A recent study from Kyoto University Hospital published in Supportive Care in Cancer reveals that nearly 40% of patients with gynecologic cancer experience appetite loss during chemotherapy, resulting in significant declines in calorie and nutrient intake, as well as a measurable drop in quality of life. The research emphasizes appetite loss as a critical target for supportive care in patients whose nutritional needs are often overlooked.
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Led by Ayami Koike and colleagues, the study involved 153 patients diagnosed with gynecologic cancer between July 2022 and March 2026. After accounting for withdrawals and incomplete data, 105 patients were included in the analysis. Participants completed dietary questionnaires both before their treatment and one day prior to their third chemotherapy cycle. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was used to assess appetite and quality of life, while treatment-related symptoms were monitored using the patient-reported version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).
The results indicated that 39% of the participants reported appetite loss before their third chemotherapy cycle. Compared to those who maintained their appetite, these patients experienced a median additional reduction of 320.8 kilocalories in daily energy intake. They also saw declines in protein, fat, and carbohydrate consumption, with statistically significant decreases across all macronutrients. However, the overall dietary composition remained stable, suggesting that the loss of appetite led to a proportional reduction in all food intake rather than favoring any specific nutrient.
Analysis of micronutrients showed that out of 16 clinically relevant nutrients, 13 experienced significant reductions in patients with appetite loss. Key nutrients such as iron, zinc, and magnesium demonstrated particularly large decreases. Despite this, when adjusted for total energy intake, differences in nutrient density became statistically insignificant, indicating that while overall intakes fell, the diet’s relative nutritional balance remained largely intact.
Notably, patients with appetite loss also showed a greater decline in consumption of red and processed meats, aligning with research identifying such foods as frequently aversive during anticancer treatment. Taste changes were found to be the most significant treatment-related symptom associated with appetite loss, with multivariable analysis revealing a strong correlation between taste alterations and lower appetite scores.
The connection between appetite loss and quality of life was evident, with individual scores showing negative correlations with global health status. Changes in appetite were notably tied to various aspects of functioning, including role and cognitive functioning, highlighting that the impact of appetite loss extends beyond physical health to affect psychological and social well-being.
Further analysis involving a separate cohort of 127 patients revealed fluctuations in quality of life scores throughout chemotherapy cycles, emphasizing that significant changes might occur between hospital visits when healthcare providers are not present to monitor them. Despite significant subjective reports of dietary decline, objective nutritional markers including weight loss and serum albumin levels showed no significant differences between groups, suggesting traditional monitoring may overlook the impacts of appetite loss.
The authors caution against inferring causality, noting that the study's design limits establishing the temporal relationship between appetite loss and dietary intake. They highlight the need for tailored nutritional counseling and interventions like oral supplements that could address the common issues of appetite and taste changes in cancer treatment. Systematic screening using patient-reported outcomes is recommended to detect these issues early and mitigate their effects on nutrition and quality of life during treatment.