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Li S, Amakye WK, Zhao Z, Xin X, Jia Y, Zhang H, Ren Y, Zhou Y, Zhai L, Kang W, Lu X, Guo J, Wang M, Xu Y, Yi J, Ren J. Prognostic value of anthropometric- and biochemistry-based nutrition status indices on blood chemistry panel levels during cancer treatment. Nutrition 2024; 126:112520. [PMID: 39111096 DOI: 10.1016/j.nut.2024.112520] [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: 01/22/2024] [Revised: 05/24/2024] [Accepted: 06/08/2024] [Indexed: 09/10/2024]
Abstract
Body weight, body mass index (BMI), Nutrition Risk Screening 2002 (NRS2002), and prognostic nutritional index (PNI) are among vital nutrition status indices employed during cancer treatment. These have also been associated with levels of blood chemistry panels (BCPs), which are touted as significant indicators of disease prognosis. However, it remains unclear which nutrition status index better predicts future trends in specific BCPs. Using the records of 407 cancer patients, we retrospectively examined the potential of nutritional status indices at baseline for predicting changes in specific BCPs over a 6-week period. Generally, both serum biochemical parameters and nutrition status indices fluctuated over the study period among study participants. PNI was often linearly associated with blood cell counts (white blood cells [WBCs] and hemoglobin) compared with anthropometric-based nutrition status indices. Increase in body weight was protective against having abnormal lymphocyte levels at 6 weeks (odds ratio [OR]: 0.960-0.974; CI: 0.935-0.997; P < 0.05), while increase in baseline PNI was associated with 0.865-0.941 and 0.675-0.915 odds of having future abnormal WBC and lymphocyte levels, respectively. Increases in PNI were also protective against having future abnormal albumin levels (OR: 0.734-0.886) and 8.5-12.5% decreases in the odds of having an abnormal C-reactive protein level in subsequent visits. Changes in NRS2002 tended to be associated with the odds of having future abnormal blood glucose levels. In conclusion, the serum biochemistry-derived nutrition status index, PNI, is a more consistent measure as an early indicator to track the trends of future changes in the BCPs of cancer patients. This implies that PNI could be targeted as an early-warning measure with relevant preventive interventions for patients at risk of malnutrition.
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Affiliation(s)
- Suyun Li
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Beijing, 100021, China
| | - William Kwame Amakye
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510641, Guangdong, China
| | - Zikuan Zhao
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510641, Guangdong, China
| | - Xiaowei Xin
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Beijing, 100021, China
| | - Ying Jia
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Beijing, 100021, China
| | - Hui Zhang
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Beijing, 100021, China
| | - Yuwei Ren
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Langfang, 065001, China
| | - Yuxin Zhou
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Langfang, 065001, China
| | - Lina Zhai
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Langfang, 065001, China
| | - Weicong Kang
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Langfang, 065001, China
| | - Xuemin Lu
- Department of Clinical Nutrition, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Langfang, 065001, China
| | - Ji Guo
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510641, Guangdong, China
| | - Min Wang
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510641, Guangdong, China
| | - Yongzhao Xu
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510641, Guangdong, China
| | - Junlin Yi
- Department of Radiotherapy, National Cancer Hospital/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Science, Beijing, 100021, China
| | - Jiaoyan Ren
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510641, Guangdong, China.
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Tian M, Xu H, Wang H, Wang H, Dai Z, Ding C, Guo H, Jin X. Pretreatment Computed Tomography-Defined Sarcopenia, Treatment-Associated Muscle Loss, and Survival in Patients With Cervical Cancer: A Systematic Review and Meta-Analysis. Nutr Rev 2024:nuae130. [PMID: 39340837 DOI: 10.1093/nutrit/nuae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2024] Open
Abstract
CONTEXT Sarcopenia has been identified as a potential predictor of poor prognosis in various types of cancer. However, the impact of pretreatment sarcopenia and the reduction of skeletal muscle mass during treatment on survival outcomes of patients with cervical cancer is still not well understood. OBJECTIVE This meta-analysis was conducted to investigate the impact of pretreatment sarcopenia and treatment-associated muscle loss on survival outcomes in patients with cervical cancer. DATA SOURCES The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies exploring the relationship between muscle loss and the prognosis of cervical cancer until January 1, 2023. DATA EXTRACTION The hazard ratios (HRs) and 95% CIs for overall survival (OS) and progression-free survival (PFS) were extracted. DATA ANALYSIS The data were analyzed using R software. The studies' quality was assessed using the Quality in Prognostic Studies tool. Twelve observational studies involving 1498 patients with cervical cancer were included in the analysis, with a prevalence of sarcopenia ranging from 24.8% to 57.5%. Sarcopenia was an independent predictor of poor OS (HR, 1.68; 95% CI, 1.28-2.21; P < .01) and PFS (HR, 1.53; 95% CI, 1.19-1.98; P < .01) in patients with cervical cancer. Additionally, the decrease in skeletal muscle during treatment was also significantly related to the OS (HR, 4.46; 95% CI, 2.87-6.94; P < .01) and PFS (HR, 2.89; 95% CI. 1.83-4.55; P < .01). CONCLUSIONS The prevalence of pretreatment sarcopenia was high among patients with cervical cancer. Pretreatment sarcopenia and skeletal muscle loss during treatment both negatively affected prognosis in cervical cancer.
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Affiliation(s)
- Mengxing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Huiting Xu
- Department of Abdominal Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Hongbin Wang
- Department of Gynecology and Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Huifen Wang
- Nursing Department, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Zhu Dai
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Chenchen Ding
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Huan Guo
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
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Zhou H, Lv D, Cui F, Qian Gong, Li J, Wen J, Jia M, Kang Y, Rong Y, Zhang W, Shuang W. Prognostic value of the geriatric nutritional risk index in patients with non-metastatic clear cell renal cell carcinoma: a propensity score matching analysis. Nutr J 2024; 23:114. [PMID: 39342187 DOI: 10.1186/s12937-024-01010-7] [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: 08/28/2023] [Accepted: 09/03/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND This study aimed to investigate the prognostic value of the geriatric nutritional risk index (GNRI) in patients with non-metastatic clear cell renal cell carcinoma (ccRCC) who underwent nephrectomy. METHODS Patients with non-metastatic ccRCC who underwent nephrectomy between 2013 and 2021 were analyzed retrospectively. The GNRI was calculated within one week before surgery. The optimal cut-off value of GNRI was determined using X-tile software, and the patients were divided into a low GNRI group and a high GNRI group. The Kaplan-Meier method was used to compare the overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) between the two groups. Univariate and multivariate Cox proportional hazard models were used to determine prognostic factors. In addition, propensity score matching (PSM) was performed with a matching ratio of 1:3 to minimize the influence of confounding factors. Variables entered into the PSM model were as follows: sex, age, history of hypertension, history of diabetes, smoking history, BMI, tumor sidedness, pT stage, Fuhrman grade, surgical method, surgical approach, and tumor size. RESULTS A total of 645 patients were included in the final analysis, with a median follow-up period of 37 months (range: 1-112 months). The optimal cut-off value of GNRI was 98, based on which patients were divided into two groups: a low GNRI group (≤ 98) and a high GNRI group (> 98). Kaplan-Meier analysis showed that OS (P < 0.001), CSS (P < 0.001) and RFS (P < 0.001) in the low GNRI group were significantly worse than those in the high GNRI group. Univariate and multivariate Cox analysis showed that GNRI was an independent prognostic factor of OS, CSS and RFS. Even after PSM, OS (P < 0.05), CSS (P < 0.05) and RFS (P < 0.05) in the low GNRI group were still worse than those in the high GNRI group. In addition, we observed that a low GNRI was associated with poor clinical outcomes in elderly subgroup (> 65) and young subgroup (≤ 65), as well as in patients with early (pT1-T2) and low-grade (Fuhrman I-II) ccRCC. CONCLUSION As a simple and practical tool for nutrition screening, the preoperative GNRI can be used as an independent prognostic indicator for postoperative patients with non-metastatic ccRCC. However, larger prospective studies are necessary to validate these findings.
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Affiliation(s)
- Huiyu Zhou
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Dingyang Lv
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Fan Cui
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Qian Gong
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Jinshuai Li
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Jie Wen
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Mohan Jia
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Yinbo Kang
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Yi Rong
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Wenlong Zhang
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China
| | - Weibing Shuang
- Department of Urology, The First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan, Shanxi Province, China.
- First Clinical Medical College of Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China.
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4
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Wei C, Ai H, Mo D, Wang P, Wei L, Liu Z, Li P, Huang T, Liu M. A nomogram based on inflammation and nutritional biomarkers for predicting the survival of breast cancer patients. Front Endocrinol (Lausanne) 2024; 15:1388861. [PMID: 39170737 PMCID: PMC11335604 DOI: 10.3389/fendo.2024.1388861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Background We aim to develop a new prognostic model that incorporates inflammation, nutritional parameters and clinical-pathological features to predict overall survival (OS) and disease free survival (DFS) of breast cancer (BC) patients. Methods The study included clinicopathological and follow-up data from a total of 2857 BC patients between 2013 and 2021. Data were randomly divided into two cohorts: training (n=2001) and validation (n=856) cohorts. A nomogram was established based on the results of a multivariate Cox regression analysis from the training cohorts. The predictive accuracy and discriminative ability of the nomogram were evaluated by the concordance index (C-index) and calibration curve. Furthermore, decision curve analysis (DCA) was performed to assess the clinical value of the nomogram. Results A nomogram was developed for BC, incorporating lymphocyte, platelet count, hemoglobin levels, albumin-to-globulin ratio, prealbumin level and other key variables: subtype and TNM staging. In the prediction of OS and DFS, the concordance index (C-index) of the nomogram is statistically greater than the C-index values obtained using TNM staging alone. Moreover, the time-dependent AUC, exceeding the threshold of 0.7, demonstrated the nomogram's satisfactory discriminative performance over different periods. DCA revealed that the nomogram offered a greater overall net benefit than the TNM staging system. Conclusion The nomogram incorporating inflammation, nutritional and clinicopathological variables exhibited excellent discrimination. This nomogram is a promising instrument for predicting outcomes and defining personalized treatment strategies for patients with BC.
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Affiliation(s)
- Caibiao Wei
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Huaying Ai
- Department of Injection Room, The People’s Hospital of Yingtan, Yingtan, Jiangxi, China
| | - Dan Mo
- Department of Breast, Guangxi Zhuang Autonomous Region Maternal and Child Health Care Hospital, Nanning, China
| | - Peidong Wang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Liling Wei
- Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhimin Liu
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Peizhang Li
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Taijun Huang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Miaofeng Liu
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
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5
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Nasso R, D'Errico A, Motti ML, Masullo M, Arcone R. Dietary Protein and Physical Exercise for the Treatment of Sarcopenia. Clin Pract 2024; 14:1451-1467. [PMID: 39194921 DOI: 10.3390/clinpract14040117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Sarcopenia is a multifactorial age-related disorder that causes a decrease in muscle mass, strength, and function, leading to alteration of movement, risk of falls, and hospitalization. This article aims to review recent findings on the factors underlying sarcopenia and the strategies required to delay and counteract its symptoms. We focus on molecular factors linked to ageing, on the role of low-grade chronic and acute inflammatory conditions such as cancer, which contributes to the onset of sarcopenia, and on the clinical criteria for its diagnosis. The use of drugs against sarcopenia is still subject to debate, and the suggested approaches to restore muscle health are based on adequate dietary protein intake and physical exercise. We also highlight the difference in the amount and quality of amino acids within animal- and plant-based diets, as studies have often shown varying results regarding their effect on sarcopenia in elderly people. In addition, many studies have reported that non-pharmacological approaches, such as an optimization of dietary protein intake and training programs based on resistance exercise, can be effective in preventing and delaying sarcopenia. These approaches not only improve the maintenance of skeletal muscle function, but also reduce health care costs and improve life expectancy and quality in elderly people.
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Affiliation(s)
- Rosarita Nasso
- Department of Medical, Movement and Well-Being Sciences (DiSMMeB), University of Naples "Parthenope", Via Medina 40, 80133 Napoli, Italy
| | - Antonio D'Errico
- Department of Medical, Movement and Well-Being Sciences (DiSMMeB), University of Naples "Parthenope", Via Medina 40, 80133 Napoli, Italy
| | - Maria Letizia Motti
- Department of Medical, Movement and Well-Being Sciences (DiSMMeB), University of Naples "Parthenope", Via Medina 40, 80133 Napoli, Italy
| | - Mariorosario Masullo
- Department of Medical, Movement and Well-Being Sciences (DiSMMeB), University of Naples "Parthenope", Via Medina 40, 80133 Napoli, Italy
| | - Rosaria Arcone
- Department of Medical, Movement and Well-Being Sciences (DiSMMeB), University of Naples "Parthenope", Via Medina 40, 80133 Napoli, Italy
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Ye J, Tang C, Wu R, Tang Y, Yin H, Bai Y, Han P. Preoperative blood-based nutritional biomarkers as significant prognostic factors after intravesical BCG therapy in patients with non-muscle-invasive bladder cancer. World J Urol 2024; 42:428. [PMID: 39037600 DOI: 10.1007/s00345-024-05148-1] [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: 03/15/2024] [Accepted: 06/23/2024] [Indexed: 07/23/2024] Open
Abstract
The aim of this study was to investigate the prognostic role of blood-based nutritional biomarkers, including red blood cell (RBC count), hemoglobin (Hb), total protein (TP), albumin, the serum albumin to globulin ratio (AGR) and the prognostic nutritional index (PNI) in patients who underwent intravesical treatment for non-muscle invasive bladder cancer (NMIBC). A total of 501 NMIBC patients who received intravesical Bacillus Calmette-Guerin (BCG) treatment following transurethral resection of bladder tumor (TURBT) were included. The optimal cutoff values for these nutrition-based indicators were determined using receiver operating characteristic curve analysis. We observed a significantly higher recurrence-free survival (RFS) rate in patients with elevated levels of RBC count, Hb, TP, and albumin. Cox univariate and multivariate Cox regression analyses demonstrated that serum albumin (P = 0.002, HR = 0.51, 95%CI: 0.33-0.78), RBC count (P = 0.002, HR = 0.50, 95%CI: 0.32-0.77), TP (P = 0.028, HR = 0.62, 95%CI: 0.41-0.95), Hb (P = 0.004, HR = 0.53, 95%CI: 0.33-0.84), AGR (P = 0.003, HR = 0.46, 95%CI: 0.27-0.76) and PNI (P = 0.019, HR = 0.56, 95%CI: 0.35-0.91) were significant independent factors predicting RFS. These cost-effective and convenient blood-based nutritional biomarkers have the potential to serve as valuable prognostic indicators for predicting recurrence in NMIBC patients undergoing BCG-immunotherapy.
