Study Suggests Link Between BMI, Nutritional Markers, and Chemotherapy Toxicity in Older Adults With Tumors

PHILADELPHIA (March 17, 2020) — A recently published study led by a researcher at Fox Chase Cancer Center concluded that a combination of body mass index (BMI) and levels of albumin, a protein made by the liver, can predict how well older adults with cancer will be able to tolerate the side effects of chemotherapy.

“Oncologists should carefully consider these factors as part of a comprehensive GA [geriatric assessment] before recommended chemotherapy for older adults with cancer,” the authors wrote of their findings, which they believe are the first to document a protective effect of high BMI in this population.

The study, led by Efrat Dotan, MD, an associate professor in the Department of Hematology/Oncology, used data on 750 patients ranging from 65 to 94 years of age who were treated with chemotherapy. More than half the patients (58.6 percent) were receiving therapy for metastatic disease. The overarching goal of this large study was to identify the most important factors that affect older adults who are treated with chemotherapy for advanced cancer.

In this report, Dotan and colleagues evaluated the association between chemotherapy toxicity and nutritional factors, including pretreatment BMI, unintentional weight loss in the prior six months, and albumin levels among older adults with solid tumors.

The results showed that among older adults with advanced cancer, higher BMIs and normal albumin levels were associated with a lower risk of grade 3 or higher chemotherapy toxicity, which is graded on a scale of one to five. A score of one indicates minor toxicity and five indicates patient death, Dotan said.

“The main conclusion from this study is that monitoring patients’ BMI is important and can predict for outcomes among older cancer patients who are undergoing anti-cancer therapy,” she added.

“In this study, patients with BMI that was greater than 30 saw the highest benefit in terms of chemotherapy tolerance,” Dotan said. These findings bring into question the appropriate BMI recommendations for older adults, as BMI greater than 30 is categorized as obesity and considered unhealthy by the Centers for Disease Control and Prevention.

“Additional research is needed to define the clinical significance of nutritional markers,” Dotan said. She added that the study adds important data that provide an understanding of the associations between these nutritional factors and chemotherapy tolerance in older adults with cancer. However, limited data are available that can guide appropriate treatment selection and nutritional interventions for these patients.

The study, “Associations Between Nutritional Factors and Chemotherapy Toxicity in Older Adults With Solid Tumors,” was published in Cancer.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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