Efrat Dotan1, William P Tew2, Supriya G Mohile3, Huiyan Ma4, Heeyoung Kim4, Can-Lan Sun4, Bette Caan5, William Dale4, Ajeet Gajra6, Heidi D Klepin7, Cynthia Owusu8, Cary P Gross9, Hyman Muss10, Andrew Chapman11, Vani Katheria4, Arti Hurria4. 1. Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. 2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 3. University of Rochester Medical Center, Rochester, New York. 4. City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California. 5. Division of Research, Kaiser Permanente Medical Program of North California, Oakland, California. 6. Cardinal Health, Dublin, Ohio. 7. Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina. 8. Case Western Comprehensive Cancer Center, Cleveland, Ohio. 9. Yale School of Medicine, New Haven, Connecticut. 10. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 11. Jefferson Senior Adult Oncology Center, Sidney Kimmel Cancer Center, Jefferson Health System, Philadelphia, Pennsylvania.
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.
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.
Authors: Bette J Caan; Jeffrey A Meyerhardt; Candyce H Kroenke; Stacey Alexeeff; Jingjie Xiao; Erin Weltzien; Elizabeth Cespedes Feliciano; Adrienne L Castillo; Charles P Quesenberry; Marilyn L Kwan; Carla M Prado Journal: Cancer Epidemiol Biomarkers Prev Date: 2017-05-15 Impact factor: 4.254
Authors: Arti Hurria; William Dale; Margaret Mooney; Julia H Rowland; Karla V Ballman; Harvey J Cohen; Hyman B Muss; Richard L Schilsky; Betty Ferrell; Martine Extermann; Kenneth E Schmader; Supriya G Mohile Journal: J Clin Oncol Date: 2014-08-20 Impact factor: 44.544
Authors: Hans Wildiers; Pieter Heeren; Martine Puts; Eva Topinkova; Maryska L G Janssen-Heijnen; Martine Extermann; Claire Falandry; Andrew Artz; Etienne Brain; Giuseppe Colloca; Johan Flamaing; Theodora Karnakis; Cindy Kenis; Riccardo A Audisio; Supriya Mohile; Lazzaro Repetto; Barbara Van Leeuwen; Koen Milisen; Arti Hurria Journal: J Clin Oncol Date: 2014-08-20 Impact factor: 44.544
Authors: Grant R Williams; Mustafa Al-Obaidi; Chen Dai; Nabiel Mir; Sai Alekha Challa; Michael Daniel; Harita Patel; Brett Barlow; Crystal Young-Smith; Olumide Gbolahan; Ravi Paluri; Smita Bhatia; Smith Giri Journal: Cancer Date: 2020-09-04 Impact factor: 6.860
Authors: Heidi D Klepin; Can-Lan Sun; David D Smith; Rawad Elias; Kelly M Trevino; Ashley Leak Bryant; Daneng Li; Christian Nelson; William P Tew; Supriya G Mohile; Ajeet Gajra; Cynthia Owusu; Cary Gross; Stuart M Lichtman; Vani V Katheria; Hyman B Muss; Andrew E Chapman; Harvey Jay Cohen; Arti Hurria; William Dale Journal: JCO Oncol Pract Date: 2021-04-21