A scoping review of cachexia, sarcopenia, and malnutrition in patients with locally advanced cervical cancer undergoing chemoradiotherapy revealed that women who lost at least 10% muscle mass during treatment had a six times higher mortality rate, regardless of their weight at the start of treatment, according to findings published in Clinical Nutrition Open Science.
However, screening at baseline and muscle quantification during treatment could help to identify patients at higher risk for cachexia, sarcopenia, and malnutrition.
"Weight alone is a dangerously inadequate screening tool," said lead study author Canio Martinelli, MD, Director of Clinical and Translational Research, Sbarro Health Research Organization, Temple University. "[Routine nutritional] screening requires no additional resources. The tools already exist."
Background and Study Methods
Routine nutritional screening is not recommended by major cancer guidelines to look for signs of muscle loss and malnourishment. Yet, between 20% and 60% of women with advanced cervical cancer experience sarcopenia, malnutrition, and cachexia.
Researchers conducted a literature search for studies that reported sarcopenia, malnutrition, or cachexia in relation to disease survival, toxicity, treatment completion, or quality of life in patients with locally advanced cervical cancer who received chemoradiotherapy. A total of 23 studies including 4,352 women were included in the scoping review.
Key Findings
Malnutrition, which was included in 17 of the 23 studies, was associated with a 1.5- to 3.7-fold higher mortality rate.
Sarcopenia, which was included in 15 of the studies, was a predictor of survival for 5 out of 11 assessments (hazard ratio [HR] = 1.75–3.60), and sarcopenia obesity had a hazard ratio of 2.65.
Body composition loss while on treatment was associated with at least a 7% to 10% decline in the quantity of skeletal muscle (HR = 6.02) and at least 15% loss of intermuscular fat (HR = 8.52), both of which were a predictive measure of higher mortality rates.
Malnourished women or women with sarcopenia had 1.2- to 2.5-fold higher rates of grade ≥3 toxicity and treatment interruption. The risk increased to 3- to 5-fold with multiple unfavorable features of body composition.
Quality-of-life scores declined by 11% during treatment when there were signs of malnutrition, sarcopenia, or cachexia.
Seventeen of the studies had high bias risk due to attrition and inadequate cofounder control.
"The evidence across thousands of women is consistent," said Antonio Giordano, MD, PhD, Founder of the Sbarro Institute. "Nutritional status predicts survival. The guidelines need to catch up."
DISCLOSURE: For full disclosures of the study authors, visit clinicalnutritionopenscience.com.
