Variation of resting energy expenditure after the first chemotherapy cycle in acute leukemia patients

Monitoring energy balance through clinical and serum biomarkers in patients with hematologic malignancies undergoing chemotherapy

Despite widespread concern about energy imbalance due to tumor and chemotherapy-related side effects, little is known about detailed variations in energy input, metabolic rate, and physical activity. This study explored changes in energy balance components and serum biomarkers of patients with hematologic malignancies undergoing chemotherapy. Our prospective study included 40 patients with hematologic malignancies hospitalized for chemotherapy. We measured energy balance components, physical function, and serum biomarkers at baseline and weekly after chemotherapy for 3 weeks. Significant weight loss, representing negative energy balance, occurred at 2 (p = 0.002) and 3 weeks (p < 0.001) post-chemotherapy. Statistically reduced oral intake was observed at 3 weeks post-chemotherapy (p = 0.040), and resting energy expenditure statistically decreased according to Harris-Benedict equation, but not to Penn State University equation. Physical function according to DEMMI score decreased significantly at 3 weeks post-chemotherapy (p = 0.002). Serum biomarker analysis demonstrated significant changes in albumin, total protein, CXCL13, and GDF15, with exception of leptin. Although conventional serum biomarkers (total protein and albumin) did not reach pathological states despite their statistical differences, subgroup analysis showed CXCL13 in weight loss group and GDF15 in reduced oral intake group were significantly changed. Over half of patients (65.0%, n = 26) suffered from energy imbalance associated with weight loss and reduced oral intake during chemotherapy. Serial laboratory results suggested that novel biomarkers (CXCL13, GDF15) could be correlated with cachexic state and reduced food intake. Monitoring clinical and serum biomarkers associated with energy balance together can help identify needs for nutritional support in patients with hematologic malignancies undergoing chemotherapy.

The effects of chemotherapy on energy metabolic aspects in cancer patients: A systematic review

BACKGROUND & AIMS

Cancer survival rates have increased significantly creating more awareness for comorbidities affecting the Quality of Life. Chemotherapy may induce serious metabolic alterations. These complications can create an energy imbalance, worsening prognosis. The effect of chemotherapy on energy metabolism remains largely unknown. The purpose of this systematic review is to determine the impact of chemotherapy on energy metabolism, creating more insight in a patients' energy requirements.

METHODS

We identified relevant studies up to May 2nd, 2019 using PubMed and Web of Science. Studies including all types of cancer and stages were selected. Only patients that underwent chemotherapy whether or not followed by surgery or radiotherapy were selected. Maximum follow-up was set at 6 months. Resting energy expenditure (REE), measured by indirect calorimetry (IC) or predicted by the Harris-Benedict equation (HB_Eq), was our primary outcome. Results regarding body composition were considered as secondary outcome parameter.

RESULTS

16 studies were selected, including 267 patients. Overall, a significant decrease in REE [-1.5% to -24.91%] 1-month post-chemotherapy was reported. Two studies on breast cancer conducted a 3 and 6-month follow-up and found an increase in REE of 4.01% and 5.72% (p < .05), revealing a U-shaped curve in the expression of REE. Changes are accompanied by (non)significant variations in body composition (Fatmass (FM) and Fatfree Mass (FFM)). HB_Eq tends to underestimate REE by 4.03%-27.1%.

CONCLUSION

Alterations in REE, accompanied by changes in body composition, are found during and after chemotherapy in all cancer types and stages, revealing a U-shaped curve. Changes in FFM are suggested to induce variations in REE concomitant to catabolic effects of the disease and administered drug. HB_Eq tends to underestimate REE, stressing the need for adequate assessment to meet patients' energy requirements and support dietary needs.

Resting energy metabolism and anticancer treatments

PURPOSE OF REVIEW

Cachexia is a multifactorial syndrome associated with morbidity and mortality in cancer patients and represents a major challenge in cancer management. Elevated energy expenditure is supposed to contribute to cachexia. The current article presents the recent findings on the resting energy expenditure (REE) in cancer and the clinical implications for anticancer treatments.

RECENT FINDINGS

Half of cancer patients present with hypermetabolism (measured REE >110% of predicted REE). Hypermetabolism is associated with clinical and biological features of cachexia. Hypermetabolic patients - even those with normal nutritional status - have a high risk of severe acute toxicity and a poor prognosis.

SUMMARY

Recent discoveries have highlighted the REE as an essential component of nutritional assessment in cancer patients. Multimodal care for cachexia should include REE measurements and dedicated pharmacologic interventions such as adrenoreceptor blockade in case of hypermetabolism.