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Moulton C, Grazioli E, Ibáñez-Cabellos JS, Murri A, Cerulli C, Silvestri M, Caporossi D, Pallardó FV, García-Giménez JL, Magno S, Rossi C, Duranti G, Mena-Molla S, Parisi A, Dimauro I. Physical Activity and Epigenetic Aging in Breast Cancer Treatment. Int J Mol Sci 2024; 25:8596. [PMID: 39201283 PMCID: PMC11355047 DOI: 10.3390/ijms25168596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Biological age, reflecting the cumulative damage in the body over a lifespan, is a dynamic measure more indicative of individual health than chronological age. Accelerated aging, when biological age surpasses chronological age, is implicated in poorer clinical outcomes, especially for breast cancer (BC) survivors undergoing treatments. This preliminary study investigates the impact of a 16-week online supervised physical activity (PA) intervention on biological age in post-surgery female BC patients. Telomere length was measured using qPCR, and the ELOVL2-based epigenetic clock was assessed via DNA methylation pyrosequencing of the ELOVL2 promoter region. Telomere length remained unchanged, but the ELOVL2 epigenetic clock indicated a significant decrease in biological age in the PA group, suggesting the potential of PA interventions to reverse accelerated aging processes in BC survivors. The exercise group showed improved cardiovascular fitness, highlighting PA's health impact. Finally, the reduction in biological age, as measured by the ELOVL2 epigenetic clock, was significantly associated with improvements in cardiovascular fitness and handgrip strength, supporting improved recovery. Epigenetic clocks can potentially assess health status and recovery progress in BC patients, identifying at-risk individuals in clinical practice. This study provides potential and valuable insights into how PA benefits BC survivors' health, supporting the immediate benefits of a 16-week exercise intervention in mitigating accelerated aging. The findings could suggest a holistic approach to improving the health and recovery of post-surgery BC patients.
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Affiliation(s)
- Chantalle Moulton
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (C.M.); (M.S.); (D.C.)
| | - Elisa Grazioli
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (E.G.); (A.M.); (C.C.); (A.P.)
| | - José Santiago Ibáñez-Cabellos
- EpiDisease S.L., Scientific Park, University of Valencia, 46026 Paterna, Spain;
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (F.V.P.); (J.L.G.-G.)
| | - Arianna Murri
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (E.G.); (A.M.); (C.C.); (A.P.)
| | - Claudia Cerulli
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (E.G.); (A.M.); (C.C.); (A.P.)
| | - Monica Silvestri
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (C.M.); (M.S.); (D.C.)
| | - Daniela Caporossi
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (C.M.); (M.S.); (D.C.)
| | - Federico V. Pallardó
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (F.V.P.); (J.L.G.-G.)
- INCLIVA Health Research Institute, INCLIVA, 46010 Valencia, Spain
- Consortium Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, 46010 Valencia, Spain
| | - José Luis García-Giménez
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (F.V.P.); (J.L.G.-G.)
- INCLIVA Health Research Institute, INCLIVA, 46010 Valencia, Spain
- Consortium Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, 46010 Valencia, Spain
| | - Stefano Magno
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy; (S.M.); (C.R.)
| | - Cristina Rossi
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy; (S.M.); (C.R.)
| | - Guglielmo Duranti
- Unit of Biochemistry and Molecular Biology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy;
| | - Salvador Mena-Molla
- EpiDisease S.L., Scientific Park, University of Valencia, 46026 Paterna, Spain;
- Department of Physiology, Faculty of Pharmacy, University of Valencia, 46100 Burjassot, Spain
| | - Attilio Parisi
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (E.G.); (A.M.); (C.C.); (A.P.)
| | - Ivan Dimauro
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (C.M.); (M.S.); (D.C.)
