Dietary Counseling and Nutritional Monitoring for Cancer Cachexia in Breast Cancer: A Randomized Controlled Trial

Nutritional Intervention in Cancer Cachexia

Abstract

Objective: To assess the effectiveness of personalized dietary counseling and regular nutritional monitoring in improving cancer-related cachexia among women with breast cancer, using the validated Mini-Cancer Cachexia Score (Mini-CASCO).

Methodology: A parallel, single phase, two-arm interventional study was conducted at Fauji Foundation Hospital, Rawalpindi from June to December 2024. A total of 134 participants were randomized in a 1:1 ratio using block stratified allocation to either an intervention group (n=67), which received standard oncologic care supplemented with individualized dietary counseling and nutritional monitoring every 15–21 days, or a control group (n=67), which received standard care alone. The magnitude and severity of cachexia was assessed at baseline and 6 months using Mini-CASCO across five domains including body composition, inflammatory-metabolic profile, physical performance, appetite, and quality of life.

Results: Of 134 participants enrolled, 130 (97%) completed follow-up. After 6 months, the intervention group demonstrated a significant reduction in overall Mini-CASCO score (Δ=−14.4 ± 5.1; p<0.01; Cohen’s d=2.0), whereas the control group showed only a small decrease (Δ=−2.6 ± 4.9; p=0.03). Between-group analyses demonstrated significant improvements attributable to the intervention across all Mini-CASCO domains, including body weight/composition (Δ=−5.2 ± 2.6), inflammatory–metabolic profile (Δ=−2.5 ± 1.5), physical performance (Δ=−1.8 ± 1.1), appetite/anorexia (Δ=−1.9 ± 1.0), and quality of life (Δ=−1.0 ± 0.7) (all p<0.001). The overall effect size was large (partial η²=0.38), indicating strong clinical relevance.

Conclusion: Incorporating structured dietary counseling and nutritional monitoring into routine oncology care significantly attenuates cachexia and enhances functional, metabolic, and psychosocial outcomes in women with breast cancer. Mini-CASCO functioned effectively as an outcome tool for monitoring therapeutic response, supporting nutrition-sensitive strategies within cancer care pathways.