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Original research
Malnutrition is associated with poor survival in women receiving radiotherapy for cervical cancer
  1. Janna Laan1,2,
  2. Luc van Lonkhuijzen2,3,
  3. Karel Hinnen1,
  4. Bradley Pieters1,2,
  5. Inge Dekker4,
  6. Lukas Stalpers1,2 and
  7. Henrike Westerveld1,5
  1. 1 Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
  3. 3 Department of Gynecology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
  4. 4 Department of Nutrition and Dietetics, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
  5. 5 Department of Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Janna Laan, Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands; j.j.laan{at}amsterdamumc.nl

Abstract

Objective Cancer patients are at risk of malnutrition, which is associated with poor oncological outcomes. The aim of this study was to assess the incidence of malnutrition before, during, and after radiotherapy in locally advanced cervical cancer patients. In addition, we evaluated the impact of malnutrition on survival, and whether and when malnourished patients were referred to a dietitian.

Methods This retrospective cohort study included cervical cancer patients who received primary or adjuvant radiotherapy with curative intent between January 2013 and January 2021. Patient and treatment characteristics, including longitudinal data on weight and dietary care, were retrieved from the electronic patient files. Malnutrition was defined by body mass index and weight loss according to the Global Leadership Initiative on Malnutrition (GLIM). Overall survival was estimated using the Kaplan–Meier method. Cox proportional hazard regression analysis was used to estimate hazard ratios for key prognostic factors.

Results A total of 294 patients were included. Median follow-up was 40 months (range 7–101 months). Malnutrition occurred in 44 patients (15%) at baseline, in 132 (45%) during radiotherapy, and in 63 (21%) during follow-up. Referral to a dietician occurred in 45% of the 138 patients who were malnourished before or during radiotherapy. Malnutrition was significantly associated with worse survival after adjusting for age, performance score, diabetes, histology, International Federation of Gynecology and Obstetrics (FIGO) stage, and nodal stage. The 3 year overall survival in patients with malnutrition was 77% (95% confidence interval (CI) 70% to 85%) and without malnutrition 89% (95% CI 83% to 95%); p=0.001). Independent significant risk factors for worse overall survival were: malnutrition, age ˃52 years, adenocarcinoma, FIGO stage III/IV, and N1 disease.

Conclusion Malnutrition was common in cervical cancer patients treated with radiotherapy and was associated with a shorter overall survival. Further studies are needed to evaluate the effectiveness of better monitoring of malnutrition and faster and better dietary intervention on survival and quality of life.

  • Uterine Cervical Neoplasms
  • Radiotherapy
  • Radiation Oncology

Data availability statement

Data are available upon reasonable request. Research data can be made available on request to the corresponding author, but are not currently freely available online.

https://doi.org/10.1136/ijgc-2023-005024

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    Data availability statement

    Data are available upon reasonable request. Research data can be made available on request to the corresponding author, but are not currently freely available online.

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    Footnotes

    • Contributors Conceptualization: JL, LvL, LJAS, and HW. Data curation: JL. Formal analysis JL. Investigation: JL. Methodology: JL, BP, and LJAS. Project administration JL. Resources: LvL, KH, BP, LJS, and HW. Supervision: LvL, LJS, and HW. Validation: LvL and ID. Visualization: JL. Writing—original draft: JL. Writing—review and editing: LvL, ID, KH, BP, LJAS, and HW. Guarantor HW. All authors have read and agreed to the published version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests BP: grant ELEKTA (payment to the institution) and payment by BD (to the institution).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.