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2
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McLay K, Stonewall N, Forbes L, Peters C. The association between malnutrition risk and revised Edmonton Symptom Assessment System (ESAS-r) scores in an adult outpatient oncology population: a cross-sectional study. J Patient Rep Outcomes 2024; 8:71. [PMID: 38995461 PMCID: PMC11245459 DOI: 10.1186/s41687-024-00750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/23/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Cancer-associated malnutrition is associated with worse symptom severity, functional status, quality of life, and overall survival. Malnutrition in cancer patients is often under-recognized and undertreated, emphasizing the need for standardized pathways for nutritional management in this population. The objectives of this study were to (1) investigate the relationship between malnutrition risk and self-reported symptom severity scores in an adult oncology outpatient population and (2) to identify whether a secondary screening tool for malnutrition risk (abPG-SGA) should be recommended for patients with a specific ESAS-r cut-off score or group of ESAS-r cut-off scores. METHODS A single-institution retrospective cross-sectional study was conducted. Malnutrition risk was measured using the Abridged Patient-Generated Subjective Global Assessment (abPG-SGA). Cancer symptom severity was measured using the Revised Edmonton Symptom Assessment System (ESAS-r). In accordance with standard institutional practice, patients completed both tools at first consult at the cancer centre. Adult patients who completed the ESAS-r and abPG-SGA on the same day between February 2017 and January 2020 were included. Spearman's correlation, Mann Whitney U tests, receiver operating characteristic curves, and binary logistic regression models were used for statistical analyses. RESULTS 2071 oncology outpatients met inclusion criteria (mean age 65.7), of which 33.6% were identified to be at risk for malnutrition. For all ESAS-r parameters (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing), patients at risk for malnutrition had significantly higher scores (P < 0.001). All ESAS-r parameters were positively correlated with abPG-SGA score (P < 0.01). The ESAS-r parameters that best predicted malnutrition risk status were total ESAS-r score, lack of appetite, tiredness, and wellbeing (area under the curve = 0.824, 0.812, 0.764, 0.761 respectively). Lack of appetite score ≥ 1 demonstrated a sensitivity of 77.4% and specificity of 77.0%. Combining lack of appetite score ≥ 1 with total ESAS score > 14 yielded a sensitivity of 87.9% and specificity of 62.8%. CONCLUSION Malnutrition risk as measured by the abPG-SGA and symptom severity scores as measured by the ESAS-r are positively and significantly correlated. Given the widespread use of the ESAS-r in cancer care, utilizing specific ESAS-r cut-offs to trigger malnutrition screening could be a viable way to identify cancer patients at risk for malnutrition.
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Affiliation(s)
- Katherine McLay
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
| | - Nicole Stonewall
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Laura Forbes
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Christine Peters
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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3
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Urrizola A, Dajani O, Aass N, Bjerkeset E, Hjermstad MJ, Kaasa S, Klepstad P, Pirnat A, Raaness I, Steinsheim H, Bye A. Nutrition impact symptom monitoring and weight loss outcomes: a longitudinal radiotherapy study. BMJ Support Palliat Care 2024:spcare-2024-004939. [PMID: 38862183 DOI: 10.1136/spcare-2024-004939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Nutrition impact symptoms (NIS) are associated with weight loss (WL), and decreased energy intake in cross-sectional studies. We aimed to ascertain associations between changes in NIS burden, energy intake and WL over time in patients with advanced cancer. METHODS Adult patients from an observational radiotherapy study for painful bone metastases self-reported NIS and WL using the Patient-Generated Subjective Global Assessment tool (PG-SGA) at baseline and week eight (W8). NIS burden, the sum of NIS per patient, categorised as 0, 1-2 and ≥3 with changes defined as 2-point differences from baseline to W8 were used. Energy intake was assessed by 24-hour recall interviews. RESULTS 111 patients (72.1%) were analysed and grouped by NIS burden; 0 NIS (44.1%), 1-2 NIS (30.6%) and ≥3 NIS (25.2%). Patients with NIS burden of ≥3 reported higher baseline WL compared with those with 1-2 or 0 NIS (46.4% vs 18.2% vs 10.2%, respectively, p=0.002). At W8, 21 patients (19%) reported improved NIS burden, accompanied by a lower proportion of severe (≥5%) new-onset WL (19% vs 42.1%) and higher energy intake (median 29.6 vs 21.2 kcal/kg) than those with worsened NIS burden (17.1%). CONCLUSIONS NIS management may improve energy intake and prevent WL, emphasising the importance of systematic follow-up and interventions. CLINICALTRIALSGOV REGISTRATION NCT02107664.
