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

• Published in: Journal of human nutrition and dietetics Vol. 32; no. 4; pp. 480 - 491
• Main Authors: Sánchez, M., Castro‐Eguiluz, D., Luvián‐Morales, J., Jiménez‐Lima, R., Aguilar‐Ponce, J. L., Isla‐Ortiz, D., Cetina, L.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.08.2019
• Subjects: Adequacy; Adipose tissue; Anthropometry; Body composition; Body weight; Body weight loss; Cancer; cancer cachexia; Carbohydrates; Cervical cancer; Cervix; Chemoradiotherapy; Chemotherapy; Computed tomography; Diagnosis; Diet; Energy intake; Health risk assessment; Malnutrition; Muscles; Nutritional status; Overweight; Patients; Radiation therapy; Sarcopenia; Skeletal muscle; Tumors; Weight loss; malnutrition; cervical cancer; cancer cachexia
• ISSN: 0952-3871; 1365-277X
• DOI: 10.1111/jhn.12649

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.