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Diagnostic and prognostic utility of phase angle in patients with cancer

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Abstract

Patients with cancer experience dynamic and longitudinal changes in nutritional status and body composition along the disease trajectory. They often want to know about their outlook with regard to treatment outcomes and overall survival. One of the commonly used measures for body composition is bioelectrical impedance analysis (BIA). BIA is an easy-to-use, quick, inexpensive, noninvasive, and reproducible technique that is often incorporated in daily clinical practice. Phase angle (PA), which is derived from BIA, is an indicator of cell membrane health and integrity. Higher PA values reflect better cell function, higher muscle mass, and lower fat mass. PA is also thought to be a proxy of water distribution (ratio between extracellular water [ECW] and intracellular water [ICW]) and body cell mass. In this narrative review, we discuss studies examining the diagnostic and prognostic value of PA regarding nutritional status, body composition and physical function, complications of cancer treatments, overall survival, symptoms, and quality of life (QOL) in patients with cancer. The literature suggests that PA is moderately to strongly correlated with body composition and physical function but only weakly correlated with nutritional status, complications, survival, symptoms, and QOL. Furthermore, the PA cutoff values vary significantly according to study and patient population with the diversity of bioelectrical impedance technology and electrode composition and placement. Thus, PA has yet to be routinely incorporated into clinical practice for patients with cancer. Future research is needed to determine how to translate scientific understanding of PA to clinical practice.

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Abbreviations

AUC:

Area Under the Curve.

BIA:

Bioelectrical Impedance Analysis.

ECW:

Extracellular Water.

GLIM:

criteria Global Leadership Initiative on Malnutrition criteria.

HR:

Hazard Ratio.

ICW:

Intracellular Water.

NRI:

Nutritional Risk Index.

NRS:

-2002 Nutritional Risk Screening 2002.

OR:

Odds Ratio.

PA:

Phase Angle.

QOL:

Quality of Life.

ROC:

Receiver Operating Characteristic.

SGA:

Subjective Global Assessment.

SARC:

-F Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls.

TBW:

Total Body Water.

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Acknowledgements

We would like to thank Donald Norwood, Scientific editor at the University of Texas MD Anderson Cancer Center for assistance with manuscript preparation.

Funding

The authors received no financial support for the research reported in, authorship of, and/or publication of this article.

Financial / Non-financial interests.

KA and EB declare no conflict of interest. DH has been a paid consultant for Eton Pharmaceuticals.

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Authors and Affiliations

  1. Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan

    Koji Amano

  2. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, 480-1195, Nagakute city, Aichi, Japan

    Koji Amano

  3. Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, 1414, 77030, Unit, Houston, TX, USA

    Eduardo Bruera & David Hui

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  1. Koji Amano
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Contributions

KA and DH created the study concept and design, performed data acquisition and interpretation, and prepared the manuscript. KA, EB, and DH edited and reviewed the manuscript. All authors agree to submit.

Abbreviations: PA, phase angle; BIA, bioelectrical impedance analysis; SGA, Subjective Global Assessment; NRS-2002, Nutritional Risk Screening 2002; GLIM criteria, Global Leadership Initiative on Malnutrition criteria; NRI, Nutritional Risk Index; BMI, body mass index; EWGSOP, European Working Group on Sarcopenia for Older People; AWGS, Asian Working Group for Sarcopenia; SARC-F, strength, assistance with walking, rising from a chair, climbing stairs, and falls; ECOG PS, Eastern Cooperative Oncology Group performance status; ECW, extracellular water; ICW, intracellular water; TBW, total body water; CRP, C-reactive protein; QOL, quality of life; FACT-G, Functional Assessment of Cancer Therapy - General; FAACT ACS, Functional Assessment of Anorexia/Cachexia Therapy anorexia/cachexia subscale.

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Correspondence to Koji Amano.

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Amano, K., Bruera, E. & Hui, D. Diagnostic and prognostic utility of phase angle in patients with cancer. Rev Endocr Metab Disord 24, 479–489 (2023). https://doi.org/10.1007/s11154-022-09776-z

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