The Case of the Weight Loss Wishes
Craig was diagnosed with colorectal cancer after a routine colonoscopy and subsequent colectomy. He meets with Lacey, the oncology nurse, to discuss managing the side effects of his FOLFOX chemotherapy. Lacey notes that Craig’s age is 71, weight is 255 lbs., and body mass index ([BMI], a body fat ratio based on weight and height) is 38. Craig describes his activity level as “walking to the mailbox and exercising my fingers on the remote control. This cancer treatment will help me knock off some of this extra weight.”
What Would You Do?
Obesity is defined as a BMI of 30 or greater and is associated with an increased risk for gastrointestinal and other cancers. But even for obese patients, rapid weight loss during cancer treatment is generally not advisable (https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq) because it can lead to increased fatigue, reduced physical function, and poor treatment tolerance. Furthermore, the distribution of adipose (fat) and lean tissue can affect the delivery of and body’s response to systemic therapies (https://doi.org/10.33371/ijoc.v14i3.720), which has implications for treatment efficacy and toxicities.
Sarcopenia refers to skeletal muscle loss that often leads to a decline in physical function. The natural progression of sarcopenia begins as early as age 40 and continues throughout a person’s lifetime. Cachexia also involves muscle wasting, but it differs from sarcopenia because of its connection to increased inflammatory markers and basal metabolic rate. Appendicular lean mass, muscle strength, and physical function are used to measure sarcopenia (https://doi.org/10.1001/jamanetworkopen.2020.4783) in adults.
Combining the two conditions, sarcopenic obesity occurs from muscle loss in the setting of obesity. As lean tissue recedes, fat tissue may increase and infiltrate (https://doi.org/10.33371/ijoc.v14i3.720) the remaining muscle. Sarcopenia and sarcopenic obesity are independent prognostic factors in the oncology setting.
Routinely measuring BMI, muscle strength, and functional status may not be feasible in cancer care, but oncology nurses can empower patients with strategies to prevent muscle loss before, during, and after cancer treatment. ONS’s Get Up, Get Moving approach (https://www.ons.org/make-a-difference/quality-improvement/get-up-get-moving) gives oncology nurses the tools to motivate patients to fight fatigue while undergoing cancer therapies, including patient education handouts, exercise guides, and progress measurement resources.
Lacey uses the Get Up, Get Moving patient teaching videos to inspire Craig to think about what he could do to slowly increase his physical exercise. Craig says he feels motivated to start walking short distances every other day and recalls how he used to enjoy weightlifting. He also commits to 20 minutes of resistance training twice a week and agrees to log his activities to share with Lacey when he comes to the clinic for treatment.