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Affiliation(s)
- Junjiang Ye
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Cai Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ruicheng Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yin Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hesheng Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Denaro N, Bareggi C, Galassi B, Beltramini G, Wekking D, Proh M, Ibba T, Solinas C, Garrone O. Nutrition in HNSCC: is it a matter for oncologists? The role of multidisciplinary team-a narrative literature review. Front Oncol 2024; 14:1430845. [PMID: 39022585 PMCID: PMC11251948 DOI: 10.3389/fonc.2024.1430845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Background Malnutrition, defined as weight loss and unsatisfactory nutrient intake, is very common in patients with head and neck squamous cell carcinoma (HNSCC) in either the early or palliative setting. Despite increased awareness, nutritional programs are not yet adequately implemented in these patients. There are several reasons for this delay: differences in composition, the expertise of the multidisciplinary teams involved in HNSCC patients' treatment, and economic and network resources conditioning faster or slower nutritional supply delivery. This situation affects the outcomes and the quality of life of HNSCC patients. Materials and methods We investigated available literature about nutritional support in HNSCC patients and its impact on outcomes, prognosis, and quality of life, and we focused on the role of the multidisciplinary team. We considered 8,491 articles, and after excluding duplicates and manuscripts not written in English, 1,055 were analyzed and 73 were deemed eligible for the present work. Results After the literature review, we can state that malnutrition, sarcopenia, and cachexia are associated with systemic inflammation and closely correlated with poor outcomes. An evaluation of the nutritional status of the multidisciplinary team before, during, and after therapy could improve patient outcomes, as the goal of the therapeutic approach is widely designed. Conclusions We suggest that the treatment workflow definition is fundamental and propose a tailored nutritional approach that could benefit HNSCC patients' outcomes and quality of life. These results could be achieved by a multidisciplinary team.
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Affiliation(s)
- Nerina Denaro
- Oncologia Medica Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda, Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Claudia Bareggi
- Oncologia Medica Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda, Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Barbara Galassi
- Oncologia Medica Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda, Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Giada Beltramini
- Chirurgia Maxillofacciale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Demi Wekking
- Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Michele Proh
- Otorinolaringoiatra Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Tullio Ibba
- Otorinolaringoiatra Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cinzia Solinas
- Medical Oncology Department, Azienda Ospedaliera Universitaria (AOU) Cagliari, Policlinico Di Monserrato (CA), Monserrato, Italy
| | - Ornella Garrone
- Oncologia Medica Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda, Ospedale Maggiore Policlinico Milano, Milan, Italy
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8
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Kang MK, Lee H. Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer. Ann Gastroenterol Surg 2024; 8:534-552. [PMID: 38957563 PMCID: PMC11216795 DOI: 10.1002/ags3.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/03/2024] [Accepted: 02/24/2024] [Indexed: 07/04/2024] Open
Abstract
Malnutrition, characterized by altered body composition and impaired function, is particularly prevalent among gastric cancer patients, affecting up to 60% of them. Malnutrition in these patients can manifest both before and after surgery, due to factors such as gastric outlet obstruction, cancer cachexia, and anatomical changes. Notably, total gastrectomy (TG) presents the most significant nutritional challenges. However, function-preserving gastrectomy, such as pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG), have shown promise in improving nutritional outcomes. Effective nutritional risk screening and assessment are vital for identifying patients at risk. Nutritional support not only improves nutritional parameters but also reduces complications, enhances quality of life (QoL) and survival rates. Those unable to maintain more than 50% of the recommended intake for over 7 days are recommended for nutritional support. Common methods of nutritional support include oral nutrition supplements (ONS), enteral nutrition (EN), or parenteral nutrition (PN) depending on the patient's status. Effect of perioperative nutritional support remains controversial. Preoperative interventions including ONS and PN have shown mixed results, with selective benefits in patients with sarcopenia or hypoalbuminaemia, while impact of EN in gastric outlet obstruction patients have been positive. In contrast postoperative support appears to be consistent. Tube feeding after TG has shown improvements, and ONS have been effective in reducing weight loss and improving nutritional biomarkers. PN was also associated with benefits such as weight maintenance and QoL. This review explores the mechanisms, assessment, and clinical impact of malnutrition, emphasizing the importance of nutritional support in gastric cancer patients undergoing gastrectomy.
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Affiliation(s)
- Min Kyu Kang
- Division of Gastrointestinal Surgery, Department of SurgerySeoul National University HospitalSeoulSouth Korea
| | - Hyuk‐Joon Lee
- Division of Gastrointestinal Surgery, Department of SurgerySeoul National University HospitalSeoulSouth Korea
- Department of Surgery & Cancer Research InstituteSeoul National University College of MedicineSeoulSouth Korea
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9
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Kiss N, Prado CM, Curtis AR, Abbott G, Denehy L, Edbrooke L, Baguley BJ, Fraser SF, Daly RM. Risk factors for low muscle mass, malnutrition, and (probable-) sarcopenia in adults with or without a history of cancer in the UK Biobank. Clin Nutr 2024; 43:1736-1746. [PMID: 38843582 DOI: 10.1016/j.clnu.2024.05.041] [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: 02/13/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND AND AIMS Early identification of people at risk of cancer-related malnutrition, low muscle mass (LMM) and sarcopenia is crucial to mitigate the impact of adverse outcomes. This study investigated risk factors associated with LMM, malnutrition and (probable-) sarcopenia and whether these varied in people with or without a history of cancer. METHODS Participants in the UK Biobank, with or without a history of cancer, who completed the Oxford WebQ at the baseline assessment were included. LMM was estimated from fat-free mass derived from bioelectrical impedance analysis, and low muscle strength from handgrip strength, and used to identify probable or confirmed sarcopenia following the European Working Group on Sarcopenia in Older People 2 definition. The Global Leadership Initiative on Malnutrition criteria were applied to determine malnutrition. Generalised linear models were used to estimate prevalence ratios (PR) for associations between risk factors (clinical, functional, nutritional) and study outcomes. RESULTS Overall, 50,592 adults with (n = 2,287, mean ± SD 59.7 ± 7.1 years) or without (n = 48,305, mean ± SD 55.8 ± 8.2 years) cancer were included. For all participants (PRs [cancer, without cancer]), slow walking pace (PR 1.85; 1.99), multimorbidity (PR 1.72; 1.51), inflammation (PR 2.91; 2.07), and low serum 25(OH)D (PR 1.85, 1.44) were associated with higher prevalence of LMM, while higher energy intake (PR 0.55; 0.49) was associated with lower prevalence. Slow walking pace (PR 1.54 [cancer], 1.51 [without cancer]) and higher protein intake (PR 0.18 [cancer]; 0.11 [without cancer]) were associated with increased or decreased prevalence of malnutrition, respectively regardless of cancer status. Multimorbidity was the only common factor associated with higher prevalence (PR 1.79 [cancer], 1.68 [without cancer]) of (probable-)sarcopenia in all participants. CONCLUSION Risk factors for LMM and malnutrition were similar in adults with and without cancer, although these varied between LMM and malnutrition. These findings have implications for the future of risk stratification, screening and assessment for these conditions and the development or modification of existing screening tools.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Annie R Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Linda Denehy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Lara Edbrooke
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Physiotherapy Department, University of Melbourne, Parkville, Australia
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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10
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Hjermstad MJ, Jakobsen G, Arends J, Balstad TR, Brown LR, Bye A, Coats AJ, Dajani OF, Dolan RD, Fallon MT, Greil C, Grzyb A, Kaasa S, Koteng LH, May AM, McDonald J, Ottestad I, Philips I, Roeland EJ, Sayers J, Simpson MR, Skipworth RJ, Solheim TS, Sousa MS, Vagnildhaug OM, Laird BJ. Quality of life endpoints in cancer cachexia clinical trials: Systematic review 3 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2024; 15:794-815. [PMID: 38553255 PMCID: PMC11154790 DOI: 10.1002/jcsm.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 06/07/2024] Open
Abstract
The use of patient-reported outcomes (PROMs) of quality of life (QOL) is common in cachexia trials. Patients' self-report on health, functioning, wellbeing, and perceptions of care, represent important measures of efficacy. This review describes the frequency, variety, and reporting of QOL endpoints used in cancer cachexia clinical trials. Electronic literature searches were performed in Medline, Embase, and Cochrane (1990-2023). Seven thousand four hundred thirty-five papers were retained for evaluation. Eligibility criteria included QOL as a study endpoint using validated measures, controlled design, adults (>18 years), ≥40 participants randomized, and intervention exceeding 2 weeks. The Covidence software was used for review procedures and data extractions. Four independent authors screened all records for consensus. Papers were screened by titles and abstracts, prior to full-text reading. PRISMA guidance for systematic reviews was followed. The protocol was prospectively registered via PROSPERO (CRD42022276710). Fifty papers focused on QOL. Twenty-four (48%) were double-blind randomized controlled trials. Sample sizes varied considerably (n = 42 to 469). Thirty-nine trials (78%) included multiple cancer types. Twenty-seven trials (54%) featured multimodal interventions with various drugs and dietary supplements, 11 (22%) used nutritional interventions alone and 12 (24%) used a single pharmacological intervention only. The median duration of the interventions was 12 weeks (4-96). The most frequent QOL measure was the EORTC QLQ-C30 (60%), followed by different FACIT questionnaires (34%). QOL was a primary, secondary, or exploratory endpoint in 15, 31 and 4 trials respectively, being the single primary in six. Statistically significant results on one or more QOL items favouring the intervention group were found in 18 trials. Eleven of these used a complete multidimensional measure. Adjustments for multiple testing when using multicomponent QOL measures were not reported. Nine trials (18%) defined a statistically or clinically significant difference for QOL, five with QOL as a primary outcome, and four with QOL as a secondary outcome. Correlation statistics with other study outcomes were rarely performed. PROMs including QOL are important endpoints in cachexia trials. We recommend using well-validated QOL measures, including cachexia-specific items such as weight history, appetite loss, and nutritional intake. Appropriate statistical methods with definitions of clinical significance, adjustment for multiple testing and few co-primary endpoints are encouraged, as is an understanding of how interventions may relate to changes in QOL endpoints. A strategic and scientific-based approach to PROM research in cachexia trials is warranted, to improve the research base in this field and avoid the use of QOL as supplementary measures.
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Affiliation(s)
- Marianne J. Hjermstad
- Department of OncologyOslo University HospitalOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)OsloNorway
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
| | - Jann Arends
- Department of Medicine I, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Trude R. Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNTNU–Norwegian University of Science and TechnologyTrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research Group, UiTThe Arctic University of NorwayTromsøNorway
| | - Leo R. Brown
- Department of Clinical SurgeryUniversity of EdinburghEdinburghUK
- Royal Infirmary of EdinburghEdinburghUK
| | - Asta Bye
- Department of OncologyOslo University HospitalOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet – Oslo Metropolitan UniversityOsloNorway
| | | | - Olav F. Dajani
- Department of OncologyOslo University HospitalOsloNorway
| | - Ross D. Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie T. Fallon
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
| | - Christine Greil
- Department of Medicine I, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Stein Kaasa
- Department of OncologyOslo University HospitalOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Lisa H. Koteng
- Department of OncologyOslo University HospitalOsloNorway
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | | | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
- Department of Clinical Service, Division of Cancer Medicine, Section of Clinical NutritionOslo University HospitalOsloNorway
| | - Iain Philips
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Eric J. Roeland
- Oregon Health and Science UniversityKnight Cancer InstitutePortlandORUSA
| | - Judith Sayers
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Melanie R. Simpson
- Department of Public Health and NursingNorwegian University of Science and TechnologyTrondheimNorway
| | | | - Tora S. Solheim
- Department of Public Health and Nursing, Cancer Clinic, St Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of TechnologySydneyNSWAustralia
| | - Ola M. Vagnildhaug
- Department of Public Health and Nursing, Cancer Clinic, St Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
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11
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Li N, Xue D, Men K, Li L, Yang J, Jiang H, Meng Q, Zhang S. Influence of malnutrition according to the glim criteria on the chemotherapy toxicities in patients with advanced lung cancer. Support Care Cancer 2024; 32:358. [PMID: 38750262 DOI: 10.1007/s00520-024-08556-6] [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: 02/18/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Cancer-associated malnutrition is highly prevalent in advanced lung cancer, and 50% of global cancer-related deaths are attributed to cancer-associated malnutrition. Platinum-containing chemotherapy is the standard treatment for advanced lung cancer. Unfortunately, it can cause exacerbated toxicities, which can also have a negative impact on patient's prognosis and quality of life. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been proposed as the world's first accepted diagnostic criteria for malnutrition. However, the effectiveness of GLIM criteria in predicting chemotherapy toxicities in patients with advanced lung cancer is unclear. The aim of this study was to apply the GLIM criteria to assess the prevalence of pre-treatment diagnosis of malnutrition in patients with advanced non-small cell lung cancer (NSCLC) and to determine the impact of nutritional status on patient's chemotherapy toxicity. METHODS We conducted a study of hospitalized patients with pathologically and clinically diagnosed advanced NSCLC who presented to our hospital from May 2021 to January 2022. Initially, the Nutritional Risk Screening-2002 (NRS-2002) was used for nutritional risk screening, and nutritional status was assessed using the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and GLIM criteria. Chemotherapy toxicity was assessed and graded according to CTCAE5.0, and chemotherapy efficacy was assessed according to RECIST1.1. Kappa test was used to analyze the agreement between PG-SGA and GLIM criteria. Univariate and multivariate logistic regression analyses were used to determine the relationship between malnutrition and chemotherapy toxicity. RESULTS A total of 215 patients with advanced NSCLC were evaluated for nutritional status. Most of the patients had normal BMI (61.86%) before the start of treatment, 40% were well-nourished as assessed by the PG-SGA tool, and 51.17% were well-nourished as assessed by GLIM criteria. Consistency analysis showed moderate agreement (Kappa = 0.463, P < 0.001) and their correlation was also moderate (Spearman, rs = 0.475, P < 0.001). The objective response rate (ORR) (P = 0.040) and disease control rate (DCR) (P < 0.001) were significantly lower in malnourished patients diagnosed according to GLIM criteria than in well-nourished patients. Multivariate analysis showed that malnutrition (OR = 1.531,95%CI 0.757-3.009; OR = 6.623,95%CI 1.390-31.567, P = 0.046) diagnosed by GLIM criteria was an independent predictor of chemotherapy toxicity. Conclusions Malnutrition diagnosed by GLIM criteria better predicts toxicity during chemotherapy, determines the degree of clinical benefit of chemotherapy, and may affect patient prognosis.
