Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors

Abstract

Background Nutritional status can directly affect morbidity and mortality in older adults with cancer. This study evaluated the association between pretreatment body mass index (BMI), albumin level, and unintentional weight loss (UWL) in the prior 6 months and chemotherapy toxicity among older adults with solid tumors. Methods This was a secondary analysis of a prospective, multicenter study involving chemotherapy‐treated patients 65 years old or older. Geriatric assessment, BMI, albumin level, and UWL data were collected before treatment. Multivariable logistic regression models evaluated the associations between nutritional factors and the risk of grade 3 or higher (grade 3+) chemotherapy toxicity. Results Seven hundred fifty patients with a median age of 72 years (range, 65‐94 years) and mostly stage IV disease were enrolled. The median pretreatment BMI and albumin values were 26 kg/m2 (range, 15.1‐52.1 kg/m2) and 3.9 mg/dL (range, 1.0‐5.0 mg/dL), respectively. Nearly 50% of the patients reported UWL, with 17.6% reporting >10% UWL. Multivariable analysis revealed no association between >10% UWL and a risk for grade 3+ chemotherapy toxicity (adjusted odds ratio [AOR], 0.87; P = .58). Multivariable analysis showed a trend toward an association between a BMI ≥ 30 kg/m2 and a decreased risk of grade 3+ chemotherapy toxicity (AOR, 0.65; P = .06), whereas a low albumin level (≤3.6 mg/dL) was associated with a higher risk of grade 3+ chemotherapy toxicity (AOR, 1.50; P = .03). An analysis of the joint effect of BMI and albumin demonstrated the lowest risk of grade 3+ chemotherapy toxicity among patients with high BMIs (≥30 kg/m2) and normal albumin levels (AOR, 0.41; P = .008). Conclusions Among older adults with solid tumors, higher BMIs and normal albumin levels are associated with a lower risk of grade 3+ chemotherapy toxicity. Additional research is warranted to define the clinical significance of nutritional markers and to inform future interventions.

Association of malnutrition with geriatric assessment impairments and health‐related quality of life among older adults with gastrointestinal malignancies

“…Malnutrition can undermine the older adult's health status, ultimately resulting in sarcopenia and frailty 7,9 . The presence of malnutrition or weight loss has been associated with increased chemotherapy toxicities and reduced survival in older adults 10‐13 …”

Prevention of Advanced Cancer by Vitamin D3 Supplementation: Interaction by Body Mass Index Revisited

“…Pre-diagnostic weight loss may, furthermore, be an indicator of more aggressive cancer and has been shown to be associated with worse cancer survival [ 16 , 17 ]. In addition, although high BMI is an established cancer risk factor [ 8 , 9 ], it is associated with lower chemotherapy toxicity [ 18 ] and better survival [ 16 , 19 ] among cancer patients. This may explain the even stronger increase in risk of advanced cancer seen in our analyses among normal-weight participants compared to obese participants in the placebo group.…”

Association of Dietary Patterns, Inflammatory Biomarkers, and Physical Functioning among Older Female Cancer Survivors

“…20 A recent study by Dotan et al evaluated the association between pre-treatment BMI, albumin level, and unintentional weight loss in the prior 6 months and chemotherapy toxicity among older adults with solid tumors. 45 They found that higher BMIs and normal albumin levels are associated with lower risk of grade 3+ chemotherapy toxicity. 45 These results warrant additional research because of the controversy behind albumin as a nutritional factor.…”

“…45 They found that higher BMIs and normal albumin levels are associated with lower risk of grade 3+ chemotherapy toxicity. 45 These results warrant additional research because of the controversy behind albumin as a nutritional factor. Our study did not evaluate previous treatment history of participants, therefore additional studies are needed to support these results and to assess interventions to improve nutrition status of older adults with cancer undergoing therapy.…”

“…Our study did not evaluate previous treatment history of participants, therefore additional studies are needed to support these results and to assess interventions to improve nutrition status of older adults with cancer undergoing therapy. 45 Physical Functioning…”