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Affiliation(s)
- Amaia Urrizola
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
| | - Olav Dajani
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
| | - Nina Aass
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ellen Bjerkeset
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - Aleksandra Pirnat
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
| | - Ida Raaness
- Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway
| | - Hanne Steinsheim
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
| | - Asta Bye
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Center, University of Oslo, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Fuhse K. [Weight, nutrition, quality of life-Perspective of oncological patients]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023:10.1007/s00108-023-01528-8. [PMID: 37221380 DOI: 10.1007/s00108-023-01528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/25/2023]
Abstract
Nutrition is associated with pleasure and quality of life. The majority of oncological patients experience tumor-associated and treatment-associated nutrition-related symptoms and malnutrition. Consequently, the perception of nutrition during the course of the disease is increasingly more characterized by negative associations, which may persist for years after the end of treatment. This leads to a decreased quality of life, social isolation and a burden for relatives. In contrast, weight loss is initially positively perceived, especially by patients who previously perceived themselves as being overweight, until malnutrition becomes evident and leads to a decreased quality of life. Nutritional counseling can prevent weight loss, relieve adverse side effects, improve the quality of life and reduce mortality. Patients are not aware of this and the German healthcare system lacks structured and firmly established access pathways to nutritional counseling. Therefore, oncological patients need to be informed about the consequences of weight loss at an early stage and low-threshold access to nutritional counseling needs to be comprehensively implemented. Thus, malnutrition can be recognized and treated at an early stage and nutrition can contribute to a higher quality of life as a positively perceived daily activity.
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Affiliation(s)
- Katrin Fuhse
- Klinikum Bremen Mitte, Medizinische Klinik II, St.-Jürgen-Str. 1, 28205, Bremen, Deutschland.
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Bays HE, Burridge K, Richards J, Fitch A. Obesity Pillars roundtable: Excessive weight reduction with highly effective anti-obesity medications (heAOMs). OBESITY PILLARS (ONLINE) 2022; 4:100039. [PMID: 37990661 PMCID: PMC10662002 DOI: 10.1016/j.obpill.2022.100039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2023]
Abstract
Background Historically, many anti-obesity medications (AOMs) were withdrawn from development and/or the market due to safety concerns. Another challenge was that, with some exceptions, most of these AOMs had limited weight reducing efficacy. Approved AOMs often did not meet the weight reduction expectations of either clinicians, or their patients. Currently, newer approved and investigational AOMs achieve greater weight reduction than older AOMs. This has prompted an emerging new challenge of "too much weight loss" with some of these highly effective anti-obesity medications (heAOM) - something many did not think possible prior to year 2020. Methods This roundtable review includes perspectives from 3 obesity specialists with experience in the clinical use of AOMs. The intent is to provide perspectives and guidance in managing patients with obesity who experience "too much weight loss" with heAOM. Results The panelists generally agreed that before treatment with heAOMs, patients with obesity are best informed about the importance of healthful nutrition, adequate hydration, routine physical activity, behavior modification techniques, goals of treatment, and anticipated changes not only from a medical standpoint, but also from a psychosocial standpoint. Clinicians might best recognize that the definition of "excessive weight reduction" may have both objective and subjective considerations, with body composition analyses often essential to accurately assess adiposity. Conclusions The consensus of the panelists is reflected in a proposed structured and algorithmic approach to the patient with excessive weight reduction. Once properly evaluated, if the excessive weight reduction is determined most likely due to the heAOM hyper-responders, then this should prompt the clinician to educate the patient (and possibly family and friends) on the health and psychosocial aspects of weight reduction, and engage in a shared decision-making process that determines if the heAOM is best kept at the same dose, decreased in dose, temporarily held, or rare cases, best discontinued.
