenic diets are of interest to both cancer patients and clinicians, yet there is little research regarding their effectiveness and clinicians’ perceptions of them. A survey of 206 Canadian medical oncologists revealed that nearly half (49%) were asked about low-sugar diets by their patients at least weekly. The majority (87%) did not endorse ketogenic diets for patients undergoing active cancer treatment. Future studies should explore the effect of low-sugar and ketogenic diets on health outcomes for cancer patients along all aspects of the cancer continuum (e.g.,newly diagnosed, currently in treatment, survivorship).

Article: Siemens W, Boehlke C, Bennett MI, Offner K, Becker G, Gaertner J. Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care-a blinded, randomized, sham-controlled pilot cross-over trial. Support Care Cancer. 2020 Nov;28(11):5323-5333. doi: 10.1007/s00520-020-05370-8. Epub 2020 Mar 3. PMID: 32128614; PMCID: PMC7547037.

Abstract: Purpose: Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. Methods: A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensity-modulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a "slight improvement." Results: Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: - 0.2, 95% confidence interval - 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. Conclusion: TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least "slight pain relief" from PBT. Differences for gender and incident pain aspects demand future trials.

Review: The safety and efficacy of Transcutaneous electrical nerve stimulation (TENS) for cancer inpatients’ pain has not been well established. This study comparing Intensity-modulated high TENS to placebo TENS in 20 patients found that change in average pain intensity was not statistically different between the groups, yet the intervention was deemed safe and 7 patients desired a future TENS prescription. Additional study in larger sample sizes and diverse populations are warranted.