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Nutrition in acute and chronic diseases

Weight loss, phase angle, and survival in cancer patients undergoing radiotherapy: a prospective study with 10-year follow-up

Abstract

Background/Objectives

Cancer patients undergoing radiotherapy (RT) frequently experience weight loss and changes in body composition, which negatively affect their nutritional status, lead to a poor clinical prognosis, and reduce survival rates. This study aimed to evaluate whether changes in body weight, phase angle, and standardized phase angle are associated with longer survival in cancer patients undergoing RT.

Methods

This prospective cohort study included 62 cancer patients who underwent RT between 2008 and 2009 and were followed until 2019. Anthropometric and bioelectrical impedance analysis data were assessed before and after RT. The Kaplan–Meier method was used to calculate survival, and mortality risk was assessed using the Cox proportional hazards model.

Results

Kaplan–Meier analysis indicated no significant difference in survival time after the 10-year follow-up between patients who had weight loss during RT and those with weight maintenance or weight gain during RT. Mortality risk was associated, in the adjusted multivariate analysis, with age (p = 0.023), site of treatment (p = 0.001), and weight loss during RT (p = 0.044). Every 1 kg lost increased the risk of death by 25% compared with patients who maintained or gained weight during RT. Changes in phase angle and standardized phase angle after RT were not associated with increased mortality risk.

Conclusions

Weight loss during RT, site of treatment, and age are associated with a higher risk of death in cancer patients after the 10-year follow-up.

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Fig. 1: Consort flow chart of screening patients eligible in the study and for survival analysis.
Fig. 2: Kaplan–Meier survival curves for cancer patients with weight loss and weight maintenance groups.

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References

  1. Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis - clinical relevance and applicability of impedance parameters. Clin Nutr. 2012;31:854–61.

    Article  Google Scholar 

  2. Grundmann O, Yoon SL, Williams JJ. The value of bioelectrical impedance analysis and phase angle in the evaluation of malnutrition and quality of life in cancer patients - a comprehensive review. Eur J Clin Nutr. 2015;69:1290–7.

    Article  CAS  Google Scholar 

  3. Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, Clausell NO. Phase angle and mortality: a systematic review. Eur J Clin Nutr. 2019;73:495–508.

    Article  Google Scholar 

  4. Barbosa-Silva MCG, Barros AJD, Wang J, Heymsfield SB, Pierson RN. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr. 2005;82:49–52.

    Article  CAS  Google Scholar 

  5. Norman K, Stobäus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R et al. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr. 2010;92:612–9.

  6. Paixão EMdaS, Gonzalez MC, Ito MK. A prospective study on the radiation therapy associated changes inbody weight and bioelectrical standardized phase angle. Clin Nutr. 2015;34:496–500.

    Article  Google Scholar 

  7. Axelsson L, Silander E, Bosaeus I, Hammerlid E. Bioelectrical phase angle at diagnosis as a prognostic factor for survival in advanced head and neck cancer. Eur Arch Oto-Rhino-Laryngol. 2018;275:2379–86.

    Article  Google Scholar 

  8. Langius JAE, Bakker S, Rietveld DHF, Kruizenga HM, Langendijk JA, Weijs PJM, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer. 2013;109:1093–9.

    Article  CAS  Google Scholar 

  9. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis - part II: utilization in clinical practice. Clin Nutr. 2004;23:1430–53.

    Article  Google Scholar 

  10. Cox DR. Regression models and life tables (with discussions). J R Stat Soc. 1972;34:187–220.

    Google Scholar 

  11. Baskar R, Lee KA, Yeo R, Yeoh KW. Cancer and radiation therapy: Current advances and future directions. Int J Med Sci. 2012;9:193–9.

    Article  Google Scholar 

  12. Read JA, Choy STB, Beale P, Clarke SJ. An evaluation of the prevalence of malnutrition in cancer patients attending the outpatient oncology clinic. Asia Pac J Clin Oncol. 2006;2:80–6.

    Article  Google Scholar 

  13. Zeng Q, Shen LJ, Guo X, Guo XM, Qian CN, Wu PH. Critical weight loss predicts poor prognosis in nasopharyngeal carcinoma. BMC Cancer. 2016;16:1–9.

    Article  Google Scholar 

  14. Sanders KJC, Hendriks LE, Troost EGC, Bootsma GP, Houben RMA, Schols AMWJ, et al. Early weight loss during chemoradiotherapy has a detrimental impact on outcome in NSCLC. J Thorac Oncol. 2016;11:873–9.

    Article  Google Scholar 

  15. Kim Y, Song C, Eom K, Kim INAH, Kim J. Combined Chemoradiotherapy-Induc Weight Loss Decreases Survival Local Adv Non-small Cell Lung Cancer Patients 2019;961:955–61.

    Google Scholar 

  16. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 1998.

  17. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: An international consensus. Lancet Oncol. 2011;12:489–95.

    Article  Google Scholar 

  18. Pereira MME, Queiroz M, dos SC, de Albuquerque NMC, Rodrigues J, Wiegert EVM, et al. The Prognostic Role of Phase Angle in Advanced Cancer Patients: A Systematic Review. Nutr Clin Pr. 2018;33:813–24.

    Article  CAS  Google Scholar 

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Acknowledgements

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

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Contributions

EMSP: study concept, responsible for data acquisition, analysis and manuscript drafting. MCG: manuscript drafting and critical review. EYN: statistical analysis. MKI: study concept and manuscript critical review. NP: study concept, data interpretation, manuscript review and final approval.

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Correspondence to Elemarcia M. S. Paixão.

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The authors declare that they have no conflict of interest.

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Paixão, E.M.S., Gonzalez, M.C., Nakano, E.Y. et al. Weight loss, phase angle, and survival in cancer patients undergoing radiotherapy: a prospective study with 10-year follow-up. Eur J Clin Nutr 75, 823–828 (2021). https://doi.org/10.1038/s41430-020-00799-w

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