Muscle Loss During Cervical Cancer Treatment Linked to sixfold Mortality Risk
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A new scoping review underscores the critical, yet often overlooked, role of nutritional status in cervical cancer treatment outcomes. The research reveals that women undergoing chemoradiotherapy for locally advanced cervical cancer who experience a loss of at least 10% of their muscle mass face a six times higher mortality rate – a risk that remains consistent nonetheless of their initial weight.
The findings, published in Clinical Nutrition Open Science, highlight a significant gap in current cancer care guidelines, which largely omit routine screening for muscle loss and malnutrition. Experts are now urging a shift toward proactive nutritional assessment and intervention to improve patient survival and quality of life.
For years, Weight-a dangerously inadequate screening tool, according to a lead study author, Director of Clinical and Translational Research at the Sbarro Health Research Organization, Temple University-has been the primary metric used to assess a patient’s nutritional status.”[Routine nutritional] screening requires no additional resources. The tools already exist.”
The scoping review analyzed 23 studies encompassing data from 4,352 women with locally advanced cervical cancer. The analysis revealed a strong correlation between body composition changes and adverse outcomes. Specifically:
- Malnutrition-was associated with a 1.5- to 3.7-fold increase in mortality.
- Sarcopenia-the loss of muscle mass and strength-was a predictor of survival in over half of the assessments (5 out of 11), with hazard ratios ranging from 1.75 to 3.60. Sarcopenia obesity,a condition where individuals have both low muscle mass and high body fat,carried an even higher risk,with a hazard ratio of 2.65.
- A decline of just 7% to 10% in skeletal muscle during treatment was linked to a 6.02-fold increase in mortality. A 15% loss of intermuscular fat correlated with an 8.52-fold increase.
These changes in body composition weren’t just linked to mortality; they also significantly impacted treatment tolerance. women experiencing malnutrition or sarcopenia had a 1.2- to 2.5-fold higher rate of severe (grade ≥3) toxicity and required more frequent treatment interruptions. This risk escalated to 3- to 5-fold when multiple unfavorable body composition features were present.
Quality of Life Severely Impacted
Beyond survival rates and treatment side effects, the study also demonstrated a clear impact on patients’ overall well-being. Quality-of-life scores declined by 11% during treatment in women exhibiting signs of malnutrition, sarcopenia, or cachexia-a complex metabolic syndrome associated with weight loss and muscle atrophy.
Despite the compelling evidence, a significant limitation of the included studies was a high risk of bias, stemming from patient attrition and insufficient control for confounding factors. Seventeen of the 23 studies were flagged for these issues.
“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.”
The findings underscore the urgent need for incorporating routine nutritional screening, including muscle mass quantification, into the standard of care for women undergoing chemoradiotherapy for locally advanced cervical cancer. Further research is needed to refine screening protocols and develop targeted interventions to mitigate the devastating consequences of muscle loss and malnutrition.
For full disclosures of the study authors, visit clinicalnutritionopenscience.com.
