Background
Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide. In routine clinical practice, treatment decisions are primarily based on disease stage and patient functional status as assessed by the Eastern Cooperative Oncology Group (ECOG) scale. However, a considerable proportion of patients with apparently preserved functional status experience poor tolerance to standard anticancer treatment. One of the key but often underestimated factors contributing to reduced treatment tolerance is impaired nutritional status, which frequently develops before the initiation of therapy and is not systematically considered during treatment planning.
Objective
To evaluate nutritional status as a criterion for risk stratification and treatment tolerance in patients with colorectal cancer.
Materials and Methods
An analysis of clinical and literature data was performed focusing on the impact of nutritional status on the course of colorectal cancer. Key nutritional parameters included body mass index (BMI), unintentional weight loss (≥5% and ≥10%) prior to treatment, and clinical signs of malnutrition. These parameters were assessed in relation to ECOG performance status, tolerance of systemic anticancer therapy, treatment-related toxicity, dose reductions, and treatment delays.
Results
Impaired nutritional status, particularly unintentional weight loss of ≥10% before treatment initiation, was associated with reduced tolerance to systemic anticancer therapy in patients with colorectal cancer. Patients with significant weight loss experienced higher rates of treatment-related toxicity, more frequent dose reductions and delays, and earlier discontinuation of therapy, even in the presence of a satisfactory ECOG performance status. Nutritional status enabled identification of a high-risk patient subgroup in whom standard treatment regimens were poorly tolerated.
Clinical Implications
Using nutritional status as an additional criterion for risk stratification allows a more accurate assessment of patient readiness for systemic anticancer therapy. Incorporation of nutritional assessment into treatment planning may support treatment individualization, reduce the incidence of complications, and improve clinical outcomes.
Conclusion
Nutritional status represents an important criterion for risk stratification and treatment tolerance in patients with colorectal cancer. Routine assessment of nutritional status before initiating anticancer therapy should be considered an essential component of comprehensive colorectal cancer care.