Severe Deficiency of Vitamin D and Anthracycline-Taxane Regimen are associated with Cachexia Following Breast Cancer Chemotherapy: A Single Center Assessment Using Two Consensus-Based Criteria

Abstract

Background: Cancer cachexia in breast cancer (BC) patients is not commonly reported, particularly in Indonesia. This study assessed the prevalence of cachexia in local patients with BC receiving chemotherapy, and the associated factors. Methods: This cross-sectional study included 160 BC patients who started chemotherapy between July 2018 and June 2022. We collected data including age, body mass index, comorbidity, stage, surgery type, chemotherapy information, neutrophil-to-lymphocyte ratio, albumin, vitamin D, C-reactive protein, and the presence of chemotherapy- induced nausea and vomiting. We used the Fearon and Evans criteria to define the outcomes of cachexia. A multivariate logistic regression test was used to determine the factors related to the cachexia status following chemotherapy. Results: During and after chemotherapy, 61 participants (38.1%) and 32 participants (20%) experienced cachexia based on Fearon and Evans criteria, respectively. All the patients had a deficient vitamin D concentration at baseline and vitamin D below median value (8.94 ng/mL) was classified as severe deficiency. Vitamin D severe deficiency was associated with an increased risk of cachexia (OR 2.47, 95%CI 1.19–5.11, p=0.014 for Fearon; and OR 2.47, 95%CI 1.03–5.92, p=0.043 for Evans), as well as anthracycline-taxane regimen based on Fearon criteria only (OR 4.35, 95%CI 1.39–13.53, p=0.011). Conclusion: Our findings demonstrated that vitamin D severe deficiency and anthracycline- taxane regimen were associated with cachexia occurrence among BC patients following chemotherapy. Strategies and further investigation are warranted to reduce cachexia occurrence, along with nutritional support during chemotherapy.