Investigations on the nutritional status of advanced breast cancer patients. The influence of long-term treatment with megestrol acetate or tamoxifen

The nutritional status of three groups of postmenopausal women (age 41-80 yrs) with advanced breast cancer was investigated with special reference to vitamin B6. The interference of hormonal treatment was studied with respect to the progestin megestrol acetate (Group MA, n = 14) and the antiestrogen tamoxifen (Group TAM, n = 15) compared with untreated patients (Group U, n = 11). Healthy postmenopausal women served as controls (Group C, n = 16). Nutritional status was judged from body mass index (BMI), vitamin and trace element status, hematology, and clinico-chemical parameters. Intake of nutrients was calculated from a food record. Hormonal status was studied by analysis of LH, FSH, and prolactin in plasma and of steroids and catecholamines and their metabolites in 24-hour urine. Compared with values for Group C, nutrient intake, hematology, clinico-chemical parameters, and 24-hour urinary excretion of catecholamines and their metabolites of patient groups (U, TAM, and MA) were not significantly different. The BMI of patients was significantly higher (by about 10%; 60% showed an overweight) than that of controls. With respect to fat-soluble vitamin status, significantly lower plasma levels of vitamin A (at least 40% lower, with deficient levels in more than 50% of the patients), D (40% lower), and E (20% lower) were found for Group U. However, water-soluble vitamin status of the four groups was fairly similar. A significantly higher excretion of xanthurenic acid in 24-hour urine, after an oral tryptophan load, was observed for Groups TAM and MA. This is most probably the result of hormonal treatment without affecting vitamin B6 status. Small, but significant, differences between groups were found for trace element status, especially with respect to lower plasma selenium of Group U (25% lower). LH, FSH, and prolactin in plasma and excretion of steroids in 24-hour urine showed levels that could be expected for controls and for untreated and hormonally treated patients. We concluded that the nutritional status of all patients is reasonably adequate. Hormonal treatment did not influence vitamin B6 status, although levels of vitamins A, D, and E and of selenium seem to be elevated.