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Affiliation(s)
- Ning Li
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Dinglong Xue
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kaiya Men
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lijun Li
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiaxin Yang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hao Jiang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qingwei Meng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
| | - Shuai Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
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12
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Al-Amouri FM, Badrasawi M. Taste alteration and its relationship with nutritional status among cancer patients receiving chemotherapy, cross-sectional study. PLoS One 2024; 19:e0302990. [PMID: 38723006 PMCID: PMC11081316 DOI: 10.1371/journal.pone.0302990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
The aim of this study is to determine the prevalence of taste alterations (TAs) during chemotherapy and their association with nutritional status and malnutrition. In addition to the associated factors with TA, including sociodemographic health-related factors and clinical status, and to investigate coping strategies to manage TA. A multicenter cross-sectional design study was conducted on 120 cancer patients aged at least 18 who had been undergoing at least one round of chemotherapy. TAs were evaluated using the chemotherapy-induced taste alteration scale (CiTAS), the malnutrition universal screening tool (MUST) was used for nutritional screening, the antineoplastic side effects scale (ASES) was used for subjective assessment of chemotherapy side effects, and the Charlson comorbidity index (CCI) was used for comorbidity assessment. SPSS21 software was used to analyze the data, and the independent T-test and one-way ANOVA test were used to determine the association between TAs and a variety of related variables. The prevalence of TAs was 98.3%. Among participants, 48.3% were at low risk of malnutrition, 20% at medium risk, and 31.7% at high risk. Malnutrition risk was associated with taste disorders (p<0.05). Patients' age, gender, educational level, and physical status were associated with TAs (p<0.05). Type of cancer, chemotherapy regimen, and number of chemotherapy cycles were also associated with TAs (p<0.05). A variety of antineoplastic side effects were associated with TAs (p<0.05), including nausea, vomiting, dry mouth, sore mouth and throat, excessive thirst, swallowing difficulty, appetite changes, weight loss, dizziness, lack of energy, disturbed sleep, anxiety, and difficulty concentrating. TAs were associated with an increased number of comorbidities, and individuals with diabetes, pulmonary diseases, and hypertension were associated with TAs (P<0.05). Patients in this study rarely practice self-management strategies to cope with TAs. A high prevalence (98.3%) of TAs in cancer patients receiving chemotherapy was found, and it was linked to a variety of negative outcomes. Chemotherapy-induced TAs are an underestimated side effect that requires more attention from patients and health care providers.
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Affiliation(s)
- Fatima Masoud Al-Amouri
- Department of Nutrition and Food Technology, An-Najah National University, Nablus, Palestine
| | - Manal Badrasawi
- Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, Palestine
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13
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Benna-Doyle S, Baguley BJ, Laing E, Kiss N. Nutritional interventions during treatment for ovarian cancer: A narrative review and recommendations for future research. Maturitas 2024; 183:107938. [PMID: 38367367 DOI: 10.1016/j.maturitas.2024.107938] [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: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
Most women with ovarian cancer are diagnosed at an advanced stage (stage III or IV), when the intraabdominal spread of the tumour impacts nutrient intake and absorption. Up to 70 % of women with ovarian cancer are malnourished and approximately 40 % are affected by muscle loss at the time of diagnosis. Women with ovarian cancer are at high risk of nutritional decline due to invasive treatment and the severity of side-effects. This review explores the evidence evaluating nutritional interventions during treatment for ovarian cancer and their effect on nutritional status, muscle mass, and clinical outcomes. Perioperative immunonutrition has been investigated with mixed results for immediate postoperative outcomes. Individualised nutrition counselling as part of a multimodal prehabilitation programme prior to surgery shows promising results; however, the effects are limited by sample size. Nutrition counselling as part of a mixed intervention with exercise shows high acceptability and suggests improvements in dietary intake and quality of life during chemotherapy treatment, while oral nutritional supplements and nutrition education appear to reduce symptom burden. Individualised nutrition counselling during treatment also appears to be associated with improved overall survival; however, the evidence is limited to a single retrospective study. A key finding from this review is that, despite the high prevalence of malnutrition and muscle loss in women with ovarian cancer and the critical importance of addressing these modifiable prognostic factors, nutrition intervention studies are limited. Prospective studies with samples large enough to provide adequate power to evaluate intervention effectiveness are urgently required to inform optimal management.
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Affiliation(s)
- Sarah Benna-Doyle
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
| | - Erin Laing
- Peter McCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
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14
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Navarro-Ibarra MJ, Saucedo-Tamayo MDS, Alemán-Mateo H, Parra-Sánchez H, Othón-Ontiveros P, Hernández J, Caire-Juvera G. Association Between Interleukin 6 and C-Reactive Protein Serum Levels and Body Composition Compartments and Components in Breast Cancer Survivors. Biol Res Nurs 2024; 26:231-239. [PMID: 37844913 DOI: 10.1177/10998004231207022] [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] [Indexed: 10/18/2023]
Abstract
Obesity is highly prevalent in breast cancer (BC) survivors. Adipose tissue promotes inflammation, affecting recurrence, morbidity, and quality of life. This study aimed to determine the relationship of body composition parameters with the levels of C-reactive protein (CRP) and interleukin 6 (IL-6) in female BC survivors. Additionally, we evaluated the association of log-transformed serum concentrations of CRP and IL-6 with the appendicular skeletal lean mass index (ASMI). The results showed that CRP was positively associated with body fat percentage (BFP; β adjusted = .08, 95% CI: .02-.14) in all participants, and with fat mass index (FMI; β = .24, 95% CI: .08-.40) only in premenopausal women. IL-6 was positively associated with FMI (β adjusted = .16, 95% CI: .03-.29), while ASMI decreased as CRP levels increased (β adjusted = -.30, 95% CI: -.53 to -.06). Interventions to improve body composition in BC survivors should also consider the role of inflammatory markers in changes in body composition to avoid sarcopenic obesity (SO) and the risk of BC recurrence.
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Affiliation(s)
- María Jossé Navarro-Ibarra
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
- Departamento de Nutrición, Facultad de Medicina Mexicali, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | - Heliodoro Alemán-Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
| | - Héctor Parra-Sánchez
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
| | | | - Jesús Hernández
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
| | - Graciela Caire-Juvera
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
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15
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Doğan Akagündüz D, Şahin H, Akagündüz B. Malnutrition and Related Factors in Older Patients With Gastrointestinal Cancer Receiving Chemotherapy. Cureus 2024; 16:e58252. [PMID: 38745807 PMCID: PMC11093618 DOI: 10.7759/cureus.58252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives The incidence and mortality of gastrointestinal (GI) malignancies increase exponentially with age. Malnutrition is a documented poor prognostic factor in older patients with cancer. There is insufficient data about the prevalence of malnutrition and associated factors in older patients with GI cancer. Thus, we aimed to investigate the prevalence of malnutrition and related factors among older patients with GI cancer. Methods A total of 121 patients aged over 70 years diagnosed with various types of GI cancers applied to the medical oncology clinic included in this cross-sectional study. We evaluated the nutrition status with a mini-nutritional assessment (MNA) score. Results The prevalence of malnutrition was 76 (62.8%) in our study population. The mean age was 76.5 (range 70 to 90 years), and 71 (58.6%) were male. In the multivariate logistic regression model, lower BMI (OR: 3.379, 95% CI: 1.465-7.812, p = 0.005), having gastroesophageal cancer (OR: 5.797, 95% CI: 2.387-14.091, p<0.001), treating with palliative chemotherapy (OR: 4.597, 95% CI: 1.799-11.772, p = 0.002), and frailty according to G8 score (OR: 10.798, 95% CI: 4.495-25.924, p<0.001) were associated with malnutrition. Conclusions Our study revealed that palliative chemotherapy, low BMI, frailty, and gastroesophageal cancer are risk factors for malnutrition in older patients with GI cancer. Physicians need to be aware of patients who may be at risk for malnutrition. Patients at risk of malnutrition may benefit from interventions to enhance their nutrition. Further studies consisting of larger cohorts are needed to determine malnutrition and related factors in older patients with cancer.
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Affiliation(s)
- Diğdem Doğan Akagündüz
- Nutrition and Dietetics, Mengücek Gazi Training and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, TUR
| | - Hilal Şahin
- Nutrition and Dietetics, Faculty of Health Science, Erzincan Binali Yıldırım University, Erzincan, TUR
| | - Baran Akagündüz
- Medical Oncology, Mengücek Gazi Training and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, TUR
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16
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Curtis AR, Livingstone KM, Daly RM, Abbott G, Kiss N. Dietary patterns linked to lower odds of malnutrition are associated with all-cause and cancer mortality in adults with cancer. J Nutr Health Aging 2024; 28:100026. [PMID: 38388112 DOI: 10.1016/j.jnha.2023.100026] [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: 09/21/2023] [Accepted: 11/30/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Dietary patterns, characterised by protein, polyunsaturated fatty acids, and vitamin D, reduce the odds of malnutrition in cancer survivors. However, it is unclear whether these dietary patterns also improve prognosis. This study prospectively examined associations between dietary patterns linked to lower odds of malnutrition and the risk of all-cause and cancer mortality in adult cancer survivors from the UK Biobank cohort. DESIGN Prospective observational study. SETTING AND PARTICIPANTS Cancer survivors from the UK Biobank (mean ± SD, 7.1 ± 6.3 years since diagnosis) were included (n = 2415; 59.7 ± 7.1 years; 60.7% female). MEASUREMENTS Dietary intake was estimated using the Oxford WebQ 24-h dietary assessment. Dietary patterns ('high oily fish and nuts', and 'low oily fish') were derived using reduced rank regression (response variables: protein (g/kg/day), polyunsaturated fatty acids (g/day) and vitamin D (μg/day)). Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cancer mortality. Nonlinear relationships were examined using restricted cubic splines. Models were adjusted for demographic and health characteristics. Sub-group analyses investigated relationships in sub-samples of adults with i) high nutritional risk (lung, gastrointestinal, haematological, or head and neck tumours) and ii) recent cancer diagnosis (cancer diagnosis within two years prior to assessment). RESULTS Deaths due to all-causes (n = 305) and cancer (n = 249) were identified during a median 10.4 (IQR: 10.2-10.8) years follow-up. There were no statistically significant linear associations between the dietary patterns and all-cause or cancer mortality. However, a U-shaped association between the 'high oily fish and nuts' pattern, characterised by higher intake of oily fish and nuts and seeds, and all-cause mortality (p-non-linearity = 0.004) was identified, as well as with all-cause (p-non-linearity = 0.006) and cancer mortality (p-non-linearity = 0.035) in adults with a high nutritional risk cancer diagnosis (lung, gastrointestinal, haematological, or head and neck tumours), indicating that both above and below mean intake was associated with increased risk. The 'low oily fish' pattern, characterised by lower oily fish but higher potato intake, also had a non-linear association with all-cause mortality (p-non-linearity = 0.046) where lower but not higher than mean intake increased mortality risk. No dietary patterns were significantly associated with mortality in adults with a recent cancer diagnosis. CONCLUSION 'High oily fish and nuts' or 'low oily fish' dietary patterns that were protective against malnutrition were associated with risk of all-cause and cancer mortality in adults with cancer. Future research should assess the efficacy of these dietary patterns in the acute treatment period when malnutrition is most prevalent.
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Affiliation(s)
- Annie R Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia.
| | - Katherine M Livingstone
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia; Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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17
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Wang PP, Soh KL, Binti Khazaai H, Ning CY, Huang XL, Yu JX, Liao JL. Nutritional Assessment Tools for Patients with Cancer: A Narrative Review. Curr Med Sci 2024; 44:71-80. [PMID: 38289530 DOI: 10.1007/s11596-023-2808-4] [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: 06/20/2023] [Accepted: 10/08/2023] [Indexed: 02/24/2024]
Abstract
Cancer patients are at high risk of malnutrition, which can lead to adverse health outcomes such as prolonged hospitalization, increased complications, and increased mortality. Accurate and timely nutritional assessment plays a critical role in effectively managing malnutrition in these patients. However, while many tools exist to assess malnutrition, there is no universally accepted standard. Although different tools have their own strengths and limitations, there is a lack of narrative reviews on nutritional assessment tools for cancer patients. To address this knowledge gap, we conducted a non-systematic literature search using PubMed, Embase, Web of Science, and the Cochrane Library from their inception until May 2023. A total of 90 studies met our selection criteria and were included in our narrative review. We evaluated the applications, strengths, and limitations of 4 commonly used nutritional assessment tools for cancer patients: the Subjective Global Assessment (SGA), Patient-Generated Subjective Global Assessment (PG-SGA), Mini Nutritional Assessment (MNA), and Global Leadership Initiative on Malnutrition (GLIM). Our findings revealed that malnutrition was associated with adverse health outcomes. Each of these 4 tools has its applications, strengths, and limitations. Our findings provide medical staff with a foundation for choosing the optimal tool to rapidly and accurately assess malnutrition in cancer patients. It is essential for medical staff to be familiar with these common tools to ensure effective nutritional management of cancer patients.
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Affiliation(s)
- Peng-Peng Wang
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia.