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Affiliation(s)
- Harold Edward Bays
- Diplomate of American Board of Obesity Medicine, President Louisville Metabolic and Atherosclerosis Research Center, University of Louisville Medical School, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | - Karli Burridge
- Owner, Gaining Health, Clinical Liaison, Partnerships- Enara Health, Glen Ellyn, Illinois, 60137, USA
| | - Jesse Richards
- Diplomate American Board of Obesity Medicine, Medicine University of Oklahoma, Obesity Medicine OU Bariatrics, Tulsa, OK, 74104, USA
| | - Angela Fitch
- Diplomate American Board of Obesity Medicine, Medicine Harvard Medical School, Massachusetts General Hospital Weight Center, Boston, MA, 02114, USA
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Rodríguez-Cañamero S, Cobo-Cuenca AI, Carmona-Torres JM, Pozuelo-Carrascosa DP, Santacruz-Salas E, Rabanales-Sotos JA, Cuesta-Mateos T, Laredo-Aguilera JA. Impact of physical exercise in advanced-stage cancer patients: Systematic review and meta-analysis. Cancer Med 2022; 11:3714-3727. [PMID: 35411694 PMCID: PMC9554454 DOI: 10.1002/cam4.4746] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Health professionals predict that the number of people who will suffer and die from oncological diseases will continue to increase. It is vitally important to provide comprehensive care to these patients and prescribe physical exercise programs as adjuvant therapy. The objective of this systematic review was to determine the impact of physical exercise on advanced‐stage cancer patients. A literature search was performed in eight different databases. This search focused on randomized controlled trials (RCTs) published during the last 10 years. To assess the methodological quality of the sample of 15 RCTs finally obtained, the PEDro scale was used. Aerobic and strength training methods were used. The combination of both aerobic and strength training methods was the most frequently reported. Likewise, different physical and psychological variables were recorded, from which improvements were seen in fatigue, independence, quality of life and sleep, among others. The participation in physical exercise programs by advanced‐stage cancer patients has a positive impact on health. Providing these programs serves as adjuvant therapy, facilitating the comprehensive care of patients. Similarly, aerobic, strength or mixed training programs increase the muscle mass of patients and therefore reduce hypotonia, the main side effect during the advanced‐stages of cancer.
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Affiliation(s)
- Sergio Rodríguez-Cañamero
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Clínica Hemodiálisis Avericum Toledo, Toledo, Spain
| | - Ana Isabel Cobo-Cuenca
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Juan Manuel Carmona-Torres
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Diana Patricia Pozuelo-Carrascosa
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Esmeralda Santacruz-Salas
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Joseba Aingerun Rabanales-Sotos
- Department of Nursing, Physiotherapy and Occupational Therapy, Facultad de Enfermería, Universidad de Castilla-La Mancha, Albacete, Spain.,Grupo de Actividades Preventivas en el ámbito Universitario de Ciencias de la Salud (GAP-CS), Universidad de Castilla-La Mancha, Albacete, Spain
| | | | - José Alberto Laredo-Aguilera
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
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Weight Loss in Advanced Cancer: Sex Differences in Health-Related Quality of Life and Body Image. Life (Basel) 2022; 12:life12010105. [PMID: 35054498 PMCID: PMC8781117 DOI: 10.3390/life12010105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 12/13/2022] Open
Abstract
Weight maintenance is a priority in cancer care, but weight loss is common and a serious concern. This study explores if there are sex differences in the perception of weight loss and its association to health-related quality of life (HRQoL) and body image. Cancer patients admitted to Advanced Medical Home Care were recruited to answer a questionnaire, including characteristics, the HRQoL-questionnaire RAND-36, and a short form of the Body Image Scale. Linear regression analyses stratified by sex and adjusted for age were performed to examine associations between percent weight loss and separate domains of HRQoL and body image score in men and women separately. In total, 99 participants were enrolled, of which 80 had lost weight since diagnosis. In men, an inverse association between weight loss and the HRQoL-domain physical functioning, β = −1.34 (95%CI: −2.44, −0.24), and a positive association with body image distress, β = 0.22 (95%CI: 0.07, 0.37), were found. In women, weight loss was associated with improvement in the HRQoL-domain role limitations due to physical health, β = 2.02 (95%CI: 0.63, 3.41). Following a cancer diagnosis, men appear to experience weight loss more negatively than women do. Recognizing different perceptions of weight loss may be of importance in clinical practice.
