Nicole Kiss

Energy Metabolism in Gynecological Cancers: A Scoping Review

Determining energy requirements is vital for optimizing nutrition interventions in pro-catabolic conditions such as cancer. Gynecological cancer encompasses the most common malignancies in women, yet there is a paucity of research on its metabolic implications. The aim of this review was to explore the literature related to energy metabolism in gynecological cancers. We were particularly interested in exploring the prevalence of energy metabolism abnormalities, methodological approaches used to assess energy metabolism, and clinical implications of inaccurately estimating energy needs. A search strategy was conducted from inception to 27 July 2021. Studies investigating energy metabolism using accurate techniques in adults with any stage of gynecological cancer and the type of treatment were considered. Of the 874 articles screened for eligibility, five studies were included. The definition of energy metabolism abnormalities varied among studies. Considering this limitation, four of the five studies reported hypermetabolism. One of these studies found that hypermetabolism was more prevalent in ovarian compared to cervical cancer. Of the included studies, one reported normometabolism at the group level; individual-level values were not reported. One of the studies reported hypermetabolism pre- and post-treatment, but normometabolism when re-assessed two years post-treatment. No studies explored clinical implications of inaccurately estimating energy needs. Overall, commonly used equations may not accurately predict energy expenditure in gynecological cancers, which can profoundly impact nutritional assessment and intervention.

Exploring awareness, perceptions, and practices relating to nutritional status and low muscle mass in patients with ovarian cancer

Abstract Purpose Women with ovarian cancer are at high risk of malnutrition and muscle loss due to advanced-stage diagnosis and treatment toxicities. Evidence-based guidelines recommend screening for malnutrition and sarcopenia to prevent associated adverse consequences, including reduced survival. This study aimed to describe awareness and perceptions of nutrition-related issues and practices in ovarian cancer among Australian healthcare professionals. Methods A national survey was completed between November 2023 and March 2024. The 24-item survey evaluated awareness and perceptions of nutrition-related issues, screening and referral practices for malnutrition and sarcopenia at specific timepoints (from diagnosis, during, and/or post-treatment) and barriers to nutrition care in ovarian cancer. Results Professionals (n = 57) were predominantly nurses (39%), dietitians (23%), or surgeons (19%). The most reported nutrition-related issues at diagnosis were weight loss (67%), overweight/obesity (54%), and sarcopenia (44%). During treatment, weight loss (70%) and sarcopenia (65%) were prominent, while post-treatment, weight gain (46%) and sarcopenia (39%) were most reported. The perceived clinical importance of malnutrition and sarcopenia varied according to professional discipline. Professionals identified chemotherapy as the treatment with the highest nutrition risk (97%), and 75% reported observing self-initiated dietary changes during treatment, yet 18% indicated their health services did not screen for nutrition risk, and 58% did not screen for sarcopenia. Key barriers were lack of established processes for sarcopenia screening (75%), limited dietetic services (60%), and lack of specific referral pathways (58%). Conclusion The perceived importance of malnutrition and sarcopenia in ovarian cancer varies according to professional discipline despite robust evidence of the importance to clinical outcomes.