- Nursing College of Guangxi Medical University, Nanning, 530021, China.
| | - Kim Lam Soh
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia.
| | - Huzwah Binti Khazaai
- Department of Biomedical Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia
| | - Chuan-Yi Ning
- Nursing College of Guangxi Medical University, Nanning, 530021, China
| | - Xue-Ling Huang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jia-Xiang Yu
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia
| | - Jin-Lian Liao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
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18
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Baş D, Sönmez Ö, Koç ES, Celayir ÖM, Hajhamidiasl L, Tontaş E. Is virtual nutritional counseling efficacious for cancer patients during the COVID-19 pandemic? J Telemed Telecare 2024; 30:79-89. [PMID: 36912038 PMCID: PMC10014450 DOI: 10.1177/1357633x231158831] [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: 11/29/2022] [Accepted: 02/04/2023] [Indexed: 03/14/2023]
Abstract
This study investigates the outcomes of virtual nutritional counseling (VNC) for oncology patients during the Covid-19 pandemic. Our study evaluated the nutritional status data of cancer patients at the baseline and after VNC. An oncology dietitian evaluated the patients by video calling each patient via WhatsApp and sent an individual nutrition diet plan and recommendations via e-mail. Patient-Generated Subjective Global Assessment (PG-SGA) was used as a screening and evaluation tool to assess nutritional status. A total of 157 patients with a mean age of 55.8 ± 14.7 (r = 19-89) were included in the study. Researchers detected at least one nutrition-related sign in 77.7% of patients. After the VNC and based on the final PG-SGA assessments, 62.2% of the patients whose baseline PG-SGA Score-B improved to Score-A, 12.5% with a baseline PG-SGA Score-C improved to Score-A and 54.2% with a baseline Score-C improved to a Score-B (χ2 = 55,000, P < 0.001). Based on the number of VNCs, the improvement in malnutrition status following two sessions and three or more sessions was found to be 17.6% and 35.7%, respectively (P < 0.001). Our results confirm that VNC can improve the nutritional status of cancer patients. Hence, nutritional counseling should be an integral part of oncological treatment.
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Affiliation(s)
- Dilşat Baş
- Department of Nutrition and Dietetics, School of Health Sciences, İstanbul Galata University, İstanbul, Türkiye
- Department of Nutrition and Dietetics, Acıbadem Altunizade Hospital, İstanbul, Türkiye
| | - Özlem Sönmez
- Department of Medical Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Türkiye
| | - Elif Sitre Koç
- Department of Internal Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Türkiye
| | - Özde Melisa Celayir
- Department of Medical Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Türkiye
| | - Ladan Hajhamidiasl
- Department of Nutrition and Dietetics, Institute of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye
| | - Ebru Tontaş
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, USA
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Dambrós BF, Kobus RA, da Rosa R, Pereira LJ, Hinnig PDF, Di Pietro PF, Kunradi Vieira FG. The effect of oral dietary interventions on nutritional status and treatment tolerance in patients with hematologic neoplasms receiving chemotherapy: a systematic review. Nutr Rev 2023:nuad161. [PMID: 38114131 DOI: 10.1093/nutrit/nuad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
CONTEXT Adverse events from chemotherapy treatment affect food intake, nutritional status, and treatment tolerance in cancer patients. However, the effect of nutritional intervention in patients with hematologic neoplasms receiving chemotherapy remains unknown. OBJECTIVE The aim of this systematic review was to evaluate the evidence on nutritional interventions on nutritional status, treatment tolerance, inflammatory markers, quality of life, and mortality in patients with hematologic neoplasms receiving chemotherapy. DATA SOURCES The MEDLINE, LILACS, CINAHL, Web of Science, Embase, ICTRP, CENTRAL, and ClinicalTrials.gov databases were searched. Additional literature and the bibliographies of identified articles were also considered. DATA EXTRACTION Randomized controlled trials in individuals with hematologic neoplasms receiving chemotherapy along with nutritional counseling and oral nutritional supplementation, and intake of supplementary food products, alone or in combination, were assessed as criteria of interest. The data were extracted independently by 2 researchers. The risk of bias was assessed through the Cochrane risk-of-bias tool (RoB 2). DATA ANALYSIS Ten studies were included up to August 15, 2022 (updated in November of 2022). With regard to the outcomes, 4 studies assessed nutritional status and 2 studies showed a positive result of the intervention on some of the markers. Seven studies assessed certain markers of treatment tolerance and only 2 studies showed improvement in the outcome after the intervention. CONCLUSION The studies that found positive results are quite different from each other in terms of intervention, study time, and design. More randomized controlled trials are needed to test different dietary interventions using placebo and blinding, when possible, and with reduced sample variability in individuals with hematologic neoplasms receiving chemotherapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020196765.
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Affiliation(s)
- Betina Fernanda Dambrós
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Rafaela Alexia Kobus
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Raquel da Rosa
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Luciana Jeremias Pereira
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Patrícia de Fragas Hinnig
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Patricia Faria Di Pietro
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Molfino A, Gallicchio C, Imbimbo G, Melena M, Antonini S, Gigante A, Muscaritoli M. Evaluation of Anorexia in Cancer and Its Association with Autonomic Nervous System Activity Assessed by Heart Rate Variability. Nutrients 2023; 15:4936. [PMID: 38068794 PMCID: PMC10707971 DOI: 10.3390/nu15234936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
Alterations in the central nervous system in cancer patients are pivotal in determining appetite dysregulation and body weight loss (BWL). Autonomic nervous system activity was tested by measuring heart rate variability (HRV) in cancer patients presenting with anorexia. We considered inpatients with different types of cancer and investigated anorexia using their FAACT scores. HRV was evaluated by a three-channel Holter ECG. The domains of low frequencies (LF, sympathetic activity) and high frequencies (HF, parasympathetic activity) were calculated. Also, SDNN (autonomic activity) and RMSSD (parasympathetic activity) were assessed. We enrolled 56 patients with cancer and 23 controls. In cancer patients, RMSSD and SDNN were lower than in controls (p < 0.001 and p = 0.009). Sympathetic activity (LF nu) was lower in cancer patients than in controls (p = 0.023), including sympathovagal balance (LF/HF nu ratio) (p = 0.025). RMSSD was reduced in anorexic (p < 0.001) and non-anorexic (p = 0.003) cancer patients compared to controls. The SDNN was lower in anorexic cancer patients than in non-anorexic cancer patients (p = 0.025), and it was lower in anorexic cancer patients than in controls (p = 0.001). LF nu was lower in anorexic cancer patients than in controls (p = 0.015), as was LF/HF (p = 0.031). SDNN was negatively correlated with BWL in the cancer group (rho = -0.40; p = 0.007). Our data support the hypothesis that autonomic nervous system dysregulation exists in patients with cancer presenting with anorexia, with implications for its diagnosis and treatment.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.G.); (G.I.); (M.M.); (S.A.); (A.G.); (M.M.)
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Deng C, Zhang S, Ling J, Chen Z, Feng Y, Xie Y, Liu X, Hu C, Hou T. Prognostic value of the fibrinogen albumin ratio index (FARI) in nasopharyngeal carcinoma patients undergoing radiotherapy. Sci Rep 2023; 13:20630. [PMID: 37996660 PMCID: PMC10667530 DOI: 10.1038/s41598-023-48029-0] [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: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023] Open
Abstract
There is mounting evidence that malnutrition and systemic inflammation status are involved in the prognosis of various cancers. In this study, we aimed to evaluate the prognostic value of the pretreatment fibrinogen-albumin ratio index (FARI) in nasopharyngeal carcinoma (NPC) patients receiving definite radiotherapy. NPC patients who received definite radiotherapy between January 2013 and December 2019 were included. A receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value. The clinicopathological characteristics of the patients were compared via the Chi-square test. Survival curves were analyzed by the Kaplan‒Meier method. The prognostic factors were evaluated by univariate and multivariate analyses via Cox hazards regression analysis. A total of 225 patients were enrolled, and the median follow-up time was 48.5 months. High FARI was correlated with worse ECOG score (p = 0.003), higher EBV-DNA titer (p = 0.047), and more advanced clinical stage (p < 0.001). In the multivariable analysis, FARI independently predicted OS (HR 2.399, 95% CI 1.294-4.450, P < 0.001), PFS (HR 2.085, 95% CI 1.200-3.625, P = 0.009), and DMFS (HR 2.527, 95% CI 1.288-4.958, P < 0.001). The current findings suggest that a high pretreatment FARI is an independent predictor of OS, PFS and DMFS in NPC patients undergoing definite radiotherapy.
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Affiliation(s)
- Chao Deng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Sujuan Zhang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Jie Ling
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Zui Chen
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yuhua Feng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yangchun Xie
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Chunhong Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Tao Hou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China.
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Yu Y, Wu J, Wu H, Wang Z, Wu S, Hong L, Xu B, Shao L. A large-scale study integrating nutritional indicators and clinicopathological parameters to evaluate prognosis, follow-up, and postoperative chemotherapy decisions in rectal cancer patients. Support Care Cancer 2023; 31:686. [PMID: 37945781 DOI: 10.1007/s00520-023-08147-x] [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: 07/20/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the role of nutritional indicators and clinicopathological parameters in predicting the progression and prognosis for pathological stage II-III rectal cancer (RC) patients without neoadjuvant radiotherapy. In addition, we sought to explore the high-risk population who may require postoperative chemotherapy. METHODS A total of 894 consecutive RC patients were enrolled in this study. Univariate and multivariate Cox analysis were performed to identify the independent risk factors for PFS and OS. The nomogram and calibration curves were conducted according to multivariable analysis result. Kaplan-Meier survival curves and log-rank tests were performed for different groups. Finally, random survival forest (RSF) model was developed to predict the probability of progression. RESULTS Our results revealed that CEA level, pathological stage, tumor deposit, and PNI were independently associated with PFS in RC patients. Similarly, the results indicated that CEA level, pathological stage, tumor deposit, PNI, and NRI were independently associated with OS. RSF model revealed that group 1 had the highest risk of progression at the 12th month of follow-up, group 2 had the highest risk of progression at the 15th month of follow-up, while group 3 had the highest risk of progression at the 9th month of follow-up. Besides, subgroup analysis suggested that the high-risk group needs postoperative adjuvant chemotherapy, while patients in the low- and moderate-risk groups may not need postoperative adjuvant chemotherapy. Finally, we validated our results with the SEER database. CONCLUSIONS In conclusion, we demonstrated that preoperative nutritional indicator and clinicopathological parameters could act as auxiliary prognostication tools for RC patients without neoadjuvant radiotherapy. We also established follow-up strategies for different groups of patients. Collectively, incorporating nutritional assessment into risk stratification for RC resection is crucial and should be an integral part of preoperative planning.
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Affiliation(s)
- Yilin Yu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Junxin Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China.
| | - Haixia Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Zhiping Wang
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Shiji Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Liang Hong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Lingdong Shao
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China.
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Uno K, Yoshikawa N, Kitami K, Mori S, Shibata T, Iyoshi S, Fujimoto H, Mogi K, Yoshihara M, Tamauchi S, Ikeda Y, Yokoi A, Kato K, Hoshiba T, Oguchi H, Kajiyama H. The sarcopenia index measured using the lumbar paraspinal muscle is associated with prognosis in endometrial cancer. Jpn J Clin Oncol 2023; 53:942-949. [PMID: 37519058 DOI: 10.1093/jjco/hyad086] [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: 05/07/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE The number of type-II endometrial cancer patients has been increasing and the prognosis is not favorable. We aim to investigate whether sarcopenia index in any of several different muscles could serve as a novel biomarker of prognosis in patients with type-II endometrial cancer. METHODS We retrospectively investigated a total of 194 patients at four hospitals. Ninety patients were treated as derivation set and the other 104 patients as validation set. Using preoperative computed tomography images, we measured the horizontal cross-sectional area at the third lumbar spine level: the (i) psoas major, (ii) iliac and (iii) paraspinal muscle. The clinical information including recurrence-free survival and overall survival were retrospectively collected. These results were validated with external data sets of three hospitals. RESULTS The median values of the sarcopenia index (cm2/m2) ± standard deviation with the first data of 90 patients using the psoas, iliac and paraspinal muscle were 3.4 ± 1.0, 1.7 ± 0.6 and 12.6 ± 3.2, respectively. In univariate analyses, the sarcopenia indexes measured using the psoas or paraspinal muscle were associated with recurrence-free survival and overall survival. On the other hand, in multivariate analyses, only the sarcopenia index using paraspinal muscle was significantly related to recurrence-free survival (hazard ratio = 3.78, 95% confidence intervals = 1.29-5.97, P = 0.009) and overall survival (hazard ratio = 3.13, 95% confidence interval = 1.18-8.26, P = 0.022). Paraspinal sarcopenia index was also related to overall survival (hazard ratio = 3.74, 95% confidence interval = 1.31-10.72, P = 0.014) even in patients with advanced stage. Serum albumin was significantly correlated with the sarcopenia index (P = 0.012). Within the analysis of the validation set, sarcopenia index using paraspinal muscle was related to recurrence-free survival (hazard ratio = 2.06, P = 0.045) in multivariate analysis and recurrence-free survival (P = 0.009) in patients with advanced stage. CONCLUSIONS The sarcopenia index using the paraspinal muscle, not psoas, could be a suitable index to predict recurrence-free survival and overall survival in patients with type-II endometrial cancer even in advanced stage.