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Photobiomodulation therapy prevents dysgeusia chemotherapy induced in breast cancer women treated with doxorubicin plus cyclophosphamide: a triple-blinded, randomized, placebo-controlled clinical trial. Support Care Cancer 2021; 30:2569-2580. [PMID: 34799776 DOI: 10.1007/s00520-021-06642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effectiveness of photobiomodulation (PBMT) in preventing dysgeusia in breast cancer patients treated with doxorubicin-cyclophosphamide (AC). METHODS This is a phase II, randomized, triple-blind, placebo-controlled clinical trial involving 112 breast cancer patients treated with AC. The patients were divided equally into two groups: a test group treated with 2 J red laser and 3 J infrared laser on 21 points that were symmetrically distributed on the tongue on day 0 of four cycles of AC, and an equal placebo group treated with simulated PBMT to blind the patient, evaluator, and statistician. The clinicopathological and sociodemographic data, results of taste test, and subjective taste analysis, and the QoL, ECOG performance status, body mass index, and other side effects were recorded. The data were analyzed using ANOVA-RM/Bonferroni, Friedman/Dunn, and chi-square/Fisher's exact tests. RESULTS PBMT patients showed less objective and subjective taste loss (p<0.05). On the other hand, the placebo group showed a higher ECOG status (p=0.037) and more significant weight loss (p<0.001) after four cycles of AC. The QoL was significantly higher in the PBMT group (p<0.05) at all assessment periods, and PBMT treatment also reduced the incidence of cachexia (p=0.020), anorexia (p<0.001), diarrhea (p=0.040), oral mucositis (p=0.020), and vomiting (p=0.008). CONCLUSION PBMT reduced the taste loss and improved the overall health status and QoL of patients with breast cancer treated with AC. TRIAL REGISTRATION Brazilian Clinical Trials Registry ( www.ensaiosclinicos.gov.br ) approval number RBR-9qnm34y, registered on 01/05/2021.
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9
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Gascón-Ruiz M, Casas-Deza D, Torres-Ramón I, Zapata-García M, Alonso N, Sesma A, Lambea J, Álvarez-Alejandro M, Quílez E, Isla D, Arbonés-Mainar JM. Comparation of different malnutrition screening tools according to GLIM criteria in cancer outpatients. Eur J Clin Nutr 2021; 76:698-702. [PMID: 34620998 DOI: 10.1038/s41430-021-01021-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/06/2021] [Accepted: 09/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many studies have assessed different malnutrition screening tools in oncologic patients. However, very few have been carried out using the new GLIM criteria for malnutrition. The objective of our study is to compare the most recommended screening tools with respect to the new GLIM criteria for malnutrition in cancer patients. METHODS Observational, cross-sectional, and single-center study carried out at the Medical Oncology Department at the Lozano Blesa Hospital in Zaragoza. We recruited 165 patients with tumors of the upper-gastrointestinal-tract, colorectal, and head-and-neck region undergoing outpatient treatment. All of them received MST, MUST, Nutriscore, MNA and CONUT screening tools, as well as the GLIM diagnostic criteria, which was used as the gold standard. RESULTS MNA-SF showed the best sensitivity (0.99) and lowest specificity while CONUT had the best specificity (0.89) and lowest sensitivity to detect cancer-related malnutrition. We observed high variability in the diagnostic capabilities of Nutriscore when tumor location was considered, reducing sensitivity in patients with colorectal cancer compared to those with tumors of the upper-gastrointestinal-tract or head-and-neck location (0.25, 0.83, and 0.91 respectively). The highest index of agreement between the screening tools was found between MST, MUST and Nutriscore tests. Regarding the GLIM criteria, the highest agreement index was presented by MUST tool (0.66), while CONUT presented the lowest (0.12). CONCLUSIONS Selecting the screening tool according to the type of cancer and its location may allow us to optimize its use and increase its performance, exploiting the advantages of each of them in the different populations.
