Malnutrition, Physical Function, and Quality of Life During Chemotherapy for Metastatic Breast Cancer

Aims – Evidence is lacking regarding malnutrition and the relationship with physical function and quality of life (QoL) in women with metastatic breast cancer undergoing chemotherapy. This study aimed to assess malnutrition, physical function, and quality of life at the commencement of chemotherapy and to detect changes over time.
Methods – In women with metastatic breast cancer, malnutrition (Patient-Generated Subjective Global Assessment), low muscle mass (‘sarcopenia’), muscle fat-infiltration (‘myosteatosis’) (CT-scans), protein intake (24-h recall), handgrip strength, 6-minute or 4-m walk tests, self-reported physical activity (Godin-Shephard Leisure-Time Questionnaire), physical function and QoL (EORTC-QLQc30) were assessed at the commencement of chemotherapy, and after 3, 6, 12, 26 and 52 weeks. Continuous variables were analysed using paired t-tests between baseline and follow-up time points.
Results – Fifteen women (53.7y, 95%CI [46.3;61.2]) were recruited (planned accrual target: n=50). At baseline, malnutrition was present in 3 (20%) participants, sarcopenia in 3 (20%), and myosteatosis in 7 (54%). Thirteen (87%) participants were below the cut-off for protein intake, 0 for handgrip strength, 4 (27%) for the walk test, and 4 (27%) for physical activity. Physical function and QoL were below the reference range in 10 (67%) and 9 (60%), respectively. QoL score between baseline and 52 weeks decreased by 11.7 (95% CI [2.4;20.9], p=0.025). Other variables did not significantly change over time. Weight change from 3 to 6 weeks positively correlated with activity score at 3 weeks (r=0.72, p=0.004). After 52 weeks, 4 participants dropped out, and another 6 passed away.
Conclusions – Myosteatosis, low exercise levels, impaired physical function, and poor QoL are common in women with metastatic breast cancer. The low recruitment and high attrition rates demonstrate the difficulty in studying this population. Future research and multidisciplinary care should focus on improving diet, exercise levels, physical function, and QoL.