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Affiliation(s)
- Kaname Uno
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhisa Kitami
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Sho Mori
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Takahiro Shibata
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shohei Iyoshi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany
| | - Hiroki Fujimoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Kazumasa Mogi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Yokoi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kato
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsutomu Hoshiba
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hidenori Oguchi
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Engelstrup E, Beck AM, Munk T, Bardal P, Knudsen AW. The association between nutrition impact symptoms, nutritional risk, and risk of reduced overall survival in patients with head and neck cancer. A retrospective study. Clin Nutr ESPEN 2023; 57:239-245. [PMID: 37739663 DOI: 10.1016/j.clnesp.2023.06.034] [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: 01/18/2023] [Revised: 05/17/2023] [Accepted: 06/27/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS To examine which nutritional impact symptoms (NIS) were most prevalent at the initial state of treatment in outpatients with head and neck cancer (HNC). Secondly, to examine whether there is a potential relation between risk of reduced overall survival to NIS or nutritional risk. METHODS Retrospective data collection from outpatients with HNC undergoing radiotherapy and/or systemic therapy. A clinical dietitian consulted all patients with the inclusion of a nutritional risk screening according to the Nutritional Risk Screening tool (NRS 2002) and Eastern Cooperative Oncology Group performance status (ECOG), and an assessment of NIS collected with a structured questionnaire, with the prevalence of 16 symptoms and to what degree they were nutritionally limiting. Weight loss at two months follow-up was calculated and patients were categorized as either at low or high risk of reduced overall survival in accordance with a BMI-adjusted weight loss grading system (high, score 0-2; low, score 3-4). RESULTS A total of 110 patients were included (male, 77%; age, 66 (59-71)). The mean weight loss was 4.5 kg at two months follow-up, increasing with higher BMI. Eighty-six percentage of the patients experienced 3 or more of the present NIS (P-NIS), and 44% of the patients experienced 3 or more of the nutritionally limiting NIS (L-NIS). Patients who have a high risk of reduced overall survival accounted for 45% and consisted of patients with low BMI and high percentual weight loss. No significant difference was found between the two groups in terms of NIS. CONCLUSION We found NIS to be highly prevalent among patients with head and neck cancer. Women experienced more NIS than men. Half of the patients were categorized as being at high risk of reduced overall survival, but no relation between the risk of reduced overall survival to NIS or nutritional risk was found in this study.
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Affiliation(s)
- Emilie Engelstrup
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Pernille Bardal
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Anne Wilkens Knudsen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Al-Shahethi AH, Mahdi FA, Al-Shameri EA, Abol Gaith FM. Factors Associated With Malnutrition in Hospitalized Cancer Patients in a National Oncology Center in Conflict-Affected Settings in Sana'a, Yemen: An Institution-Based Cross-Sectional Study. Cureus 2023; 15:e45411. [PMID: 37859884 PMCID: PMC10584276 DOI: 10.7759/cureus.45411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
Background Cancer can significantly impact the nutritional status of patients, which can worsen related complications and reduce the effectiveness of treatment. Malnutrition is a common complication among cancer patients, especially among older adults. This study aims to determine the prevalence of malnutrition among hospitalized cancer patients and identify factors associated with malnutrition. Methodology and methods The cross-sectional descriptive study was performed on 296 cancer patients admitted to the National Oncology Referral Center in Sana'a, Yemen, between February 1 and March 31, 2022. Malnutrition was diagnosed through clinical assessment and screening tools such as screening tools, body mass index (BMI), weight loss percentage, and mid-upper arm circumference (MUAC). Descriptive statistics, chi-square, and multivariable logistic regression analysis were used to assess factors associated with malnutrition. Results Of the 296 patients included in the analysis, most were female 225 (76.0%), and the mean age was 45.8 years. The prevalence of undernutrition, as determined by the BMI score, was 48 (16.2%). The prevalence of malnutrition was higher in females 37 (16.4%) compared to males 11(15.5%). The data indicated that 49% of hospitalized patients had experienced weight loss of 5% or more. Multivariable logistic regression analysis showed that single (AOR=12.93, 95% CI: 1.17-142.77) or widowed (AOR=11.51, 95% CI: 1.05-126.03) marital status, weight loss (AOR=7.56, 95% CI: 3.00-18.69), stomach cancer (AOR=6.77, 95% CI: 1.66-27.70), and breast cancer (AOR=2.60, 95% CI: 1.12-6.03) were associated with an increased risk of malnutrition. Conclusions The study highlights the importance of evaluating and addressing the nutritional status of cancer patients, especially at the beginning and during treatment, to improve their clinical outcomes. Prospective studies are recommended to further investigate this issue.
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Affiliation(s)
- Ahmed H Al-Shahethi
- Department of Community Health and Nutrition, Faculty of Health Sciences, University of Al-Razi, Sana'a, YEM
- Department of Community Medicine, Faculty of Medicine, 21 September University of Medical and Applied Sciences, Sana'a, YEM
| | - Fares A Mahdi
- Department of Community Medicine, Faculty of Medicine, 21 September University of Medical and Applied Sciences, Sana'a, YEM
- Department of Nursing, Ibn Alnafis University, Sana'a, YEM
| | - Emad A Al-Shameri
- Department of Community Health and Nutrition, Faculty of Health Sciences, University of Al-Razi, Sana'a, YEM
| | - Fawz M Abol Gaith
- Department of Community Health and Nutrition, Faculty of Health Sciences, University of Al-Razi, Sana'a, YEM
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Morton M, Patterson J, Sciuva J, Perni J, Backes F, Nagel C, O'Malley DM, Chambers LM. Malnutrition, sarcopenia, and cancer cachexia in gynecologic cancer. Gynecol Oncol 2023; 175:142-155. [PMID: 37385068 DOI: 10.1016/j.ygyno.2023.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023]
Abstract
Patients with gynecologic cancers are at risk for malnutrition, cancer cachexia, and sarcopenia. Accumulating data supports that malnourished patients with gynecologic cancer have worse overall survival, increased healthcare utilization and costs, and a higher incidence of postoperative complications and treatment toxicity than those who are not malnourished. Malnutrition is defined as insufficient energy intake, leading to altered body composition and subsequent impaired physical and cognitive function, and can result in sarcopenia and cachexia, defined as the loss of lean body mass and loss of body weight respectively. The etiology of cancer-related malnutrition is complex, resulting from a systemic pro-inflammatory state of malignancy with upregulation of muscle degradation pathways and metabolic derangements, including lipolysis and proteolysis, that may not respond to nutritional repletion alone. Numerous validated scoring systems and radiographic measures have been described to define and quantify the severity of malnutrition and muscle loss in both clinical and research settings. "Prehabilitation" and optimization of nutrition and functional status early in therapy may combat the development or worsening of malnutrition and associated syndromes and ultimately improve oncologic outcomes, but limited data exist in the context of gynecologic cancer. Multi-modality nutrition and physical activity interventions have been proposed to combat the biophysical losses related to malnutrition. Several trials are underway in gynecologic oncology patients to address these aims, but significant gaps in knowledge persist. Pharmacologic interventions and potential immune targets for combating cachexia related to malignancy are discussed in this review and may provide opportunities to target disease and cachexia. This article reviews currently available data regarding the implications, diagnostics, physiology, and intervention strategies for gynecologic oncology patients with malnutrition and its associated conditions.
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Affiliation(s)
- Molly Morton
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America.
| | - Jenna Patterson
- Department of Obstetrics and Gynecology; The Ohio State University Wexner Medical Center, 456 W 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Jessica Sciuva
- The Ohio State University College of Medicine; 370 W. 9(th) Ave, Columbus, OH 43210, United States of America
| | - Jaya Perni
- The Ohio State University; 281 W Lane Ave, Columbus, OH 43210, United States of America
| | - Floor Backes
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Christa Nagel
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - David M O'Malley
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Laura M Chambers
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
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Kiss N, Prado CM, Daly RM, Denehy L, Edbrooke L, Baguley BJ, Fraser SF, Khosravi A, Abbott G. Low muscle mass, malnutrition, sarcopenia, and associations with survival in adults with cancer in the UK Biobank cohort. J Cachexia Sarcopenia Muscle 2023; 14:1775-1788. [PMID: 37212184 PMCID: PMC10401543 DOI: 10.1002/jcsm.13256] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/23/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Low muscle mass (MM) is a common component of cancer-related malnutrition and sarcopenia, conditions that are all independently associated with an increased risk of mortality. This study aimed to (1) compare the prevalence of low MM, malnutrition, and sarcopenia and their association with survival in adults with cancer from the UK Biobank and (2) explore the influence of different allometric scaling (height [m2 ] or body mass index [BMI]) on low MM estimates. METHODS Participants in the UK Biobank with a cancer diagnosis within 2 years of the baseline assessment were identified. Low MM was estimated by appendicular lean soft tissue (ALST) from bioelectrical impedance analysis derived fat-free mass. Malnutrition was determined using the Global Leadership in Malnutrition criteria. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People criteria (version 2). All-cause mortality was determined from linked national mortality records. Cox-proportional hazards models were fitted to estimate the effect of low MM, malnutrition, and sarcopenia on all-cause mortality. RESULTS In total, 4122 adults with cancer (59.8 ± 7.1 years; 49.2% male) were included. Prevalence of low MM (8.0% vs. 1.7%), malnutrition (11.2% vs. 6.2%), and sarcopenia (1.4% vs. 0.2%) was higher when MM was adjusted using ALST/BMI compared with ALST/height2 , respectively. Low MM using ALST/BMI identified more cases in participants with obesity (low MM 56.3% vs. 0%; malnutrition 50% vs. 18.5%; sarcopenia 50% vs. 0%). During a median 11.2 (interquartile range: 10.2, 12.0) years of follow up, 901 (21.7%) of the 4122 participants died, and of these, 744 (82.6%) deaths were cancer-specific All conditions were associated with a higher hazard of mortality using either method of MM adjustment: low MM (ALST/height2 : HR 1.9 [95% CI 1.3, 2.8], P = 0.001; ALST/BMI: HR 1.3 [95% CI 1.1, 1.7], P = 0.005; malnutrition (ALST/height2 : HR 2.5 [95% CI 1.1, 1.7], P = 0.005; ALST/BMI: HR 1.3 [95% CI 1.1, 1.7], P = 0.005; sarcopenia (ALST/height2 : HR 2.9 [95% CI 1.3, 6.5], P = 0.013; ALST/BMI: HR 1.6 [95% CI 1.0, 2.4], P = 0.037). CONCLUSIONS In adults with cancer, malnutrition was more common than low MM or sarcopenia, although all conditions were associated with a higher mortality risk, regardless of the method of adjusting for MM. In contrast, adjustment of low MM for BMI identified more cases of low MM, malnutrition, and sarcopenia overall and in participants with obesity compared with height adjustment, suggesting it is the preferred adjustment.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
| | - Carla M. Prado
- Department of Agricultural, Food and Nutrition ScienceUniversity of AlbertaEdmontonCanada
| | - Robin M. Daly
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Linda Denehy
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
- Melbourne School of Health SciencesUniversity of MelbourneParkvilleAustralia
| | - Lara Edbrooke
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
- Department of PhysiotherapyUniversity of MelbourneParkvilleAustralia
| | - Brenton J. Baguley
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Steve F. Fraser
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and InnovationDeakin UniversityGeelongAustralia
| | - Gavin Abbott
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
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Curtis AR, Livingstone KM, Daly RM, Brayner B, Abbott G, Kiss N. Dietary patterns, malnutrition, muscle loss and sarcopenia in cancer survivors: findings from the UK Biobank. J Cancer Surviv 2023:10.1007/s11764-023-01428-8. [PMID: 37468793 DOI: 10.1007/s11764-023-01428-8] [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: 04/27/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To identify dietary patterns derived from protein, polyunsaturated fatty acids (PUFA) and vitamin D and examine associations with malnutrition, low muscle mass and sarcopenia in cancer survivors. METHODS This cross-sectional study included cancer survivors (n = 2415) from the UK Biobank (age [mean ± SD] 59.7 ± 7.1 years; 60.7% female). The Oxford WebQ 24-h dietary assessment estimated food and nutrient intakes. Reduced rank regression derived dietary patterns (response variables: protein [g/kg/day], PUFA [g/day] and vitamin D [μg/day]). Adjusted logistic regression analysis examined associations between dietary patterns and malnutrition, low muscle mass and sarcopenia. RESULTS Three dietary patterns were identified: (i) 'high oily fish and nuts', characterised by higher oily fish and nuts and seeds intake; (ii) 'low oily fish', characterised by lower oily fish intake and higher potato intake; and (iii) 'meat and dairy', characterised by higher intake of meat, poultry and dairy. Eighteen percent of participants were malnourished, 5% had low muscle mass and 6.5% had sarcopenia. Odds of being malnourished were significantly lower with adherence to a 'high oily fish and nuts' pattern (OR: 0.57; 95% CI: 0.50, 0.65) and 'low oily fish' pattern (OR: 0.81; 95% CI: 0.73, 0.90). The 'meat and dairy' pattern was not associated with malnutrition. No dietary patterns were associated with low muscle mass or sarcopenia. CONCLUSIONS Energy-rich dietary patterns were associated with lower odds of malnutrition in cancer survivors but did not influence muscle mass or sarcopenia risk. IMPLICATIONS FOR CANCER SURVIVORS Better understanding of dietary patterns may improve cancer-related outcomes for cancer survivors.
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Affiliation(s)
- Annie R Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
| | | | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Barbara Brayner
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Hardt LM, Herrmann HJ, Reljic D, Jaensch P, Zerth J, Neurath MF, Zopf Y. Are Guideline Recommendations on Supportive Nutrition and Exercise Therapy for Cancer Patients Implemented in Clinical Routine? A National Survey with Real-Life Data. Nutrients 2023; 15:3172. [PMID: 37513591 PMCID: PMC10383016 DOI: 10.3390/nu15143172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Malnutrition and cancer cachexia are highly prevalent comorbidities of cancer, limiting patients' quality of life and being relevant to prognosis. International and national clinical guidelines recommend supportive nutrition and exercise therapy for cancer patients. However, there is little current epidemiological evidence on the implementation of these guideline recommendations in clinical routine. To close this data gap, a national survey in Germany using an online questionnaire was conducted. There were 261 of a total of 5074 contacted hospitals and medical offices who participated in the survey (5.1% response rate). The data indicated that nutrition and exercise therapy for cancer patients is so far inadequately implemented, with 59% of the respondents reporting nutrition therapy as an integral part of oncological treatment, 66.7% having a nutrition specialist/team, and 65.1% routinely conducting a screening for nutritional status. Only half of the participants stated that there are defined goals in nutrition therapy. The majority of respondents (85.8%) generally recommend exercise therapy, but only a few of them provide specific offers at their own institution (19.6%) or at cooperation partners (31.7%). In order to implement the recommended combined nutrition and exercise therapy as part of regular care, there is a need for nationwide availability of multidisciplinary nutrition teams and targeted offers of individualized exercise therapy. Health policy support would be important to create the structural, financial, and staff conditions for appropriate guideline implementation in order to achieve the optimal treatment of cancer patients.
