Deterioration of nutritional status of patients with locally advanced cervical cancer during treatment with concomitant chemoradiotherapy

Abstract

Background In Mexico, 80% women with cervical cancer are diagnosed at locally advanced stages and are treated with concomitant chemoradiotherapy. The treatment modality and catabolic state confer a nutritional risk. The present study aimed to thoroughly evaluate the nutritional status and change in body composition of locally advanced cervical cancer (LACC) patients throughout treatment. Methods An observational prospective study, carried out at the Mexican National Cancer Institute, included 55 LACC patients. Nutritional status was evaluated before, during and after treatment, using anthropometric, dietary and biochemical measurements. Body composition was analysed using computed tomography images obtained at the time of diagnosis and approximately 4 months after treatment completion. Clinical outcomes were associated with changes in body composition. Results At the time of diagnosis, no patients were clinically malnourished, although 33.3% presented sarcopenia and most were overweight; by the end of treatment, 69% became clinically malnourished and 58% were sarcopenic. Average weight loss was 7.4 kg (P = 0.001). Adequacy of energy intake was reduced to 54%, obtained predominantly from carbohydrates. By the week 9, 62.8% patients became anemic and 34.5% had low albumin levels. Body composition analysis revealed that patients lost both, muscle and adipose tissues, although 27% patients were muscle depleted by the end of treatment. Patients who lost ≥10% skeletal muscle presented a higher tumour recurrence (hazard ratio = 2.957, P = 0.006) and a tendency towards diminished overall survival (hazard ratio = 2.572, not significant). Conclusions The nutritional status of cervical cancer patients deteriorates during treatment with concomitant chemoradiotherapy and, most importantly, muscle loss impacts the clinical outcome of patients.

Muscle Loss after Chemoradiotherapy as a Biomarker of Distant Failures in Locally Advanced Cervical Cancer

“…In addition, we also found that the changes in body composition were different between SCC and adenocarcinoma; it implied that the protein synthesis rate may differ between SCC and adenocarcinoma, and may affect whole-body protein metabolism in humans [28]. The nutritional status may also deteriorate during CCRT and affect the clinical outcome in LACC patients [13]. Although we found that muscle loss after CCRT was a predictor of distant failures, our hypothesis and findings should be validated in future studies.…”

“…There were some limitations of our study. First, the retrospective nature of this study limits the longitudinal assessment of nutritional status, muscle strength, physical performance (e.g., gait speed), or systemic inflammatory markers (e.g., modified Glasgow prognostic score) during the course of CCRT [13]. Second, this study could not infer causality between the body composition parameters and distant failures.…”

“…A longitudinal study of body composition can provide a comprehensive understanding of body composition changes during cancer therapy and their impact on outcomes in cancer patients [16][17][18][19]. Skeletal muscle loss after CCRT was associated with worse survival outcomes in LACC [11][12][13]. Previous studies also reported that pre-treatment sarcopenia was not a predictor of outcomes in LACC [11,12].…”

Sarcopenia in cancer: Risking more than muscle loss

“…One study found that a third of patients with cervical cancer met diagnostic criteria for sarcopenia criteria despite not being clinically malnourished. Following treatment, 69% of patients were clinically malnourished and 58% were sarcopenic [65]. This was attributed to decreased calorie intake and early satiety.…”

Immunonutrition in Cervical Cancer: Immune Response Modulation by Diet

“…Depending on the instrument used, undernourishment is estimated to range between 0% and 42.8% at diagnosis, and to increase up to 69% by the end of treatment with concomitant chemoradiation therapy and followed by brachytherapy. Overweight and obesity are more common, since they occur in 61.8-75.8% of patients and, simultaneously, sarcopenia is present in 10.5%-33.3% 45,46 . Furthermore, around 40.8% of women with CC have some comorbidity 45 , which represents a huge challenge for diagnosis and nutritional approach, since a combination of the previous diagnoses can be found in a single individual 45 .…”