Body composition, symptoms, and survival in advanced cancer patients referred to a phase I service

Abstract

Background: Body weight and body composition are relevant to the outcomes of cancer and antineoplastic therapy. However, their role in Phase I clinical trial patients is unknown.

Methods: We reviewed symptom burden, body composition, and survival in 104 patients with advanced cancer referred to a Phase I oncology service. Symptom burden was analyzed using the MD Anderson Symptom Assessment Inventory(MDASI); body composition was evaluated utilizing computerized tomography(CT) images. A body mass index (BMI)≥25 kg/m² was considered overweight. Sarcopenia, severe muscle depletion, was assessed using CT-based criteria.

Results: Most patients were overweight (n = 65, 63%); 53 patients were sarcopenic (51%), including 79% of patients with a BMI<25 kg/m² and 34% of those with BMI≥25 kg/m². Sarcopenic patients were older and less frequently African-American. Symptom burden did not differ among patients classified according to BMI and presence of sarcopenia. Median (95% confidence interval) survival (days) varied according to body composition: 215 (71-358) (BMI<25 kg/m²; sarcopenic), 271 (99-443) (BMI<25 kg/m²; non-sarcopenic), 484 (286-681) (BMI≥25 kg/m²; sarcopenic); 501 d (309-693) (BMI≥25 kg/m²; non-sarcopenic). Higher muscle index and gastrointestinal cancer diagnosis predicted longer survival in multivariate analysis after controlling for age, gender, performance status, and fat index.

Conclusions: Patients referred to a Phase I clinic had a high frequency of sarcopenia and a BMI≥25 kg/m², independent of symptom burden. Body composition variables were predictive of clinically relevant survival differences, which is potentially important in developing Phase I studies.

Figure 1. Image Acquisition and Analysis.

Computerized Tomography images requested for clinical purposes within 30 days of the completion of the symptom questionnaire (MDASI) were downloaded locally and the different tissues identified at the L3 level. Posteriorly, the cross-sectional areas determined are applied to regression equations to estimate total body fat and muscle compartments.

Figure 2. Kaplan-Meier curves of the four groups of patients.

Survival analyses were performed using Kaplan-Meier curves and log-rank tests to detect differences in survival among the four groups of patients (normal weight non-sarcopenic, normal weight sarcopenic, overweight non-sarcopenic, and overweight sarcopenic patients. Patients who are alive at last known follow up are censored at that date.