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Affiliation(s)
- Luisa M Hardt
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Hans J Herrmann
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Dejan Reljic
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Peter Jaensch
- IDC Research Institute, SRH University Wilhelm Löhe, 90763 Fürth, Germany
| | - Jürgen Zerth
- IDC Research Institute, SRH University Wilhelm Löhe, 90763 Fürth, Germany
- Faculty of Social Work, Catholic University Eichstätt-Ingolstadt, 85071 Eichstätt, Germany
| | - Markus F Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Yurdagül Zopf
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
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Feier CVI, Faur AM, Muntean C, Blidari A, Contes OE, Streinu DR, Olariu S. The Challenges of Gastric Cancer Surgery during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:1903. [PMID: 37444737 DOI: 10.3390/healthcare11131903] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The aim of this study was to quantify the impact of the COVID-19 pandemic on the surgical treatment of patients with gastric cancer. Data from patients undergoing surgery for gastric cancer during the pandemic were analyzed and the results obtained were compared with the corresponding periods of 2016-2017 and 2018-2019. Various parameters were taken into consideration and their dynamics highlight significant changes in the pandemic year compared with the two pre-pandemic periods. Statistical analysis revealed a marked decrease in the number of surgeries performed during the pandemic (p < 0.001). Severe prognostic factors for gastric cancer, including weight loss and upper gastrointestinal hemorrhage, were associated with an increased number of postoperative fistulas, while emesis was statistically correlated with a more advanced cancer stage (p < 0.011). There was also a reduction in the total duration of hospitalization (p = 0.044) and postoperative hospitalization (p = 0.047); moreover, the mean duration of surgical intervention was higher during the pandemic (p = 0.044). These findings provide evidence for the significant changes in clinical and therapeutic strategies applied to patients undergoing surgery for gastric cancer during the study period. The ongoing pandemic has exerted a substantial and complex impact, the full extent of which remains yet to be fully comprehended.
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Affiliation(s)
- Catalin Vladut Ionut Feier
- First Discipline of Surgery, Department X-Surgery, "Victor Babes" University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
- First Surgery Clinic, "Pius Brinzeu" Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Alaviana Monique Faur
- Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Calin Muntean
- Medical Informatics and Biostatistics, Department III-Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
| | - Andiana Blidari
- Oncology, Department IX-Surgery, "Victor Babes" University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
| | - Oana Elena Contes
- Oncology, Department IX-Surgery, "Victor Babes" University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
| | - Diana Raluca Streinu
- First Surgery Clinic, "Pius Brinzeu" Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Sorin Olariu
- First Discipline of Surgery, Department X-Surgery, "Victor Babes" University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
- First Surgery Clinic, "Pius Brinzeu" Clinical Emergency Hospital, 300723 Timisoara, Romania
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Zhou CJ, Lin Y, Liu JY, Wang ZL, Chen XY, Zheng CG. Malnutrition and visceral obesity predicted adverse short-term and long-term outcomes in patients undergoing proctectomy for rectal cancer. BMC Cancer 2023; 23:576. [PMID: 37349711 DOI: 10.1186/s12885-023-11083-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND To the best of our knowledge, no previous studies have explored the relationship between visceral obesity and malnutrition. Therefore, this study has aimed to investigate the association between them in patients with rectal cancer. METHODS Patients with rectal cancer who underwent proctectomy were included. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM). Visceral obesity was measured using computed tomography (CT). The patients were classified into four groups according to the presence of malnutrition or visceral obesity. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors for postoperative complications. Univariate and multivariate cox regression analyses were performed to evaluate the risk factors for overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier survival curves and log-rank tests were performed for the four groups. RESULTS This study enrolled 624 patients. 204 (32.7%) patients were included in the well-nourished non-visceral obesity (WN) group, 264 (42.3%) patients were included in the well-nourished visceral obesity (WO) group, 114 (18.3%) patients were included in the malnourished non-visceral obesity (MN) group, and 42 (6.7%) patients were included in the malnourished visceral obesity (MO) group. In the multivariate logistic regression analysis, the Charlson comorbidity index (CCI), MN, and MO were associated with postoperative complications. In the multivariate cox regression analysis, age, American Society of Anesthesiologists (ASA) score, tumor differentiation, tumor node metastasis (TNM), and MO were associated with worsened OS and CSS. CONCLUSIONS This study demonstrated that the combination of visceral obesity and malnutrition resulted in higher postoperative complication and mortality rates and was a good indicator of poor prognosis in patients with rectal cancer.
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Affiliation(s)
- Chong-Jun Zhou
- Department of Anorectal Surgery, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, No.109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Yi Lin
- Department of Endocrinology, The Wenzhou Third Clinical Institute, The Third Affiliated Hospital of Shanghai University, Wenzhou Medical University, Wenzhou People's Hospital, No. 57 Canghou Street, Wenzhou, 325000, Zhejiang, China
| | - Jie-Yu Liu
- Department of Anorectal Surgery, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, No.109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Zhong-Lin Wang
- Department of Anorectal Surgery, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, No.109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Xi-Yi Chen
- Department of Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, No.109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China.
| | - Chen-Guo Zheng
- Department of Anorectal Surgery, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, No.109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China.
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Koshimoto S, Yamazaki T, Amano K, Kako J, Arimoto M, Saitou K, Hashizume A, Takeuchi T, Matsushima E. Psychosocial Factors and the Need for Multidisciplinary Support in Nutrition Counselling for Cancer Chemotherapy Patients. Nutrients 2023; 15:2712. [PMID: 37375616 PMCID: PMC10303182 DOI: 10.3390/nu15122712] [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: 04/22/2023] [Revised: 05/28/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
This study aims to identify the background factors and experiences of patients with cancer with eating-related problems who require nutrition counselling. Using a mixed-methods approach, this secondary analysis study was conducted on patients with head and neck, oesophageal, gastric, colorectal, or lung cancers who were receiving outpatient chemotherapy. They completed a questionnaire measuring nutrition impact symptoms, eating-related distress, and quality of life (QOL). Patients who required nutrition counselling were interviewed to identify the specific issues they experienced. We reported on nutritional status and nutrition impact symptoms in a previous study. Of the 151 participants, 42 required nutrition counselling. Background factors associated with nutrition counselling were related to the following psychosocial variables: small number of people in the household, undergoing treatment while working, low QOL, and eating-related distress. Four themes were extracted from the specific issues experienced by patients: motivation for self-management, distress from symptoms, seeking understanding and sympathy, and anxiety and confusion. The desire for nutrition counselling was attributable to 'anxiety caused by the symptoms' and 'confusion about the information on eating'. Healthcare professionals should promote multidisciplinary collaboration after considering the factors associated with the required nutrition counselling to provide nutritional support.
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Affiliation(s)
- Saori Koshimoto
- School of Health Care Sciences, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
- Faculty of Human Nutrition, Department of Human Nutrition, Tokyo Kasei Gakuin University, 22 Sanban-cho, Chiyoda-ku, Tokyo 102-8341, Japan
| | - Tomoko Yamazaki
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yusima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, 2-15 Yamadaoka, Suita 565-0871, Osaka, Japan
| | - Jun Kako
- Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-08507, Mie, Japan
| | - Masako Arimoto
- Department of Clinical Nutrition, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Keiko Saitou
- Department of Clinical Nutrition, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Akiko Hashizume
- Department of Nursing, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Takashi Takeuchi
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Eisuke Matsushima
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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Johnston EA, Ibiebele TI, Friedlander ML, Grant PT, van der Pols JC, Webb PM. Association of protein intake with recurrence and survival following primary treatment of ovarian cancer. Am J Clin Nutr 2023:S0002-9165(23)48895-8. [PMID: 37146759 DOI: 10.1016/j.ajcnut.2023.05.002] [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: 08/31/2022] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Malnutrition is common during treatment for ovarian cancer and one in three report multiple symptoms affecting food intake after primary treatment. Little is known about diet post-treatment in relation to ovarian cancer survival, however, general recommendations for cancer survivors are to maintain a higher level of protein intake to support recovery and minimize nutritional deficits. OBJECTIVE To investigate whether intake of protein and protein food sources following primary treatment for ovarian cancer is associated with recurrence and survival. DESIGN Intake levels of protein and protein food groups were calculated from dietary data collected about 12 months post-diagnosis using a validated food frequency questionnaire in an Australian cohort of females with invasive epithelial ovarian cancer. Disease recurrence and survival status were abstracted from medical records (median 4.9 years follow-up). Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for protein intake and progression-free and overall survival. RESULTS Among 591 females who were progression-free at 12-months follow-up, 329 (56%) subsequently experienced cancer recurrence and 231 (39%) died. A higher level of protein intake was associated with better progression-free survival (>1-1.5 vs. ≤1 grams per kilogram body weight (g/kg): HRadjusted=0.69, 95% CI 0.48, 1.00; >1.5 vs. ≤1g/kg: HRadjusted=0.61, 95% CI 0.41, 0.90; >20% vs. ≤20% total energy intake from protein: HRadjusted=0.77, 95% CI 0.61, 0.96). There was no evidence for better progression-free survival with any particular protein food sources. There was a suggestion of better overall survival among those with higher total intakes of animal-based protein foods, particularly dairy products (HR=0.71, 95% CI 0.51, 0.99 for highest vs. lowest tertiles of total dairy intake). CONCLUSIONS After primary treatment for ovarian cancer, a higher level of protein intake may benefit progression-free survival. Ovarian cancer survivors should avoid dietary practices that limit intake of protein-rich foods.
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Affiliation(s)
- Elizabeth A Johnston
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia; Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Kelvin Grove, Queensland, Australia; Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.
| | - Torukiri I Ibiebele
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia
| | - Michael L Friedlander
- University of New South Wales Clinical School, Prince of Wales Hospital, Randwick, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Peter T Grant
- University of Melbourne, Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jolieke C van der Pols
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia; Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Kelvin Grove, Queensland, Australia
| | - Penelope M Webb
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia
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Li C, Fan Z, Guo W, Liang F, Mao X, Wu J, Wang H, Xu J, Wu D, Liu H, Wang L, Li F. Fibrinogen-to-prealbumin ratio: A new prognostic marker of resectable pancreatic cancer. Front Oncol 2023; 13:1149942. [PMID: 37051547 PMCID: PMC10083287 DOI: 10.3389/fonc.2023.1149942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/15/2023] [Indexed: 03/28/2023] Open
Abstract
BackgroundThe fibrinogen-to-prealbumin ratio (FPR), a novel immune-nutritional biomarker, has been reported to be associated with prognosis in several types of cancer, but the role of FPR in the prognosis of resectable pancreatic cancer has not been elucidated.MethodsA total of 263 patients with resectable pancreatic cancer were enrolled in this study and were randomly divided into a training cohort (n = 146) and a validation cohort (n = 117). Receiver operating characteristic curve (ROC) was used to calculate the cut-off values of immune-nutritional markers. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression were performed in the training cohort to identify the independent risk factors, based on which the nomogram was established. The performance of the nomogram was evaluated and validation by the training and validation cohort, respectively.ResultsThe optimal cutoff value for FPR was 0.29. Multivariate analysis revealed that FPR, controlling nutritional status (CONUT), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and tumor node metastasis (TNM) stage were independent predictors of overall survival (OS). The nomogram was established by involving the five factors above. The C-index of the training cohort and validation cohort were 0.703 (95% CI: 0.0.646-0.761) and 0.728 (95% CI: 0.671-0.784). Decision curve analysis and time-dependent AUC showed that the nomogram had better predictive and discriminative ability than the conventional TNM stage.ConclusionFPR is a feasible biomarker for predicting prognosis in patients with resectable pancreatic cancer. The nomogram based on FPR is a useful tool for clinicians in making individualized treatment strategies and survival predictions.
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Affiliation(s)
- Chengqing Li
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhiyao Fan
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenyi Guo
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feng Liang
- Department of General Surgery, Feicheng People’s Hospital, Taian, China
| | - Xincheng Mao
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiahao Wu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haodong Wang
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianwei Xu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dong Wu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Han Liu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Wang
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Lei Wang, ; Feng Li,
| | - Feng Li
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Lei Wang, ; Feng Li,
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Enkobahry A, Sime T, Kene K, Mateos T, Dilnesa S, Zawdie B. Blood biomarkers as potential malnutrition screening alternatives among adult patients with cancer on treatment in oncology unit of jimma tertiary hospital: A cross-sectional analysis. BMC Nutr 2023; 9:38. [PMID: 36869395 PMCID: PMC9982783 DOI: 10.1186/s40795-023-00694-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Cancer is becoming the most common global public health concern. Early malnutrition detection and treatment in patients with cancer is an important aspect of cancer management. Although Subjective global assessment (SGA) is a gold standard nutritional assessment tool, it is not routinely utilized due to it is tedious and needs patient literacy. Thus, early detection of malnutrition necessitates alternative parameters comparable with SGA. Therefore this study aims to evaluate serum albumin, Total Protein (TP), and Hemoglobin (Hgb) and their correlation with malnutrition in patients with cancer at Jimma Medical Center (JMC). METHODS Facility based cross-sectional study was conducted from October 15 to December 15, 2021 G.C at JMC among a total of 176 adult patients with cancer selected via a systematic sampling technique. Nutritional status and behavioural data were collected using the SGA tool and a structured questionnaire. Five ml of venous blood was collected and the level of serum albumin, TP and Hgb were measured using Cobas®6000 chemistry analyzer and hematology analyzer UniCel DxH 800. Descriptive statistics, independent t-test, Pearson's correlation coefficient (r), and logistic regression analysis were implemented for analysis. RESULT From the total of 176 study participants, 69.3% were females and the mean age was 50.1 ± 13.7 years. Based on SGA, 61.4% of the patients were malnourished. There was a significant decrease in the mean level of serum albumin, TP and Hgb in malnourished as compared to well-nourished patients. Serum albumin(r=-0.491), TP(r=-0.270), and Hgb (r=-0.451) had a significant correlation with SGA tool. Stage IV cancer AOR = 4.98 (1.23-20.07), Gastrointestinal (GI) cancer AOR = 3.39(1.29-8.88) and malnutrition AOR = 3.9(1.81-8.4) were significantly associated with hypoalbuminemia. Similarly, age of > 64 years AOR = 6.44(1.55-26.67), GI cancer AOR = 2.92(1.01-6.29) and malnutrition AOR = 3.14(1.43-6.94) were significantly associated with hypoproteinemia; and stage-IV cancer AOR = 3.94(1.11-13.35) and malnutrition AOR = 3.8(1.82-8.2) were significantly associated with low Hgb level. CONCLUSION AND RECOMMENDATION Altered level of serum albumin, TP and Hgb was correlated with the SGA tool of malnutrition. Therefore, it is suggested to be used as an alternative or additional screening tool for prompt detection of malnutrition in adult patients with cancer.
