Non-small cell lung cancer (NSCLC) is the most common cancer and the major cause of cancer-related deaths in China and globally [1]. Systemic chemotherapy is the mainstream treatment for metastatic NSCLC without a driving gene, with an objective tumor response rate of 25–35% [2]. At cancer diagnosis, approximately 50% of patients present with some nutritional deficits [3].This prevalence may even rise depending on the tumor location and stage. The highest prevalence is noted in patients with tumors of the gastrointestinal tract and the lungs [4].

Systemic administration of chemotherapy agents targets rapidly dividing cells, including those in the bone marrow and gastrointestinal tract epithelial direct effects of chemotherapy agents can result in gastrointestinal toxicities, which in turn affect the nutritional statuses of patients [5]. Chemotherapy-induced nausea, vomiting, diarrhea, constipation, anorexia, taste disorder, and early satiety are the symptoms commonly reported by patients undergoing chemotherapy [6]. A subset of these patients may experience the symptoms to an extent that limits their dietary intake, and their nutritional statuses may be compromised, leading to negative outcomes for patients and treatment facilities [7].Malnourished patients experience decreased quality of life, diminished treatment tolerance, increased number of complications, and prolonged hospital admissions,all of which jeopardize treatment adherence and tumor control and ultimately increase the mortality and healthcare burden [8]. Therefore, detecting malnutrition early in patients with cancer has become increasingly important.

Nutritional screening includes anthropometric parameters [body mass index (BMI) and weight loss percentage] and biochemical parameters [hemoglobin(Hb) and albumin] [9-12]. Gastrointestinal symptoms,weight loss, and Hb and albumin levels often decrease in patients receiving chemotherapy [13]. An easy routine screening of malnutrition in patients with cancer should include these factors.

The current study aimed to assess the reallife nutritional status changes and gastrointestinal symptoms in patients with advanced NSCLC receiving chemotherapy.

Materials and methods

This cross-sectional study was conducted at the Cancer Centre, Tongji Hospital, Tongji Medical College,Huazhong University of Science and Technology,between January 2016 and January 2017. Informed consent was obtained from all participants. Biochemical and clinical data were assessed before the first chemotherapy cycle and after the second chemotherapy cycle.

The selection criteria were as follows: age between 19 and 75 years and pathological diagnosis of stage IV NSCLC. Meanwhile, patients who underwent any surgery or radiotherapy as treatment were excluded from the study. The present research was conducted in accordance with the guidelines in the Declaration of Helsinki, and all procedures involving human subjects/patients were approved by the ethics committee.

Data analysis

Descriptive statistics were used for the qualitative and quantitative variables, frequency, percentage, mean,and standard deviation (SD). The average distance of the groups was compared using the paired-samples t analysis was performed using the SPSS software,version 18 (SPSS, Inc., USA). P ＜ 0.05 was considered statistically significant.

Table 1 General characteristics (mean values and standard deviations; number of patients and percentage values)Variables n %Sex Male 70 67.31 Femal 34 32.69 Age (years)Mean 54.57 SD 9.32 Weight (kg)Mean 62.28 SD 10.05 BMI (kg/m2)Mean 22.98 SD 3.19 Weight loss (kg)Mean 2.38 SD 2.85 Weight loss≥ 5 32 30.77≥ 10 13 12.50

Results

General characteristics

A total of 104 patients with advanced NSCLC [34(32.69%) women and 70 (67.31%) men] underwent at least two chemotherapy cycles. The mean age was 54.57 (SD 14.8) years. The mean body weight was 62.28± 10.46 kg, and the mean BMI was 22.98 ± 3.19 kg/m2(Table 1).

Unintentional weight loss before chemotherapy

Over 65.38% (68/104) of the patients experienced unintentional weight loss, whereas 30.77% and 12.50% showed ≥ 5% and ≥ 10% degrees of weight loss, respectively, within 6 months before firstline chemotherapy was administered (Table 1).Unintentional weight loss ＞ 10% in the preceding 6 months was considered a sign of malnutrition.

Gastrointestinal symptoms during chemotherapy

The most common gastrointestinal symptoms reported among all the study patients were anorexia(80/104, 76.92%), nausea (53/104, 50.96%), constipation(49/104, 47.12%), vomiting (48/104, 46.15%), taste disorders (40/104, 38.46%), early satiety (32/104,30.77%), diarrhea (13/104, 12.50%), and dysphagia(2/104, 1.92%; Table 2).

Table 2 Gastrointestinal symptoms reported during chemotherapySymptoms n %Anorexia 80 76.92 Nausea 53 50.96 Constipation 49 47.12 Vomiting 48 46.15 Taste disorders 40 38.46 Early satiety 32 30.77 Diarrhoea 13 12.50 Dysphagia 2 1.92

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