289P - Cancer cachexia following breast cancer (BC) chemotherapy was associated with clinical stage, number of chemotherapy cycles, and vitamin D concentration

Background

Cancer cachexia has been rarely reported in Indonesian BC patients. We aimed to determine the prevalence and factors associated with cancer cachexia following chemotherapy.

Methods

We performed a pre-post observation in 103 BC patients who received chemotherapy and were registered in a prospective study on chemotherapy toxicities in 2018-2020. Most data were abstracted from the main study database, including age, neutrophil-to-lymphocyte ratio, comorbidity, stage, surgery type, chemotherapy information, and the presence of chemotherapy-induced nausea and vomitus. We also analysed vitamin D concentration using ELISA method. Cachexia was defined according to existing criteria from Evans as weight loss of at least 5% or low BMI <20 kg/m2 plus low muscle strength, fatigue, anorexia, low fat-free mass index, or abnormal biochemistry. Multivariate logistic regression test was used to determine factors related to cachexia status following chemotherapy.

Results

Mean age of 103 patients was 52 years (52.5 ± 9.1). All patients had a deficient vitamin D concentration at baseline (median 8.4 ng/mL) and after chemotherapy (median 6.9 ng/mL). At baseline 4.9% of patients (5/103) had cachexia. After chemotherapy 28.2% of patients (29/103) had persistent cachexia or evolved into cachexia. Having persistent cachexia or becoming cachexia was significantly associated with late-stage presentation (OR 3.43, 95%CI 1.10–10.74, p=0.034), receiving >8 chemotherapy cycles (OR 12.05, 95%CI 2.29–63.46, p=0.003) and higher post-chemotherapy vitamin D level (OR 4.60, 95%CI 1.56–13.56, p=0.006). Having a higher baseline vitamin D level was significantly associated with a lower risk of persistent cachexia or evolving into cachexia after chemotherapy (OR 0.33, 95%CI 0.11–0.95, p=0.040).

Conclusions

Cachexia often occurs in local BC patients. Late-stage presentation, receiving >8 chemotherapy cycles and higher post-chemotherapy vitamin D level are associated with an increased risk of cachexia while having a higher baseline vitamin D level is associated with a reduced risk. Strategies and further investigation are warranted to improve cachexia with nutritional support during chemotherapy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Kementrian Riset, Tekhnologi, dan Pendidikan Tinggi Republik Indonesia.

Disclosure

All authors have declared no conflicts of interest.