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Affiliation(s)
- Aklesya Enkobahry
- Biomedical sciences department, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia.
| | - Tariku Sime
- grid.411903.e0000 0001 2034 9160Biomedical Sciences Department, Institute of Health, Jimma University, Jimma, Southwest Ethiopia
| | - Kumsa Kene
- grid.411903.e0000 0001 2034 9160Biomedical Sciences Department, Institute of Health, Jimma University, Jimma, Southwest Ethiopia
| | - Tigist Mateos
- grid.411903.e0000 0001 2034 9160Biomedical Sciences Department, Institute of Health, Jimma University, Jimma, Southwest Ethiopia
| | - Sefie Dilnesa
- Family Medicine Department, Felegehiwot Specialized Hospital, Bahirdar, Ethiopia
| | - Belay Zawdie
- grid.411903.e0000 0001 2034 9160Biomedical Sciences Department, Institute of Health, Jimma University, Jimma, Southwest Ethiopia
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Brown D, Loeliger J, Stewart J, Graham KL, Goradia S, Gerges C, Lyons S, Connor M, Stewart S, Di Giovanni A, D'Angelo S, Kiss N. Relationship between global leadership initiative on malnutrition (GLIM) defined malnutrition and survival, length of stay and post-operative complications in people with cancer: A systematic review. Clin Nutr 2023; 42:255-268. [PMID: 36716618 DOI: 10.1016/j.clnu.2023.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/11/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS The predictive validity of the GLIM criteria for survival, length of hospital stay (LOHS) and post-operative complications among people with cancer have not been systematically reviewed. This systematic review aims to determine whether GLIM malnutrition is predictive of these outcomes, and whether the predictive validity is affected by how phenotypic and etiologic criteria are assessed. METHODS Cohort studies published after 2018 were systematically reviewed according to PRISMA guidelines from Embase, Medline Complete and CINAHL Complete. Risk of bias and methodologic quality were assessed using the Journal of the Academy of Nutrition and Dietetics' Quality Criteria Checklist tool for Primary research. RESULTS In total, 21 studies were included, including 28,726 participants. All studies investigated survival, where 18 reported GLIM malnutrition is associated with decreased survival. LOHS was investigated in six studies, with all finding an association between GLIM malnutrition and longer LOHS. Post-operative complications were assessed in seven studies, of which five reported GLIM malnutrition was predictive of increased post-operative complications. Methods to assess the GLIM phenotypic and etiologic criteria varied, with consistent predictive ability for survival regardless of method of assessing reduced muscle mass. However, predictive ability was more variable across different measures of inflammation and reduced intake. CONCLUSION GLIM malnutrition was consistently predictive of worse clinical outcomes. Different measures of reduced muscle mass did not affect the predictive ability of GLIM for survival. However, variation in assessment of the etiologic criteria resulted in varying predictive ability of the GLIM diagnosis for survival.
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Affiliation(s)
- Dylan Brown
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jenelle Loeliger
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jane Stewart
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate L Graham
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sunita Goradia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Chantal Gerges
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Shania Lyons
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Molly Connor
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sam Stewart
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Adrian Di Giovanni
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sarah D'Angelo
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia; Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia.
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Comparison of laparoscopic and open radical gastrectomy for gastric cancer patients with GLIM-defined malnutrition. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:376-383. [PMID: 36154984 DOI: 10.1016/j.ejso.2022.09.009] [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: 07/04/2022] [Revised: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Malnutrition is common in the patients with gastric cancer. Radical gastrectomy remained the primary strategy of curable treatment for gastric cancer. This study is performed to explore the effect of laparoscopic radical gastrectomy on clinical outcomes in gastric cancer patients with malnutrition. METHODS Gastric cancer patients with GLIM-defined malnutrition between 2014 and 2019 at our center were enrolled. The patients were divided into two groups according to the different type of surgery. Propensity score match analysis was used to balance the clinicopathologic characteristics of two groups. Postoperative outcomes and survival were compared. Multivariate analysis was used to independent risk factors of complication, overall survival (OS), and disease-free survival (DFS). RESULTS Compared with patients underwent open radical gastrectomy, patients who underwent laparoscopic radical gastrectomy had lower rate of total, surgical and severe complications. They also had shorter postoperative hospital stay with better OS and DFS. Hypoalbuminemia (P = 0.003) was the independent risk factor of complications. Old age (≥75, P = 0.035) and TNM stage (III: P < 0.001, II: P = 0.015) were the independent risk factors of OS. Combined resection (P = 0.003) and TNM stage (III: P < 0.001, II: P = 0.001) posed independent risk factors of lacking DFS. Laparoscopic surgery proved to be the independent protective factor of complications (P = 0.014), OS (P < 0.001) and DFS (P < 0.001). CONCLUSION Laparoscopic radical gastrectomy was relative safe and showed favorable outcomes in malnourished gastric cancer patients.
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Connor JP, Destrampe E, Robbins D, Hess AS, McCarthy D, Maloney J. Pre-operative anemia and peri-operative transfusion are associated with poor oncologic outcomes in cancers of the esophagus: potential impact of patient blood management on cancer outcomes. BMC Cancer 2023; 23:99. [PMID: 36709278 PMCID: PMC9883921 DOI: 10.1186/s12885-023-10579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Both Red Blood Cell (RBC) transfusion and anemia are thought to negatively impact cancer survival. These effects have been reported with mixed findings in cancer of the esophagus. The potential impact of the application of restrictive transfusion strategies on this patient population has not been defined. MATERIALS AND METHODS We conducted a retrospective study of esophagectomies and studied cases based on whether they were anemic or were transfused peri-operatively. Clinical characteristics and known clinicopathologic prognosticators were compared between these groups. Survival was compared by Cox proportional hazard modeling. Post-operative transfusions were assessed for compliance with restrictive transfusion thresholds. RESULTS Three-hundred ninety-nine esophagectomy cases were reviewed and after exclusions 348 cases were analyzed. The median length of follow-up was 33 months (range 1-152 months). Sixty-four percent of patients were anemic pre-operatively and 22% were transfused. Transfusion and anemia were closely related to each other. Microcytic anemia was uncommon but was evaluated and treated in only 50% of cases. Most anemic patients had normocytic RBC parameters. Transfusion but not anemia was associated with a protracted/prolonged post-operative stay. Transfusion and anemia were both associated with reduced survival however only anemia was associated with decreased survival in multi-variable modeling. Sixty-eight percent of patients were transfused post-operatively and 11% were compliant with the restrictive threshold of 7 g/dL. CONCLUSIONS Pre-operative anemia and transfusion are closely associated, however only anemia was found to compromise survival in our esophageal cancer cohort, supporting the need for more aggressive evaluation and treatment of anemia. Adherence to restrictive transfusion guidelines offers an opportunity to reduce transfusion rates which may also improve short-term outcomes.
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Affiliation(s)
- Joseph P. Connor
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, Section of Transfusion Medicine, University of Wisconsin, 3147 MFCB 1685 Highland Ave, Madison, WI 53705 USA
| | - Eric Destrampe
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, Section of Transfusion Medicine, University of Wisconsin, 3147 MFCB 1685 Highland Ave, Madison, WI 53705 USA
| | - Daniel Robbins
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI USA
| | - Aaron S. Hess
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, Section of Transfusion Medicine, University of Wisconsin, 3147 MFCB 1685 Highland Ave, Madison, WI 53705 USA ,grid.28803.310000 0001 0701 8607Department of Anesthesiology, University of Wisconsin, Madison, WI USA
| | - Daniel McCarthy
- grid.28803.310000 0001 0701 8607Department of Surgery, Section of Thoracic Surgery, University of Wisconsin, Madison, WI USA
| | - James Maloney
- grid.28803.310000 0001 0701 8607Department of Surgery, Section of Thoracic Surgery, University of Wisconsin, Madison, WI USA
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Zeuge U, Fares AF, Soriano J, Hueniken K, Bajwa J, Wang W, Schmid S, Rudolph-Naiberg S, Brown MC, Yeung J, Chen EX, Jang RW, Xu W, Elimova E, Liu G, Rozenberg D, McInnis MC. Differential prognostic significance of sarcopenia in metastatic esophageal squamous and adenocarcinoma. Esophagus 2023:10.1007/s10388-022-00981-y. [PMID: 36631713 DOI: 10.1007/s10388-022-00981-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Sarcopenia indicates poor prognosis in various malignancies. We evaluated the association of sarcopenia with overall (OS) and progression-free survival (PFS) in metastatic esophageal cancer (MEC) patients, a population often presenting with poor nutritional status. METHODS In newly diagnosed MEC patients managed at the Princess Margaret (PM) Cancer Centre (diagnosed 2006-2015), total muscle area, visceral adiposity (VA), and subcutaneous adiposity (SA) were quantified on abdominal computed tomography at L3. Sarcopenia was determined using published cutoffs, based on sex and height. RESULTS Of 202 MEC patients, most were male (166/82%), < 65 years (116/57%), and had adenocarcinoma histology (141/70%); 110/54% had recurrent MEC after initial curative-intent treatment; 92/46% presented with de novo MEC. At stage IV diagnosis, 20/10% were underweight, 97/48% were normal-weight and 84/42% were overweight/obese; 103/51% were sarcopenic. Sarcopenia was associated with worse median OS (4.6 vs. 7.9 months; log-rank p = 0.03) and 1-year survival, even after adjusting for other body composition variables (e.g., BMI, VA, and SA): adjusted-HR 1.51 [95% CI 1.1-2.2, p = 0.02]. In post hoc analysis, sarcopenia was highly prognostic in adenocarcinomas (p = 0.003), but not squamous cell carcinomas (SCC). In patients receiving palliative systemic treatment (104/51%), sarcopenia was associated with shorter PFS (p = 0.004) in adenocarcinoma patients (75/72%). CONCLUSIONS In metastatic esophageal adenocarcinomas, sarcopenia is associated with worse PFS and OS. In metastatic esophageal SCC, there was a non-significant trend for worse PFS but no association with OS. In order to offset the poor prognosis associated with sarcopenia particularly in metastatic esophageal adenocarcinoma patients, future research should focus on possible countermeasures.
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Affiliation(s)
- Ulf Zeuge
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
- Zuger Kantonsspital, Baar, Switzerland
| | - Aline F Fares
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
- Hospital de Base and Faculty of Medicine, São Jose Do Rio Preto, Brazil
| | - Joelle Soriano
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - Katrina Hueniken
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jaspreet Bajwa
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Wanning Wang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - Sabine Schmid
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Sarah Rudolph-Naiberg
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - M Catherine Brown
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - Jonathan Yeung
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - Eric X Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - Raymond W Jang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - Wei Xu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Elena Elimova
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada.
| | - Dmitry Rozenberg
- Division of Respirology, Temerty Faculty of Medicine, Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Micheal C McInnis
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
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Muscaritoli M, Bar-Sela G, Battisti NML, Belev B, Contreras-Martínez J, Cortesi E, de Brito-Ashurst I, Prado CM, Ravasco P, Yalcin S. Oncology-Led Early Identification of Nutritional Risk: A Pragmatic, Evidence-Based Protocol (PRONTO). Cancers (Basel) 2023; 15:cancers15020380. [PMID: 36672329 PMCID: PMC9856655 DOI: 10.3390/cancers15020380] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient's ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian's role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Gil Bar-Sela
- Oncology Department, Emek Medical Center, Afula 1834111, Israel
| | - Nicolo Matteo Luca Battisti
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
- Breast Cancer Research Division, The Institute of Cancer Research, London SW3 6JJ, UK
| | - Borislav Belev
- Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Enrico Cortesi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Paula Ravasco
- Faculty of Medicine and Centre for Interdisciplinary Research in Health (CIIS-UCP), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
- Centre for Interdisciplinary Research Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal
| | - Suayib Yalcin
- Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara 06800, Turkey
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Molfino A, Emerenziani S, Tonini G, Santini D, Gigante A, Guarino MPL, Nuglio C, Imbimbo G, La Cesa A, Cicala M, Muscaritoli M. Early impairment of food intake in patients newly diagnosed with cancer. Front Nutr 2023; 9:997813. [PMID: 36687669 PMCID: PMC9849803 DOI: 10.3389/fnut.2022.997813] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background Patients with gastrointestinal or lung cancer often suffer from a loss of appetite (anorexia), resulting in reduced food intake (hypophagia) and body weight loss. This study evaluated the prevalence of anorexia, hypophagia, pre-cachexia and cachexia in patients with cancer at time of diagnosis. Patients and methods Patients with newly diagnosed gastrointestinal or lung cancers were included. Body mass index (BMI) and weight loss over the prior 6 months were recorded. Patients were assessed for (pre-)cachexia and for anorexia using the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) and a specific anorexia questionnaire (AQ). Energy and protein intake were calculated through food diaries. Patients were considered hypophagic if intake was ≤70% of guideline-recommended levels. Results Overall, 102 patients [53 male; median age: 67 (range, 21-88) years] were enrolled. Mean BMI (± standard deviation) was 23.1 ± 3.4 kg/m2; average percentage of weight loss was 10.1 ± 7.8%. At diagnosis, 68% (69/102) of patients had cachexia, and 11% (11/102) pre-cachexia. Prevalence of anorexia was 57% (58/102) and 75% (76/102) according to FAACT and AQ, respectively. Forty-eight percent (49/102) of patients had hypophagia. Patients with anorexia had lower daily energy (p = 0.002) and protein intake (p = 0.0257), and greater percentage of weight loss (p = 0.0005). In patients with hypophagia, negative correlations were observed between percentage of weight loss and total daily calorie (r = -0.40; p = 0.01) and protein intake (r = -0.340; p = 0.018). Conclusion Anorexia, inadequate nutritional intake and cachexia are highly prevalent in patients with gastrointestinal or lung cancer at diagnosis. Negative protein and energy balance may play an important role in the pathogenesis of cachexia. Early multimodal strategies to improve food intake are urgently needed.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sara Emerenziani
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | | | | | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Chiara Nuglio
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Michele Cicala
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy,*Correspondence: Maurizio Muscaritoli,
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Wang HB, Xu XT, Tian MX, Ding CC, Tang J, Qian Y, Jin X. Prognostic values of the prognostic nutritional index, geriatric nutritional risk index, and systemic inflammatory indexes in patients with stage IIB-III cervical cancer receiving radiotherapy. Front Nutr 2023; 10:1000326. [PMID: 36937347 PMCID: PMC10017984 DOI: 10.3389/fnut.2023.1000326] [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: 07/22/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Growing evidence suggests that nutritional status and inflammation are associated with survival in various cancers. This study aimed to evaluate the prognostic value of the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and systemic inflammatory indexes (neutrophil/lymphocyte ratio [NLR], monocyte/lymphocyte ratio [MLR], and platelet/lymphocyte ratio [PLR]) in patients with stage IIB-III cervical cancer receiving radiotherapy. Results The ideal cutoff values for the PNI, GNRI, NLR, MLR, and PLR were 48.3, 97.04, 2.8, 0.41, and 186.67, respectively. Low PNI and GNRI scores were associated with poor OS and PFS. High NLR, MLR, and PLR also predicted inferior 5-year OS and PFS rates in patients with stage IIB-III cervical cancer. Multivariate Cox regression analysis identified tumor size, histological type, stage, number of metastatic lymph nodes, PNI, GNRI, NLR, PLR, and MLR as significant prognostic factors for OS and PFS. Conclusions The current findings suggest that the PNI, GNRI, NLR, PLR, and MLR are essential parameters for predicting prognosis in patients with stage IIB-III cervical cancer receiving radiotherapy.
