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ONCOLOGY


The benefits of body composition analysis


Body composition analysis promises to revolutionise cancer treatment. Michael Johannes Maisch MD argues the case for low-cost, easy-to-use screening tools that can assess body composition accurately for the benefit of cancer patients.


Significant progress has been made in cancer research and treatment in recent decades, resulting in more effective pharmacological therapy and improved patient outcomes. However, even as oncologists embrace personalised therapy, they neglect the critical parameter of the patient’s body composition. Weight and height are outdated measurements that should be replaced with more meaningful data.


Cancer patients are not alike. The type and stage of the cancer, existing co-morbidities, body composition, nutritional status and social environment vary from patient to patient. As all these factors play a role in treatment and prognosis, the treating physician has to consider every detail. For example, science has progressed so far that the expression of genes in breast cancer tissue – in addition to the well- established hormone and HER2 receptors – is now used to predict the patient’s prognosis and response to treatment. Since every patient and every tumour is unique, it is only reasonable to give every patient personalised therapy.


Significance of body composition for treatment


The image of cancer that often comes to mind first is one of an emaciated man or woman. Although some patients match this image, not every patient is underweight, particularly in the early stages of the disease. As a matter of fact, overweight and obesity may be risk factors in the development of some types of cancer (eg breast, colon, rectal and endometrial). Many patients diagnosed with these cancer types are overweight or obese. Body composition not only varies from one patient to another, but it also changes during the course of the disease and treatment. Most cancer patients lose weight and lean mass. There is a risk of overlooking the loss or low level of lean tissue in patients who are of normal weight or overweight because their Body mass index (BMI) does not fall below a certain threshold. BMI is an insufficient measure as it is based exclusively on weight and height and cannot differentiate between fat mass (FM) and skeletal muscle


mass (SMM). The data can be misleading, as evidenced by the example of a body builder and an obese person with the same BMI but significant differences in health status.


Sarcopenia: neglected aspect in cancer treatment


Loss of skeletal muscle mass with subsequent impairment of strength and function is called ‘sarcopenia’. Although sarcopenia generally affects the elderly, it can develop in patients treated for cancer, HIV, COPD, chronic heart failure or nutrition- related pathogenic mechanisms (eg protein deficiency). The disease-related loss of SMM, especially in cancer patients, is associated with muscle catabolism induced by inflammation and inactivity (attributed to multiple side effects from treatment such as fatigue, dyspnea or depression). Sarcopenia can occur at any age and in all weight classes: cachectic, overweight or normal weight patients – all can present with a low SMM. Sarcopenia is an independent predictor for many adverse outcomes such as low survival rates or surgical complications in cancer patients.


The ESPEN guidelines on nutrition in cancer patients published in 2016 define cancer cachexia as reduced fat free mass (FFM) quantified by an appendicular skeletal muscle mass index (aSMMI) below the cut-off points of 7.2 kg/m² for men and 5.5 kg/m² for women. With a body composition tool able to assess SMM, it is now possible to diagnose cancer cachexia in normal or overweight people who do not fit the image of an emaciated patient.


Body composition analysis detects serious problems


Overweight and obese people affected by cancer may develop sarcopenia, but the scale alone cannot reveal a nutritional problem. Sarcopenic obesity, which is a loss


64 I WWW.CLINICALSERVICESJOURNAL.COM MARCH 2017


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