Supportive Care in Cancer

, Volume 26, Issue 8, pp 2503–2509 | Cite as

Systematic review and meta-analysis investigating the efficacy and safety of probiotics in people with cancer

  • Hadeel HassanEmail author
  • M. Rompola
  • A. W. Glaser
  • S. E. Kinsey
  • R. S. Phillips
Review Article



Probiotics are living microorganisms that confer a health benefit on the host when administered. This systematic review and meta-analysis investigates the efficacy and safety of probiotics in adult and paediatric patients diagnosed with cancer.


A systematic review and meta-analysis was undertaken (PROSPERO registration: CRD42016050252). Randomised controlled trials (RCT), identified through screening multiple databases were included for analysis of efficacy. Non-randomised controlled trials and case reports were included for safety analysis. Outcomes included the reduction in the incidence and severity of diarrhoea, and adverse events. Where possible, data were combined for meta-analysis using a random-effects model. Planned subgroup analyses were not possible through marked heterogeneity of study characteristics.


Twenty one studies (N = 2982 participants) were included for assessment of efficacy. Probiotics may reduce the incidence of diarrhoea in patients with cancer [odds ratio (OR) = 0.52, 95% confidence interval (CI) 0.34–0.78, 95% prediction interval (PI) 0.3–0.92, I-sq 36.9%, 5 studies] and the duration of pyrexia [standardised mean difference 0.39 days, 95% CI 0.35–0.43, I-sq 0.01%, 5 studies]. Twenty five studies (N = 2242) were included in the safety analysis. Five case reports showed probiotic-related bacteraemia/fungaemia/positive blood cultures. Definitions and reporting of adverse events were variable and inconsistent.


There remain insufficient studies to assess the true effect of probiotics in people with cancer. Meta-analysis suggests probiotics may be beneficial but further studies are still required. Improved reporting of outcomes and adverse events in clinical trials are required to improve accuracy and confidence of conclusions drawn in future updates.


Probiotics Randomised controlled trials (RCT) Cancer 

Supplementary material

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  1. 1.
    Schlundt, J. Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria. FAO/WHO. 2012 October 2012; Available from: Scholar
  2. 2.
    Holzapfel WH, Haberer P, Geisen R, Björkroth J, Schillinger U (2001) Taxonomy and important features of probiotic microorganisms in food and nutrition. Am J Clin Nutr 73(2 Suppl):365s–373sCrossRefPubMedGoogle Scholar
  3. 3.
    Goldenberg, J.Z., et al.,(2015) Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev, 22(12)Google Scholar
  4. 4.
    Pammi, M. and G. Suresh, Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev, 2017. 28(6)Google Scholar
  5. 5.
    Liu, M.M., et al.,(2017) Probiotics for prevention of radiation-induced diarrhea: a meta-analysis of randomized controlled trials. PLoS One,12(6)Google Scholar
  6. 6.
    Salminen E, Elomaa I, Minkkinen J, Vapaatalo H, Salminen S (1988) Preservation of intestinal integrity during radiotherapy using live Lactobacillus acidophilus cultures. Clin Radiol 39(4):435–437CrossRefPubMedGoogle Scholar
  7. 7.
    Guarner F, Malagelada JR (2003) Role of bacteria in experimental colitis. Best Pract Res Clin Gastroenterol 17(5):793–804CrossRefPubMedGoogle Scholar
  8. 8.
    Arbuckle RB, Huber SL, Zacker C (2000) The consequences of diarrhea occurring during chemotherapy for colorectal cancer: a retrospective study. Oncologist 5(3):250–259CrossRefPubMedGoogle Scholar
  9. 9.
    Dranitsaris G, Maroun J, Shah A (2005) Estimating the cost of illness in colorectal cancer patients who were hospitalized for severe chemotherapy-induced diarrhea. Can J Gastroenterol 19(2):83–87CrossRefPubMedGoogle Scholar
  10. 10.
    Redman MG, Ward EJ, Phillips RS (2014) The efficacy and safety of probiotics in people with cancer: a systematic review. Ann Oncol 25(10):1919–1929CrossRefPubMedGoogle Scholar
  11. 11.
    H Hassan, M. Rompola, Bob Phillips,(2016) The efficacy and safety of probiotics in people with cancer: an updated systematic review and meta-analysis, PROSPEROGoogle Scholar
  12. 12.
    Higgins JP et al (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Loke YK, Price D, Herxheimer A (2007) Systematic reviews of adverse effects: framework for a structured approach. BMC Med Res Methodol 7:32CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dissemination, C.f.R.a(2008), Systematic Reviews: CRD's guidance for undertaking reviews in health care,University of York: CRDGoogle Scholar
  15. 15.
    Higgins JP, Thompson SG, Spiegelhalter DJ (2009) A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 172(1):137–159CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Team, R,(2015) RStudio: integrated development for R. RStudio, Inc.Google Scholar
  17. 17.
    The CONSORT Statement. 2016; Available from:
  18. 18.
    COMET intitiative. [cited 2017; Available from:

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Paediatric Haematology and OncologyLeeds Teaching Hospital NHS TrustLeedsUK
  2. 2.Leeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
  3. 3.Centre for Reviews and DisseminationUniversity of YorkYorkUK

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