Systemic inflammation and nutritional status in patients on palliative cancer care: A systematic review of observational studies

Abstract

This systematic literature review explores the results of studies that have analyzed the association between inflammation and nutritional status in patients with cancer in palliative care. Methods: The bibliographic research was performed in May 2019, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Group guidelines. The inclusion criteria were papers that (1) had an online abstract available, (2) were original, (3) used a cohort or cross-sectional design, (4) involved patients with advanced cancer in palliative care, and (5) assessed the association between inflammation and nutritional status. The quality assessment was performed using the Newcastle-Ottawa Scale. Results: Nine studies were selected. Weight loss (WL; n ¼ 7) was the most common nutritional marker employed and C-reactive protein (CRP; n ¼ 6) was the most common inflammatory marker. There was considerable variability (39.0%-92.2%) in the proportion of patients who had WL in a 6-month period, while CRP >5 mg/dL was common in 45.3% to 73.9% of patients. Systemic inflammation was related to nutritional status, highlighting the relationship between CRP and WL and lean mass (LM). Patients with CRP >10 mg/L have been found to have a lower LM (P < .001) and a faster rate of loss of LM at a faster rate during the disease trajectory (P ¼ .030). Conclusion: Nutritional status is associated with systemic inflammatory response. Inflammatory markers should be considered an additional parameter for the nutritional diagnosis of patients with cancer in palliative care.