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Affiliation(s)
- Marta Gascón-Ruiz
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain. .,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain.
| | - Diego Casas-Deza
- Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain.,Gastroenterology and Hepatology Department, University Hospital Miguel Servet, Av. Isabel la Católica 1-3, 50009, Zaragoza, Spain
| | - Irene Torres-Ramón
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - María Zapata-García
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Natalia Alonso
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Andrea Sesma
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Julio Lambea
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - María Álvarez-Alejandro
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Elisa Quílez
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, Av. San Juan Bosco 15, 50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Jose M Arbonés-Mainar
- Instituto de Investigación Sanitaria (IIS) Aragón, Av. San Juan Bosco, 13, 50009, Zaragoza, Spain.,Translational Research Unit, Miguel Servet University Hospital, Instituto Aragonés de Ciencias de la Salud (IACS), Av. Isabel la Católica 1-3, 50009, Zaragoza, Spain.,Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Health Institute Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
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10
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Sahin Kaya A, Bora S, Yetisyigit T. Evaluation of the Effect of Nutritional Status in Patients with Cancer Receiving Chemotherapy on Anthropometric Measurements and Quality of Life. Nutr Cancer 2021; 74:1994-2002. [PMID: 34590508 DOI: 10.1080/01635581.2021.1984541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study is to determine the nutritional status, anthropometric measurements and quality of life of adult patients with cancer receiving chemotherapy, and to evaluate their interactions. In this retrospective cross sectional study, information about the patients' demographic characteristics, anthropometric measurements, nutritional status, hand grip strengths which were measured with a portable digital hand dynamometer, and the quality of life scores were obtained from the patient files. According to NRS-2002, 16.3% of the patients were at the risk of malnutrition. The body weight, body mass index, waist circumference, hip circumference, mid-upper arm circumference, hand grip strength values of the individuals who had three or higher scores from NRS-2002 were significantly lower (p < 0.05). Considering the evaluation of the quality of life scores based on their nutritional status, the functional and general health score was significantly lower in patients at the risk of malnutrition and their symptom score was significantly higher (p < 0.05). The presence of nutritional risk in cancer patients is related to the quality of life. In conclusion, the nutritional status of patients with cancer should be evaluated regularly, and early intervention regarding this is important to increase the quality of life.
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Affiliation(s)
- Aysel Sahin Kaya
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Antalya Bilim University, Antalya, Turkey
| | - Sumeyye Bora
- Faculty of Health Sciences, Department of Nutrition and Diet, Haliç University, Istanbul, Turkey
| | - Tarkan Yetisyigit
- Department of Medical Oncology, King Hamad University Hospital, Muharraq Governorate, Bahrain
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11
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Short Nutritional Assessment Questionnaire as a predictor of undernutrition in cancer patients receiving outpatient chemotherapy: A retrospective study. Eur J Oncol Nurs 2021; 54:102013. [PMID: 34500316 DOI: 10.1016/j.ejon.2021.102013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/06/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this retrospective study was to verify whether the revised Short Nutritional Assessment Questionnaire© (SNAQ), a simplified nutritional assessment, could be comparable with serum albumin (ALB) levels as a predictor of undernutrition in cancer patients receiving outpatient chemotherapy. METHODS Of 111 patients, 79 patients with baseline ALB levels ≥3.5 g/dL were included in the analysis. Patients completed the revised SNAQ, which evaluated items including appetite loss, weight loss, nutritional supplement usage, age, and body mass index, using a maximum of 12 points (a score of ≥3 was marked as severe undernutrition). ALB levels were then monitored for 1 year using patient medical records. RESULTS There was a significant difference in event-free survival (EFS) when the SNAQ scores were classified into two groups [i.e., scores of ≤3 (SNAQ3) or scores of ≥4 (SNAQ4)]. The 150-day EFS rate was 86.8% and 57.6% for SNAQ3 and SNAQ4, respectively (hazard ratio: 2.92; 95% confidence interval: 1.31-6.51; p = 0.009). Based on the Cox proportional-hazards analysis, a higher risk of undernutrition was associated with SNAQ4 (compared with SNAQ3), C-reactive protein levels, and serum transthyretin levels. CONCLUSION The revised SNAQ is a predictor of undernutrition in cancer patients receiving outpatient chemotherapy. In particular, it is important that patients with a SNAQ score of ≥4 receive dietary guidance at an early stage as they are likely to become undernourished within a year.
