Patients with gastrointestinal cancer are more susceptible to unintentional weight loss after chemotherapy treatment
DOI:
https://doi.org/10.34117/bjdv9n5-171Keywords:
cachexia, cancer, chemotherapyAbstract
There is growing evidence showing that some chemotherapeutic agents employed for oncology treatments contribute to the induction of anorexia, leading to weight loss and the reduction of muscle mass due to the effects of treatment and the tumor, which may trigger the cachexia syndrome. Owing to the complexity of the diagnosis and body evaluation in these patients, the objective of this study was to evaluate the nutritional status of oncology patients submitted to chemotherapy treatment showing a weight loss greater than 5%. We screened 220 oncology patients and shortlisted 10 patients diagnosed with different types of tumors assisted by the Instituto Ribeirãopretano de Combate ao Câncer under chemotherapy treatment and who presented weight loss greater than 5%. Anthropometric data such as weight, height and arm circumference (AC) was used for the calculation of Body Mass Index (BMI). We also used the Arm Muscle Circumference (AMC) and Arm Muscle Area (AMB) and the application of the Oncology Patient Global Nutrition Questionnaire. The results point out that cancer patients presented different anthropometric classification pre-diagnosis and after the beginning of anticancer treatment resulting from the side effects of chemotherapeutic agents and the reduction in the volume of food ingested. Gastrointestinal tract cancer patients presented greater short-term weight loss when compared to other types of tumors. We suggest that the observed weight loss may be related to the MFLOX and FOLFOX treatment protocols, in addition to the reduction in food intake (while maintaining good nutritional quality). These factors together may lead to the reduction of life quality and life expectancy and worsened patients’ prognosis.
References
Organização Pan-Americana da Saúde. 2020. Câncer. PhilSci archive.https://www.paho.org/pt/topicos/cancer. Accessed 12 Feb2021.
SILVA JAG. 2019. Instituto Nacional do Câncer. Estimativas 2020: incidência de câncer no Brasil. PhilSci archive.https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020- incidencia-de-cancer-no-brasil. Accessed 21 Jan 2022.
World Health Organization. Global Cancer Observatory (GCO). 2020. Cancer Today. PhilSci archive. https://gco.iarc.fr/. Accessed 27 Dez 2021.
Pin F, Barreto R., Couch M.E, Bonetto A, O'Connell TM. 2019. Cachexia induced by cancer and chemotherapy yield distinct perturbations to energy metabolism. J Cachexia Sarcopenia Muscle. 10.1002/jcsm.12360.
Fearon KC, Glass DJ, Guttridge DC. 2012. Cancer cachexia: Mediators, signaling and metabolic pathways. Cell Metabolism. https://doi.org/10.1016/S1470-2045(10)70218-7.
Freire PP, Fernandez GJ, De Moraes D, Cury SS, Dal Pai-Silva M, Dos Reis PP, Rogatto SR, Carvalho RF. 2020. The expression landscape of cachexia-inducing factors in human cancers. J Cachexia Sarcopenia Muscle. https://doi.org/10.1002/jcsm.12565.
Duval PA, Bergmann RB, Do Vale IAV, Colling C, Araújo SÉ, Assunção MCF. 2015. Prevalência de caquexia neoplásica e fatores associados na internação domiciliar. Revista Brasileira de Cancerologia. https://doi.org/10.1002/jcsm.12565.
Tohgo A, Kumazawa E, Akahane K, Asakawa A, Inui A. 2002. Anticancer drugs that induce cancer-associated cachectic syndromes. Expert Rev Anticancer Ther. 10.1586/14737140.2.1.121.
Davis MP, Panikkar R. 2019. Sarcopenia associated with chemotherapy and targeted agents for cancer therapy. Ann Palliat Med. 10.21037/apm.2018.08.02.
Silva MPN. 2005. Síndrome da anorexia-caquexia em portadores de câncer. Revista
Brasileira de Cancerologia. https://doi.org/10.32635/2176-9745.RBC.2006v52n1.1910.