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Affiliation(s)
- Hong-Bing Wang
- Department of Gynecology and Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin-Tian Xu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meng-Xing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chen-Chen Ding
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Tang
- Department of Lymphoma Medicine, Breast Cancer and Soft Tissue Tumor Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Qian
- Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- *Correspondence: Xin Jin
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Marano L, Marmorino F, Desideri I, Carbone L, Rizzo A, Salvestrini V, Roviello F, Cinieri S, Donato V, De Luca R. Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group. Front Nutr 2023; 10:1045022. [PMID: 37125048 PMCID: PMC10140427 DOI: 10.3389/fnut.2023.1045022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/17/2023] [Indexed: 05/02/2023] Open
Abstract
Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.
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Affiliation(s)
- Luigi Marano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Federica Marmorino
- Unit of Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Ludovico Carbone
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- *Correspondence: Ludovico Carbone,
| | - Alessandro Rizzo
- Don Tonino Bello Oncology, IRCCS Istituto Tumori Giovanni Paolo II Bari, Bari, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Brindisi, Italy
| | - Vittorio Donato
- Department of Image Diagnostics, Ospedale San Camillo Forlanini, Rome, Italy
| | - Raffaele De Luca
- Department of Surgical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
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Mid-Arm Muscle Circumference or Body Weight-Standardized Hand Grip Strength in the GLIM Superiorly Predicts Survival in Chinese Colorectal Cancer Patients. Nutrients 2022; 14:nu14235166. [PMID: 36501196 PMCID: PMC9739446 DOI: 10.3390/nu14235166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
Our objective was to identify the optimal method to assess reduced muscle mass (RMM) using the Global Leadership Initiative on Malnutrition (GLIM) approach and investigate the roles of the GLIM approach in nutrition assessment and survival prediction in colorectal cancer (CRC) patients. During a median follow-up period of 4.2 (4.0, 4.4) years, a development cohort of 3612 CRC patients with a mean age of 64.09 ± 12.45 years was observed, as well as an external validation cohort of 875 CRC patients. Kaplan−Meier curves and multivariate Cox regression were adopted to analyze the association between GLIM-diagnosed malnutrition and the overall survival (OS) of CRC patients. A nomogram predicting individualized survival was constructed based on independent prognostic predictors. The concordance index, calibration curve, and decision curve were applied to appraise the discrimination, accuracy, and clinical efficacy of the nomogram, respectively. Patients diagnosed with severe malnutrition based on either the mid-arm muscle circumference (MAMC) or body weight-standardized hand grip strength (HGS/W) method had the highest mortality hazard ratio (HR, 1.51; 95% CI, 1.34−1.70; p < 0.001). GLIM-defined malnutrition was diagnosed in 47.6% of patients. Severe malnutrition was an independent mortality risk factor for OS (HR, 1.25; 95% CI, 1.10−1.42; p < 0.001). The GLIM nomogram showed good performance in predicting the survival of CRC patients and was clinically beneficial. Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting OS in CRC patients.
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Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study. Nutrients 2022; 14:nu14224764. [PMID: 36432451 PMCID: PMC9698070 DOI: 10.3390/nu14224764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
A survey study based on a 21-item questionnaire was conducted to assess knowledge and practices of digestive surgeons focused on nutritional support in gastrointestinal cancer patients. At least 5 staff digestive surgeons from 25 tertiary care hospitals throughout Spain were invited to participate and 116 accepted. Malnutrition was correctly defined by 81.9% of participants. In patients undergoing major abdominal surgery, 55.2% considered that preoperative nutritional support is indicated in all patients with malnutrition for a period of 7-14 days. For the diagnosis of malnutrition, only 18.1% of participants selected unintentional weight loss together with a fasting or semi-fasting period of more than one week. Regarding the advantages of enteral infusion, 93.7% of participants considered preservation of the integrity of the intestinal mucosa and barrier function, and in relation to peripheral parenteral nutrition, 86.2% selected the definition of nutrient infusion through a peripheral vein and 81.9% its indication for less than 7 days. Digestive surgeons had a limited knowledge of basic aspects of clinical nutrition in cancer patients, but there was some variability regarding clinical practice in individual cases. These findings indicate the need to develop standardized clinical protocols as well as a national consensus on nutrition support in cancer patients.
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Thampy A, Palani Kumar MK, Serva Peddha M, Reddy M. The effectiveness of whey proteins in prevention and treatment of cancer: a review. Crit Rev Food Sci Nutr 2022; 64:2088-2104. [PMID: 36111369 DOI: 10.1080/10408398.2022.2121256] [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] [Indexed: 11/03/2022]
Abstract
Cancer prevalence is rising rapidly around the globe, contributing immensely to the burden on health systems, hence the search for more effective and selective treatments still remains enticing. Whey, as a natural source, has received extensive focus in recent years because of its intriguing applications to health benefits. Growing consumer appreciation of the nutraceutical effects of whey components makes them an attractive field within cancer research. Whey is a valuable source of superior-quality proteins, lactose, vitamins, and minerals that contribute to proper nutrition as well as help hamper illness and even complement certain disease-related therapy prognosis. As a result, industry leaders and dairy producers are devising new ways to valorize it. Great emphasis on cancer prevention and treatment has been given to whey protein (WP) by the scientific community. WP intake has been proven to induce anti-cancer effects in various in vitro and in vivo studies. Nutritionists and dietitians are now enormously endorsing the role of WP in the therapeutic field, notably for cancer cachexia management. However, human intervention studies with WP are in their infancy and remain to be established with different tumor entities to provide valid proof of its ability to act as a coadjuvant in cancer treatment.
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Affiliation(s)
- Anjana Thampy
- Department of Clinical Nutrition and Dietetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Meena Kumari Palani Kumar
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysore, Karnataka, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Muthukumar Serva Peddha
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysore, Karnataka, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Madhavi Reddy
- Department of Clinical Nutrition and Dietetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
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Feng M, Ji J, Li X, Ye X. Identification of the Exercise and Time Effects on Human Skeletal Muscle through Bioinformatics Methods. Genet Res (Camb) 2022; 2022:9582363. [PMID: 36072011 PMCID: PMC9420641 DOI: 10.1155/2022/9582363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background The human body has more than 600 kinds of skeletal muscles, which accounts for about 40% of the whole weight. Most skeletal muscles can make bones move, and their strength and endurance directly affect their performance during exercise. Methods To determine the effects of exercise and time on human skeletal muscle, we downloaded the microarray expression profile of GSE1832 and analyzed it to select differentially expressed genes (DEGs). Then, a protein-protein interaction (PPI) network was established, and the hub genes were identified. Afterwards, DEGs were applied to perform Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Finally, with the help of Gene Set Enrichment Analysis (GSEA), the gene sets in the 7 samples were enriched in the KEGG pathway. Results Through a series of bioinformatics analyses, we obtained a total of 271 DEGs. After that, four hub genes were determined through the PPI network, namely, EP300, STAT1, CDKN1A, and RAC2. In addition, we got that these DEGs were enriched in GO, such as regulation of cell population proliferation, cellular water homeostasis, and so on, and in KEGG, namely, hepatitis B, Epstein-Barr virus infection, small cell lung cancer, pathways in cancer, and others. Finally, the gene set in the samples obtained by GSEA was enriched in the cell cycle, chemokine signaling pathway, DNA replication, cytokine receptor interaction, ECM receptor interaction, and focal adhesion in KEGG. Conclusion The findings obtained in this study will provide new clues for elucidating the mechanism of exercise and time on human skeletal muscles.
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Affiliation(s)
- Mufang Feng
- School of Sports Science and Engineering, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China
| | - Jie Ji
- Department of Rehabilitation, Minhang Hospital Fudan University, 170 Xin-Song Road, Shanghai 201199, China
| | - Xiaoliu Li
- Department of Rehabilitation, Minhang Hospital Fudan University, 170 Xin-Song Road, Shanghai 201199, China
| | - Xinming Ye
- School of Sports Science and Engineering, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China
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Christou CN, Ehrsson YT, Westerbergh J, Risérus U, Laurell G. Longitudinal Changes in the Fatty Acid Profile in Patients with Head and Neck Cancer: Associations with Treatment and Inflammatory Response. Cancers (Basel) 2022; 14:3696. [PMID: 35954360 PMCID: PMC9367269 DOI: 10.3390/cancers14153696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023] Open
Abstract
Studies on fatty acids (FAs) in patients with head and neck cancer (HNC) are limited. We aimed to investigate the longitudinal changes of circulating FAs in patients with HNC and to examine potential correlations of FA changes with treatment. The secondary aims were to investigate correlations of FAs with cytokines and patient-related factors, and if any FAs correlated with disease recurrence or death. A total of 174 patients with HNC were included before treatment and followed-up at three time points after the start of the treatment through blood sampling and body weight measurements. Serum FA profiling was assessed by gas chromatography. The total follow-up time was 3 years. The levels of almost all FAs changed from baseline to 7 weeks. The change in FA 14:0 was associated with treatment and the change in 18:3n-6 was associated with the patients' pre-treatment BMI. FAs 14:0 and 18:0 were correlated with weight changes from baseline to 7 weeks. IL-6 was correlated with three FAs at 7 weeks and with two FAs at 1 year. Patients with higher levels 20:5n-3 at 3 months had a higher risk of all-cause death within 3 years (HR 2.75, 95% CI 1.22-6.21). Treatment, inflammation, and weight loss contributed in a complex manner to the altered FA profile in the studied cohort. The association between IL-6 and FAs in patients with HNC is in line with earlier studies and suggests the opportunity for regulating inflammation in HNC patients through modulation of FAs.
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Affiliation(s)
- Constantina N Christou
- Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden; (Y.T.E.); (G.L.)
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden; (Y.T.E.); (G.L.)
| | - Johan Westerbergh
- Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden;
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Uppsala University, 752 37 Uppsala, Sweden;
| | - Göran Laurell
- Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden; (Y.T.E.); (G.L.)
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Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [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: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
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Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Guler MN, Tscheiller NM, Sabater-Molina M, Gimeno JR, Nebigil CG. Evidence for reciprocal network interactions between injured hearts and cancer. Front Cardiovasc Med 2022; 9:929259. [PMID: 35911555 PMCID: PMC9334681 DOI: 10.3389/fcvm.2022.929259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) and cancer are responsible for 50% of all deaths in middle-aged people. These diseases are tightly linked, which is supported by recent epidemiological studies and case control studies, demonstrating that HF patients have a higher risk to develop cancer such as lung and breast cancer. For HF patients, a one-size-fits-all clinical management strategy is not effective and patient management represents a major economical and clinical burden. Anti-cancer treatments-mediated cardiotoxicity, leading to HF have been extensively studied. However, recent studies showed that even before the initiation of cancer therapy, cancer patients presented impairments in the cardiovascular functions and exercise capacity. Thus, the optimal cardioprotective and surveillance strategies should be applied to cancer patients with pre-existing HF. Recently, preclinical studies addressed the hypothesis that there is bilateral interaction between cardiac injury and cancer development. Understanding of molecular mechanisms of HF-cancer interaction can define the profiles of bilateral signaling networks, and identify the disease-specific biomarkers and possibly therapeutic targets. Here we discuss the shared pathological events, and some treatments of cancer- and HF-mediated risk incidence. Finally, we address the evidences on bilateral connection between cardiac injury (HF and early cardiac remodeling) and cancer through secreted factors (secretoms).
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Affiliation(s)
- Melisa N. Guler
- Faculty of Medicine, University of Campania Luigi Vanvitelli, Caserta, Italy
- University of Strasbourg, INSERM, UMR 1260, Nanoregenerative Medicine, Strasbourg, France
- Fédération de Médecine Translationnelle de l’Université de Strasbourg, Strasbourg, France
| | - Nathalie M. Tscheiller
- University of Strasbourg, INSERM, UMR 1260, Nanoregenerative Medicine, Strasbourg, France
- Fédération de Médecine Translationnelle de l’Université de Strasbourg, Strasbourg, France
| | - Maria Sabater-Molina
- Servicio de Cardiología, Laboratorio de Cardiogenética, Centro de Investigacion Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Juan R. Gimeno
- Servicio de Cardiología, Laboratorio de Cardiogenética, Centro de Investigacion Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Canan G. Nebigil
- University of Strasbourg, INSERM, UMR 1260, Nanoregenerative Medicine, Strasbourg, France
- Fédération de Médecine Translationnelle de l’Université de Strasbourg, Strasbourg, France
- *Correspondence: Canan G. Nebigil,
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