Bioelectrical impedance analysis for monitoring cancer patients receiving chemotherapy and home parenteral nutrition

Abstract

Background: Home parenteral nutrition (HPN) can improve survival, quality of life, nutritional and functional status in cancer patients. Bioelectrical impedance analysis (BIA) is a non-invasive, validated method to assess body composition. The objective of this prospective single-arm study was to investigate the impact of HPN in advanced cancer patients receiving chemotherapy assessed by BIA, clinical and laboratory measures.

Methods: Adult malnourished cancer outpatients with solid tumors receiving anticancer treatments who were candidates for daily HPN were enrolled. Patients were assessed at baseline (T0), 60 (T1) and 90 days (T2) after HPN start. Assessments included anthropometric and clinical-oncological characteristics, performance status, inflammatory response and Patient-Generated Subjective Global Assessment (PG-SGA).

Results: Sixty-five advanced cancer patients were enrolled. Median overall survival was 317 days. Body weight, BMI, oral calorie and protein intake increased over time (P < 0.01). At T2 the proportion of well-nourished patients, Karnofsky performance status and modified Glasgow prognostic score were improved (P < 0.01), total body water was reduced (P = 0.04), and fat mass increased (P = 0.04). Reactance, resistance and phase angle were significantly associated with survival at T0, T1, and T2, respectively. At T2, PG-SGA category A was a predictor of survival (P < 0.0001).

Conclusions: After 90 days of HPN, patients experienced significantly improved nutritional status, performance status, prognostic score and some BIA measures. HPN may be an important therapy in oncology patients receiving chemotherapy. Longitudinal use of BIA may help track the effects of HPN and disease progression, potentially contributing to optimal global patient management.

Keywords: Bioelectrical impedance analysis; Body composition; Cancer; Home parenteral nutrition; Malnutrition.

Fig. 1

a BIAVECTOR at T0, T1, and T2. BIA, bioelectrical impedance analysis; T0, baseline, T1 60 and T2 90 days after the start of home parenteral nutrition; XC, reactance; RZ, resistance, H, height. b BIAVECTOR at the start of HPN (T0). BIA, bioelectrical impedance analysis; HPN, home parenteral nutrition; XC, reactance; RZ, resistance, H, height. c BIAVECTOR 60 days after the start of HPN (T1). BIA, bioelectrical impedance analysis; HPN, home parenteral nutrition; XC, reactance; RZ, resistance, H, height. d BIAVECTOR 90 days after the start of HPN (T2). BIA, bioelectrical impedance analysis; HPN, home parenteral nutrition; XC, reactance; RZ, resistance, H, height

Fig. 2

Kaplan-Meier overall survival curve

Fig. 3

a Log rank test Survival curve for PG-SGA at T2. PG-SGA category A at T2 was a predictor of survival (median duration days: 652; CI 635–660; P < 0.0001); PG-SGA category C (median duration days: 162; CI 102–222) was a predictor of mortality vs. both A and B categories (P = 0.003 and P < 0.0001, respectively). The HR for PG-SGA category as a predictor of survival for category A vs. B was 0.39 (CI 0.17–0.90); for category A vs. C was 0.15 (CI 0.06–0.37), and for category B vs. C was 0.41 (CI 0.20–0.72). PG-SGA, Patient-Generated Subjective Global Assessment; Category A = well-nourished; Category B = suspected malnutrition or moderate malnutrition; Category C = severely malnourished; T2, 90 days after the start of home parenteral nutrition. b Log-rank test Survival curve for Metastasis. No metastasis (median duration days: 487; CI 88–894) vs. any metastasis (median duration days: 213; CI 163–263) was a predictor of survival (P = 0.002). The HR for no metastasis as a predictor of survival was 0.37 (CI 0.21–0.63)