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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: 0] [Impact Index Per Article: 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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Lægreid IK, Aasarød K, Bye A, Leivestad T, Jordhøy M. The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients. Ren Fail 2013; 36:9-16. [PMID: 24028283 DOI: 10.3109/0886022x.2013.830206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the majority of the older patients in dialysis, the treatment will be lifelong. Thus, quality of life (QoL) is a crucial outcome. Our aim was to assess the QoL of older Norwegian dialysis patients and to investigate the impact of early (estimated glomerular filtration rate, eGFR ≥10 mL/min) versus late (eGFR <10 mL/min) start in dialysis, comorbidity, nutritional status and physical capacity. METHODS A self-report questionnaire including SF-36 (QoL) and the Subjective Global Assessment (SGA; nutritional status) was mailed to all patients (n = 320) ≥75 years registered in the Norwegian Renal Registry (NRR) as being in dialysis by September 2009. Reply was received from 233 patients (73%). Medical data including comorbidities and eGFR at dialysis start (obtained for 194 patients) were retrieved from the NRR. Functional capacity was determined from the SGA. RESULTS Compared to reports from younger dialysis patients, our patients scored poorer on all SF-36 subscales. Early start in dialysis was registered for 52 patients, 142 patients started late, 51.4% were well nourished (SGA A), 32.3% moderately malnourished (SGA B) and 16.4% were severely malnourished (SGA C). No significant association between any SF-36 scores and early versus late start, nutritional status or comorbidity was found. Better physical function was significantly associated with better scores on all SF-36 scales. CONCLUSIONS Our results indicate that physical function is important to all QoL aspects. Increased focus on physical rehabilitation seems pertinent. Early start of dialysis treatment was not associated with better long term QoL scores.
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Affiliation(s)
- Inger Karin Lægreid
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU , Trondheim , Norway
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Campbell KL, Bauer JD, Ikehiro A, Johnson DW. Role of Nutrition Impact Symptoms in Predicting Nutritional Status and Clinical Outcome in Hemodialysis Patients: A Potential Screening Tool. J Ren Nutr 2013; 23:302-7. [DOI: 10.1053/j.jrn.2012.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/18/2012] [Accepted: 07/27/2012] [Indexed: 12/19/2022] Open
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