Nutritional markers may predict chemotherapy tolerance in older patients
medwireNews: High BMI and normal albumin levels are associated with a reduced risk for grade 3 or higher chemotherapy-related toxicities among older patients, research indicates.
“Our findings suggest that combining these 2 nutritional factors may provide better predictions of treatment tolerance by older adults with cancer,” and thereby “guide appropriate treatment selection and nutritional interventions in this population,” say Efrat Dotan (Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA) and team.
They add: “These data are in line with other reports highlighting challenges with the use of a single nutritional marker and the importance of body composition as a predictor of treatment- and disease-related outcomes.”
The researchers explain that BMI, albumin level, and unintentional weight loss (UWL) have historically “been used as clinical indicators of nutritional status,” but there are limited data regarding the associations between these factors and chemotherapy tolerance in older cancer patients.
They therefore performed a secondary analysis of a prospective study comprising 750 participants, aged 65 years or older, recruited from 10 US institutions. All patients had solid tumors, most commonly lung (27.6%) and gastrointestinal (27.1%) cancers, and 70.8% of the patients were receiving chemotherapy in the first-line setting.
The patients with a BMI high enough to be considered obese (≥30 kg/m2) were 35% less likely to have a grade 3 or higher chemotherapy-related toxicity than those with a normal BMI (18.5–24.9 kg/m2) after adjusting for the three nutritional factors in question and the Cancer and Aging Research Group (CARG) toxicity risk group, although the association did not reach statistical significance.
On the other hand, patients with a low albumin level (≤3.6 mg/dL) were a significant 50% more likely to have a grade 3 or higher chemotherapy toxicity than those with normal albumin levels (>3.6 mg/dL).
“Given the observed high risk of grade 3+ chemotherapy associated with a low BMI and a low albumin level, we analyzed the potential joint protective effect of a high BMI and a normal albumin level on chemotherapy toxicity,” say the researchers.
And they found that participants who had a BMI of at least 30 kg/m2 and a normal albumin level had the lowest risk for grade 3 or higher chemotherapy-related toxicities, at a significant 59% lower than those with a BMI of 18.5–24.9 kg/m2 and low albumin levels.
The investigators also report that UWL occurring within 6 months prior to starting chemotherapy was not significantly associated with the incidence of grade 3 or worse chemotherapy-related toxicities – after adjusting for BMI, albumin levels, and the CARG score. The researchers attribute this to “the inaccuracy associated with a patient self-reported measure such as UWL.”
Writing in Cancer, Dotan and team conclude: “Our study provides additional support for the important impact of the BMI and albumin level on the tolerance of chemotherapy.
“Oncologists should carefully consider these factors as part of a comprehensive [geriatric assessment] before recommend[ing] chemotherapy for older adults with cancer.”
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