e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism
Original articleCorrelation between anemia, unintentional weight loss and inflammatory status on cancer-related fatigue and quality of life before chemo and radiotherapy
Introduction
Fatigue is among the most commonly reported symptoms of cancer patients, with the prevalence exceeding 70% in many studies. Although the development of this condition has been associated with a number of factors, anemia, due to cancer and its treatments and commonly defined as a haemoglobin level <12 g/dL,1 is considered the most important cause of fatigue. Unintentional weight loss (UWL) is synonymous with malnutrition and malnutrition may cause anemia too, but, while anemia is always assessed and treated in cancer patients, UWL is often underestimated or completely ignored in the management of cancer-related anemia (CRA). The aim of our study is to investigate the possible correlation between anemia, unintentional weight loss and inflammatory status, and their influence on cancer-related fatigue (CRF), and quality of life (QOL) before chemo-radiotherapy (CRT).
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Patients and methods
One hundred and sixty four consecutive patients (41% males, 59% females), median age 63 (range: 18–85) with solid tumor of different origins, treated at the Roma Saint Peter Hospital Outpatient Oncology Unit, were enrolled before starting CRT. The criteria for eligibility included absence of comorbidity (diabetes, hepatic or renal failure) and no previous oncological treatment. Baseline characteristics of the patients are described in Table 1 and cancer by site are described in Table 2. All
Statistical analysis
For the statistical analysis, we used SPSS for Window, release 14.0. The end point was to investigate the possible correlation between anemia, unintentional weight loss and systemic inflammation on cancer-related fatigue and quality of life before chemo and radiotherapy. Age, percentage of weight loss and C-reactive protein are expressed as mean ± SD. Prevalence of anemia was evaluated by the Chi-square test. MFSI-SF and EQ-5D scores were evaluated using Student's t-test and are presented as mean ±
Anemia
Thirty two percent of the patients were anemic before CRT. Anemia was significantly prevalent in the case of UWL (χ2 = 10.349; p = 0.001) (Fig. 1) and in recent surgery too (χ2 = 6.494; p = 0.011) (Fig. 2), whereas it wasn't significantly prevalent in patients with high CRP (χ2 = 1.787; p = 0.181) (Fig. 3). Anemia was weight loss-related (Spearman test: r = −0.297; p = 0.001). In Table 3 we report the mean concentrations of haemoglobin as measured in the subgroups of patients.
Weight loss
We considered significant a weight
Discussion
Even if the patients were heterogeneous, we think that our data may be useful to generate some considerations about the possible correlation between anemia, unintentional weight loss, high CRP, fatigue and quality of life in cancer patients before oncological treatment. More than 70% of cancer patients are affected by CRF, which can be more distressing and disruptive to daily activities than any other associated symptom. CRF, defined by the National Comprehensive Cancer Network (NCCN) as “a
Acknowledgements
There were no grants or funding for this work. GC carried out the study and data analyses and wrote the manuscript. IP participated in the design and coordination of the study. FS contributed to the design of the study and helped to draft the manuscript. MT, AP and AD participated in the design and collected data. MD was involved in the coordination of the study. All authors read and approved the final manuscript. There was no conflict of interest.
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