In order to improve prognosis/ survival of cancer patients, irrespective of the type and stage of cancers, patients should:
Avoid Losing Weight
Malnutrition, which leads to weight loss can be caused by various factors such as dietary avoidance/ ‘pantang’, dietary misconception, side effects from cancer treatments (low appetite/ nausea/ vomiting/ mucositis/ esophagitis/ diarrhea) or even cancer itself (external compression, strictures, etc).
Pre-cachexia is weight loss <5%. Weight loss more than 5% approached cachexia level.
As you can see from above, moderate to severe weight loss confers poorer prognosis to cancer patients and hence should be avoided at all cost.
These might explain why certain patients can be cured of early stage cancers or have good control of advanced cancers while other falters.
Few steps to avoid weight loss are:
- Improving daily calories/ energy intake (25-30 kcal/kg), protein (1.0-1.5g/ kg) and vitamins & minerals.
- Improving appetite (megestrol)
- Less restrictive/ less ‘pantang’ of foods intake
- Referral to dieticians for tailored nutritional advice
Also, a sudden drop in weight should alert cancer patients to check for recurrence or spread (metastasis) of cancer.
Avoid Losing Muscle Mass/ Sarcopenia
Exercise is important to maintain muscle mass, improve stamina, shorten recovery process from treatments (chemotherapy/ radiotherapy) and others.
Few obstacles for cancer patients to participate in exercise are fatigue (physical), depression (emotional fatigue) or/ and pain (due to cancers).
Each of these factors should be identified and remedial actions (analgesia, improve sleep, anti-depression) taken early so that cancer patients can exercise to preserve their muscle mass.
Low skeletal muscle index (SMI) is associated with worse survival in patients with various solid tumours across disease stages according to a meta-analysis.
Survival benefits from cancer treatments (chemotherapy, targeted therapy, biologic therapy, immunotherapy, radiotherapy, etc.), which ranges from 5-20%, can be easily negated by weight loss and loss of muscle mass.
Patients play important roles themselves, equally as important as treatment itself.