Assessment of Nutritional Status of Patients Receiving Chemotherapy: Sample from European Gaza Hospital

Abstract Purpose Cancer treatment itself and particularly chemotherapy unavoidably affects host cells, often producing a variety of side effects e.g., nausea, vomiting, oral pain, diarrhea, fever and chills, and further decrease in appetite, physical activity, and body weight. These effects, together with biochemical and histological injuries to major organ systems, may leave the patient with a profound nutritional insufficiency. Early nutritional assessment can identify problems to help patients increase or maintain weight, improve their response to treatment, and reduce complications. This study aimed to determine the nutritional status of patients receiving chemotherapy. Methods: A prospective study was conducted among 64 adults newly diagnosed cancer patients of various cancer sites, admitted to the Oncology Department at European Gaza Hospital (EGH) and scheduled for first cycle of chemotherapy. Nutritional status of each patient was assessed using Subjective global assessment (SGA) and anthropometry before the initiation of chemotherapy and after the completion of chemotherapy regimen. Forty-five patients out of a total of 64 patients were evaluated at baseline and after the completion of chemotherapy regimen for vitamin B12, holotranscobalamin (HoloTC), vitamin B6, Folate, methylmalonic acid (MMA), homocysteine (Hcy), albumin, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Dietary intake was assessed using 24-hour dietary recall (24HR). Results: In this study , mean age of patients was 48.58 years. Males comprised 27(42.2%) of patients whereas female accounted for 37(57.8%). It has been found that 80.3% of subjects suffered from malnutrition (moderate and sever) after the completion of chemotherapy regimen based on SGA in comparison to 35.9% where malnourished before commencing the chemotherapy cycle. The results reported drastic reduction in all the vitamins and albumin after the completion of chemotherapy regimen. Vitamin B12 (355.0(IQR 115.0) to 219.0(IQR 177.0) pg/mL, P < 0.001), HoloTC (2.90(2.85) to1.30(IQR3.15) ng/mL, P < 0.001), vitamin B6 (83.40(IQR 27.65) to 70.70(IQR 38.45) ng/mL, P < 0.001), folate (6.60(IQR 3.00) to 5.30(IQR 2.75) ng/mL, P < 0.001); albumin (4.10(IQR 0.70) to 3.20(IQR 0.85) g/dL, P < 0.001). Vitamin B12- related metabolites MMA and Hcy increased substantially indicating a functional B12 deficiency within the cells. MMA increased significantly from (3.90(IQR 3.00) to 49.70(IQR 32.00) ng/ml, P < 0.001) and Hcy also reported significant increase (3.90(IQR 0.85) to 12.60(IQR 7.05) ng/ml, P < 0.001) which is consider as independent risk factor for cardiovascular diseases. Dietary intake in terms of macronutrients and micronutrients changed significantly after the completion of chemotherapy regimen. Conclusion : Cancer patients who received chemotherapy were at risk of malnutrition hence it is a wise practice to conduct thoroughly and deep nutritional assessment for each patient at the baseline, during treatment and after the completion of chemotherapy regimen. This research has clearly indicated the possibilities of functional vitamin B12 deficiency and other deficiencies among cancer patients who were treated with chemotherapy.