Influence of nutritional status and frailty phenotype on health-related quality of life of patients with bladder or kidney cancer

Abstract

Cancer is expected to rank as the leading cause of death and the single most important barrier to increasing life expectancy in every country of the world in the 21st century. According to GLOBOCAN estimates of cancer incidence and mortality there would be about 18.1 million new cancer cases and 9.6 million cancer deaths in 2018 [1]. In Brazil, it is estimated for the 2020–2022 triennium 625,000 new cases of cancer each year, of which 7,590 cases of bladder cancer in men, ranking seventh among the most incidents, and 3,050 in women, cor responding to the 14th most common [2]. On the other hand, kidney cancer is not among the most common types of cancer in Brazil [2]; its incidence rises globally with the highest rates in developed countries and accounts for 2% of the global cancer burden [3, 4]. Cancer and its treatment are severely debilitating and are associated with health-related quality of life (HRQoL); there by it is well accepted to consider its impact when making patient management or treatment decisions [5, 6]. Quality of life is defined as a subjective multidimensional construct representing functional status, psychosocial well-being, health perceptions, and disease/treatment-related symptoms [7]. Then individual characteristics among cancer patients such as functional impairment, co-morbidity, and psychosocial dis abilities have predictive value for HRQoL [6]. Malnutrition is an independent factor for the deterioration of the HRQoL, and a low HRQoL is associated with nutrition related symptoms and weight loss [8]. Its prevalence in pa tients with cancer has been reported to range from about 20% to more than 70% due to many factors, as impaired food in take, increased energy and protein needs, decreased anabolic stimuli, and altered metabolism in different organs or tissues [9]. Frailty is considered as a biological syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, and causing vulnerability to adverse outcomes [10]. The relationship be tween malnutrition and frailty in older adults has been established, with a considerable overlap between both condi tions. With the presence of chronic disease, such as cancer, rates of frailty increase significantly [11]. Furthermore, being frail is associated with worse HRQoL in the cancer population [6, 12]. Thus, cancer may simultaneously influence patient’s nutri tional status, HRQoL, and frailty, suggesting that there may be interrelations among these factors. Nonetheless, it is unknown about these interrelationships in patients with bladder and kid ney cancer. Therefore, the aim of this study was to assess the impact of frailty and nutritional status in the HRQoL of pa tients with bladder or kidney cancer.