Our study identified several deviations from recommended values across various clinical measurements. Specifically, we found that Body Mass Index (BMI) was elevated in 49% of cases, while Waist-to-Hip Ratio (WHR) exceeded ideal levels in 90.9% of participants. Additionally, Calf Circumference was below the norm in 76% of individuals, with Fat Percentage exceeding healthy thresholds in 62.9% of the sample. Handgrip Strength was notably diminished, observed in 63.6% of subjects, while Phase Angle measurements indicated deviations in 94.8% of cases. Remarkably, our findings revealed that every participant in the study exhibited a sedentary lifestyle. These results collectively underscore the significance of these clinical parameters and highlight the widespread prevalence of deviations from ideal values within our sample.
Chemotherapy, administered with curative intent, has been shown to adversely affect body composition, physical function, insulin resistance, and lipid markers associated with atherosclerotic cardiovascular diseases in women with breast cancer, according to a study [11, 34]. The research demonstrated significant changes in adiposity markers, body weight, and BMI among female participants. Notably, these findings align with existing scientific literature, which emphasizes the critical role of BMI as an indicator of cancer incidence and prognosis [35]. Overweight and obesity have emerged as global concerns, linked to increased cancer incidence, poorer prognosis, and elevated mortality rates among cancer patients [36].
Furthermore, these conditions are associated with metabolic and inflammatory alterations in adipose tissue, as highlighted in studies [37, 38] reported that excess body weight accounted for approximately 3.9% of all cancers in 2012, with the risk varying between genders and impacting both cancer incidence and prognosis. Evidence shows that cancer risk is sex-specific when associated with adiposity [39]. Central obesity, measured by BMI and WHR, has been consistently associated with higher mortality rates from all causes and cardiovascular diseases, particularly among women, while BMI serves as a reliable marker in men, WHR is regarded as a more accurate indicator of mortality risk in women [40]. Moreover, research has indicated a strong association between WHR and increased risk of all-cause mortality and cardiovascular disease, as well as its correlation with various cancer types, including breast cancer, prostate cancer, and endothelial cancer [41, 42, 43, 44, 45].
The significant cardiovascular risk observed in our study, especially among female participants, contrasts with some findings in the scientific literature, suggesting that women generally exhibit a more favorable cardiovascular risk factor profile than men. However, our study highlights the need for further investigation into these discrepancies. Reduced calf circumference, observed in most patients, is of particular clinical relevance, as it has been associated with elevated mortality rates across all causes, increased risk of cardiovascular diseases, sarcopenia, and cancer [46]. Notably, low calf circumference serves as an independent predictor of mortality in cancer patients, as demonstrated by [47].
Another notable finding in our study was the reduced handgrip strength observed in the majority of patients. This finding aligns with previous research indicating that lower handgrip strength is associated with increased risk of all-cause mortality, cardiovascular mortality, and cancer [48]. Despite being widely studied, handgrip strength remains underexplored in clinical practice [49].
A retrospective study highlighted the prevalence of low muscle mass, handgrip strength, and gait speed, as well as sarcopenia, among cancer patients [50]. Additionally, a prospective observational study conducted at the Oncology Inpatient Unit found high rates of malnutrition, low BMI, low muscle strength, and low fat-free mass among patients [51]. These findings underscore the importance of addressing these issues in clinical practice to improve patient outcomes.
Our study identified several indicators of sarcopenia, including decreased skeletal muscle mass, increased fat percentage, reduced handgrip muscle strength, and decreased calf circumference, particularly among female participants. These findings align with previous research linking sarcopenia to worse prognosis in cancer patients [52, 53, 54].
Sarcopenia has also been associated with social isolation, which can exacerbate its effects on health outcomes [55]. Social isolation, such as that experienced during the COVID-19 pandemic, has been linked to higher mortality rates and decreased quality of life among cancer patients [56].
Our study revealed a sedentary profile among participants, with 100% of the sample classified as sedentary according to the guidelines of the American College of Sports Medicine for cancer patients. This sedentary behavior may be partially attributed to decreased physical activity levels and increased screen time during periods of social isolation, contributing to worsening lifestyles and increased health risk behaviors [57].
Physical activity has been shown to improve survival outcomes for cancer patients, regardless of BMI. However, studies have indicated a decrease in physical activity levels, strength, and cardiorespiratory capacity among cancer patients during the COVID-19 pandemic, with potential implications for their health, as highlighted where they were studied cancer patients before and after the COVID-19 pandemic, demonstrating a decrease in the level of physical activity, strength and cardiorespiratory capacity, the authors associate it with the COVID-19 pandemic, drawing attention to the consequences on the health of cancer patients [58].
We know that physical activity appears to improve survival outcomes for cancer patients, regardless of their BMI [59]. Previous studies [6, 60] already drew attention to the consequences of the level of physical activity caused during the social isolation of the COVID-19 pandemic in cancer patients. A study [61] shows this phenomenon in practice among breast cancer survivors, decreasing their level of physical activity, increasing sedentary behavior and negatively modifying their body composition.
An emerging clinical parameter with promising results is the phase angle, which has been shown to be a good predictor of nutritional status and clinical prognosis in various health conditions, including cancer. However, our study found phase angle values below recommended levels, particularly among female participants [62]. A low phase angle has been associated with compromised nutritional profile, functional status, decreased quality of life, and increased morbidity and mortality, indicating its potential as a pivotal indicator of health and integrity, especially in cancer patients [63].
While our study sheds light on concerning trends among chemotherapy patients during the COVID-19 pandemic, we cannot definitively attribute these results solely to the pandemic. Factors such as reduced physical activity due to pandemic-related insecurity and the disease's inherent effects warrant further investigation. Our study faced several limitations, including the lack of control over food intake, variability in medication administration, sample size constraints due to the pandemic, and missing data. Despite these limitations, our findings underscore the importance of continued monitoring to understand the potential influences of the pandemic and their implications for clinical prognosis.
In conclusion, patients undergoing chemotherapy treatment during the COVID-19 pandemic exhibited insufficient physical activity levels and deviations from recommended standards in various health indicators, particularly among women. Further research is needed to discern whether these trends result from pandemic-related factors or the natural progression of the disease in conjunction with inadequate healthcare measures.