Consenso Brasileiro de Caquexia/Anorexia. 2011. PhilSci archive. https://novoportal.crn1.org.br/wp-content/uploads/2014/06/CONSENSO-BRASILEIRO-DE-CAQUEXIA-ANOREXIA-EM-CUIDADOS-PALIATIVOS_-2011.pdf?e89d7b. Accessed 27 june 2022.
Gonzalez MC, Borges LR, Silveira DH, Assunção MCF, Orlandi SP. 2010. Validação da versão em português da avaliação subjetiva global produzida pelo paciente. Rev Bras Nutr Clin. 2: 102-108.
Brasil. Ministério da Saúde. Departamento de Atenção Básica. 2014. Guia Alimentar para a População Brasileira. PhilSci archive. https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf. Accessed 28 Dez 2021.
Franceschini J, Jardim JR, Fernandes ALG, Jamnik S, Santoro IL. 2010. Reproducibility of the Brazilian Portuguese version of the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire used in conjunction with its lung cancer-specific module. J Bras Pneumol. https://doi.org/10.1590/S1806-37132010000500011.
Blackburn GL, Thornton PA. 1979. Nutritional assessment of the hospitalized patients. Medical clinics of North America 63:1103-1115.
Fearon KC, Strasser F, Anker SD, Boseu I, Bruera E, Fainsinger RL, Jatoi A, Loprinz C, Macdonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Barocos VE. 2011. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 10.1016/S1470-2045(10)70218-7.
Tan BHL, Birdsell LA, Martin L, Baracos VE, Fearon KC. 2009. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. American Association for Cancer Research. 10.1158/1078-0432.CCR-09-1525.
Argiles, J. M.; Lopez-Soriano, F. J.; Busquets, S. 2008. Novel approaches to the treatment to the of cachexia. Drug Discovery Today. https://doi.org/10.1016/j.drudis.2007.10.008.
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, De Van Der Schueren M, Preiser JC. 2017. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 10.1016/j.clnu.2016.07.015.
Shawc. 2021. Management of diet in gastrointestinal cancer. Proc Nutr Soc. 10.1017/S0029665120007041.
Guo ZQ et al. 2020. Survery and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and is influence on the quality of life. Supportive Care in Cancer. https://doi.org/10.1089/ars.2011.3965.
Tartari RF, Busnello FM, Nunes CHA. 2010. Perfil nutricional de pacientes em tratamento quimioterápico em um ambulatório especializado em quimioterapia. Rev. Bras. Cancerologia. https://doi.org/10.32635/2176-9745.RBC.2010v56n1.1525.
Solheim, TS, Laird BJA, Balstad TR, Tchau A, Stene G, Barocos V, Strasser F, Griffiths G, Maddocks M, Fallon M, Kaasa S, Fearon K. Cancer cachexia: rationale for the MENAC (Multimodal-Exercise, Nutrition and Anti-inflamatory medication for cachexia) trial. BMJ Supportive & Palliative Care. 10.1136/bmjspcare-2017-001440.
Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasso C, Buonaccorso L, Van Der Schueren M, Baldwin C, Chasen M,Ripamonti CI. 2021. Cancer cachexia in adult patients: ESMO clinical practice guidelines. ESMO. 10.1016/j.esmoop.2021.100092.
While WS, Darlington A, Hopkinson JB, Fitzsimmons D, Branca A, Johnson CD. 2013. A systematic review of health-related quality of life instruments in patients with cancer cachexia. Supportive Care in Cancer. https://doi.org/10.1007/s00520-013-1881-9.
Wouter, RW, Schols AMWJ, Theys J, Helvoort AV, Langen RCJ. 2020. Nutritional Interventions in cancer cachexia: evidence and perspectives from experimental models. Front. Nutr. https://doi.org/10.3389/fnut.2020.601329.

