Improving Cancer Survival, By Patients Themselves

Improving Cancer Survival, By Patients Themselves

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.

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Post-diagnosis weight change and survival following diagnosis of early-stage breast cancer. Compared with weight maintenance, large losses (≥10%) were associated with worse survival, with HRs for all-cause death of 2.63 (2.63x risk of death) earlier and 1.60 (1.6x risk of death) later in follow-up. Modest losses (>5%–<10%) were associated with worse survival earlier (1.39x risk of death) but not later in follow-up. (FEM Cespedes, ‎2017)
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After completion of treatment and recovery from stage I-III colorectal cancer, loss of at least 10% of baseline weight was associated with significantly worse colorectal cancer-specific mortality and overall mortality. For every 5% loss of baseline weight, there was a 41% increased risk of colorectal cancer-specific mortality. Weight gain was not significantly associated with colorectal cancer-specific mortality. (JA Mayerhardt, 2017)

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.

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Shachar SS, 2016

Low skeletal muscle index (SMI)  is associated with worse survival in patients with various solid tumours across disease stages according to a meta-analysis.

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Low skeletal muscle index/ muscle mass was associated with poorer overall survival (OS), poorer cancer-specific survival (CSS) and poorer disease free survival (DFS). (Shachar SS, 2016)
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High weight loss, low muscle index, and low muscle attenuation were independently prognostic of survival. Patients who possessed all three of these poor prognostic variables survived 8.4 months (95% CI, 6.5 to 10.3), regardless of whether they presented as obese, overweight, normal weight, or underweight, in contrast to patients who had none of these features, who survived 28.4 months (95% CI, 24.2 to 32.6; P < .001). (L Martin, 2013)

Patient Factors

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.

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