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12
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Aprile G, Basile D, Giaretta R, Schiavo G, La Verde N, Corradi E, Monge T, Agustoni F, Stragliotto S. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients 2021; 13:nu13041196. [PMID: 33916385 PMCID: PMC8065908 DOI: 10.3390/nu13041196] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients' overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients' nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.
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Affiliation(s)
- Giuseppe Aprile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
- Correspondence: ; Tel.: +39-0444753906
| | - Debora Basile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Renato Giaretta
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Gessica Schiavo
- Clinical Nutritional Unit, AULSS8 Berica, 36100 Vicenza, Italy;
| | - Nicla La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, 20131 Milano, Italy;
| | - Ettore Corradi
- Clinical Nutritional Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy;
| | - Taira Monge
- Clinical Nutrition, S. Giovanni Battista Hospital, 10126 Torino, Italy;
| | - Francesco Agustoni
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Silvia Stragliotto
- Department of Oncology, Istituto Oncologico Veneto—IRCCS, 31033 Padova, Italy;
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13
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Berardi E, Madaro L, Lozanoska-Ochser B, Adamo S, Thorrez L, Bouche M, Coletti D. A Pound of Flesh: What Cachexia Is and What It Is Not. Diagnostics (Basel) 2021; 11:diagnostics11010116. [PMID: 33445790 PMCID: PMC7828214 DOI: 10.3390/diagnostics11010116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 12/18/2022] Open
Abstract
Body weight loss, mostly due to the wasting of skeletal muscle and adipose tissue, is the hallmark of the so-called cachexia syndrome. Cachexia is associated with several acute and chronic disease states such as cancer, chronic obstructive pulmonary disease (COPD), heart and kidney failure, and acquired and autoimmune diseases and also pharmacological treatments such as chemotherapy. The clinical relevance of cachexia and its impact on patients’ quality of life has been neglected for decades. Only recently did the international community agree upon a definition of the term cachexia, and we are still awaiting the standardization of markers and tests for the diagnosis and staging of cancer-related cachexia. In this review, we discuss cachexia, considering the evolving use of the term for diagnostic purposes and the implications it has for clinical biomarkers, to provide a comprehensive overview of its biology and clinical management. Advances and tools developed so far for the in vitro testing of cachexia and drug screening will be described. We will also evaluate the nomenclature of different forms of muscle wasting and degeneration and discuss features that distinguish cachexia from other forms of muscle wasting in the context of different conditions.
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Affiliation(s)
- Emanuele Berardi
- Department of Development and Regeneration, KU Leuven Campus Kulak, 8500 Kortrijk, Belgium; (E.B.); (L.T.)
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University (UHasselt), 3590 Diepenbeek, Belgium
| | - Luca Madaro
- DAHFMO Unit of Histology and Medical Embryology, Sapienza University of Rome, 00161 Rome, Italy; (L.M.); (B.L.-O.); (S.A.); (D.C.)
| | - Biliana Lozanoska-Ochser
- DAHFMO Unit of Histology and Medical Embryology, Sapienza University of Rome, 00161 Rome, Italy; (L.M.); (B.L.-O.); (S.A.); (D.C.)
| | - Sergio Adamo
- DAHFMO Unit of Histology and Medical Embryology, Sapienza University of Rome, 00161 Rome, Italy; (L.M.); (B.L.-O.); (S.A.); (D.C.)
| | - Lieven Thorrez
- Department of Development and Regeneration, KU Leuven Campus Kulak, 8500 Kortrijk, Belgium; (E.B.); (L.T.)
| | - Marina Bouche
- DAHFMO Unit of Histology and Medical Embryology, Sapienza University of Rome, 00161 Rome, Italy; (L.M.); (B.L.-O.); (S.A.); (D.C.)
- Correspondence: ; Tel.: +39-(6)-4976-6755/6573
| | - Dario Coletti
- DAHFMO Unit of Histology and Medical Embryology, Sapienza University of Rome, 00161 Rome, Italy; (L.M.); (B.L.-O.); (S.A.); (D.C.)
- Biological Adaptation and Ageing, CNRS UMR 8256, Inserm U1164, Institut de Biologie Paris-Seine, Sorbonne Université, 75006 Paris, France
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