Women with cervical cancer who experience significant muscle loss during treatment die at six times the rate of those who maintain muscle mass, according to an international review of 23 studies involving more than 4,000 patients.
The findings, published in Clinical Nutrition Open Science1, reveal that between 20% and 60% of women with advanced cervical cancer enter treatment already nutritionally compromised yet many have normal or elevated body weight, making the condition invisible on standard assessments.
Despite consistent evidence across two decades of research, major cancer guidelines from FIGO, NCCN, and ESGO do not recommend routine nutritional screening.
"Weight alone is a dangerously inadequate screening tool."Dr. Canio Martinelli, Director of Clinical and Translational Research at Temple University’s Sbarro Health Research Organization
"The screening requires no additional resources. The tools already exist."
Mortality risk:
Diagnosed malnutrition: 1.5 to 3.7 times higher death risk
Loss of 10% or more muscle mass during treatment: 6 times higher death risk
Sarcopenic obesity (muscle loss masked by excess weight): 2.7 times higher death risk
Treatment tolerance:
Malnourished patients experienced severe side effects at 2 to 5 times the rate of well-nourished patients
Treatment interruptions were 3 to 5 times more common in patients with multiple nutritional deficits
The 56-day window: Cervical cancer treatment must be completed within 56 days for optimal outcomes. Each additional day increases recurrence risk by approximately 1%. Nutritional compromise is a leading cause of treatment delays.
Three Conditions, Three Causes
The research team distinguished between three biologically distinct conditions that are often conflated:
Cachexia: Tumor-driven. Cancer cells release inflammatory signals that break down muscle regardless of food intake.
Malnutrition: Intake-driven. Patients can't eat enough due to treatment side effects, triggering the body's starvation response.
Sarcopenia: Inactivity-driven. Muscle wastes from disuse and unlike the others, responds well to exercise.
"Understanding the biology is what turns data into something doctors can use," Dr. Salvatore Cortellino said. "A patient with tumor-driven wasting needs different treatment than someone who simply can't eat."
Global Context
Cervical cancer is the fourth most common cancer in women worldwide. In 2022, there were 662,000 new cases and 349,000 deaths globally an increase from 2020.
In high-income countries, roughly three-quarters of patients complete treatment. In Uganda, that figure is 12%.
The Collaboration
The research was conducted by teams at the Sbarro Health Research Organization (Temple University, Philadelphia), SHRO Italia Foundation (Turin), and Scuola Superiore Meridionale (Naples).
"The evidence across thousands of women is consistent," said Dr. Antonio Giordano, founder of the Sbarro Institute. "Nutritional status predicts survival. The guidelines need to catch up."
Reference
1) https://www.clinicalnutritionopenscience.com/article/S2667-2685(25)00147-0/fulltext
(Newswise/HG)