Nutritional status change in patients receiving outpatient chemotherapy

Abstract

Considerable changes in the practice of chemotherapy have occurred which include the shift of the majority of therapy to an outpatient setting and the availability of more effective antiemetic agents to treat nausea and vomiting. The outpatient delivery of chemotherapy is also characterized by limited nutrition intervention. Data are not available that define the impact of these changes in chemotherapy practice on the nutritional status of outpatients receiving chemotherapy. Consequently, this study was designed to address four primary aims. The first aim was to observe the change in degree of common side effects, or symptom distress, and in nutritional and functional status measures over 3 months in outpatient chemotherapy patients. The second aim was to test the utility of two versions of a nutrition risk scoring tool. Version A includes weight change and subjective appetite ratings. Version B incorporates change in fat-free mass (FFM) measures by bioelectrical impedance analysis (BIA) and energy and protein intakes. The third purpose was to examine the relationship of the nutritional and other factors studied with response to chemotherapy. Finally, comparisons were made among the body composition results from skinfold thickness measures and BIA using instrument manufacturer-supplied and population-specific equations. A key finding from this study was that Nutrition Risk Score A detected nutritional change over time and lower scores were correlated with positive chemotherapy response. Unanticipated findings from this study were the significant gender differences in nutritional and clinical factors and their relationships to chemotherapy response. Male subjects experienced weight loss and an overall decrease in nutritional status as demonstrated by an increase in Nutritional Risk Score A, while female subjects did not have weight loss and had a trend towards improved Nutritional Risk Score A. The Kushner et al (1992) BIA equation produced the closest estimates of body fat mass to those obtained using the Durnin and Womersley (1974) skinfold method. The population-based BIA equations were not interchangeable with each other or with the manufacturer's equation. Except for female breast cancer patients, the population-based BIA equations were interchangeable with each other for estimating FFM, but not with the manufacturer's equation.