By: Staff Writer | September 10, 2026 | 9 min. read |
Key Takeaways
Nutrition and immune status before chemotherapy may predict how patients experience treatment.
Simple lab data like the Prognostic Nutritional Index may help identify high-risk patients earlier.
The goal is more proactive, personalized supportive care that improves how patients tolerate and feel during treatment.
Chemotherapy is not the same journey for every patient. For some, it is manageable, a steady climb with expected challenges. For others, it can feel like stepping into a storm without a forecast, where fatigue surges, nausea lingers and daily life is disrupted in ways that are difficult to anticipate.
At Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, researchers are working to turn that uncertainty into insight. Melissa Lopez, Ph.D., M.S., RDN, an assistant professor of public health sciences at the Miller School and nutrition lead in lifestyle medicine in the Sylvester Survivorship and Supportive Care Institute, has been awarded an NCI ENICTO pilot grant for $65,000 to investigate how nutritional and immune status may help predict which patients are most likely to struggle during chemotherapy.
Her goal is to use data already collected in routine care to better understand, and potentially anticipate, the patient experience.
Dr. Melissa Lopez is investigating the relationship between clinical and nutritional markers and chemotherapy symptoms.
“This study is evaluating whether routinely available pre-treatment clinical and nutritional markers can help predict patient-reported symptom burden during and after chemotherapy,” said Dr. Lopez. “The overarching goal is to improve early risk stratification by leveraging data already collected in clinical care.”
Why Is a Patient’s Health Before Chemotherapy Important?
Before the first infusion begins, every patient enters chemotherapy with a different baseline. That starting point, Dr. Lopez explained, plays a critical role in how the body responds to treatment stress.
“Nutritional status before treatment gives us a snapshot of a patient’s overall physiologic reserve going into chemotherapy,” Dr. Lopez said. “It reflects more than weight. It captures protein stores, immune function and inflammation.”
That reserve determines how well the body can tolerate and recover from treatment. When it is low, chemotherapy can take a heavier toll, leading to more severe fatigue, gastrointestinal toxicity and functional decline.
A Simple Index with Powerful Potential
At the center of the research is the Prognostic Nutritional Index, or PNI, a measure built from two standard lab values, albumin and lymphocyte count. Despite its simplicity, it offers meaningful insight into both nutritional and immune health.
“I chose PNI because it can be calculated with components that are already assessed as part of routine clinical care,” Dr. Lopez said. “It’s also highly scalable since it doesn’t require any additional testing or patient burden.”
PNI has already been linked to survival outcomes, but its relationship to how patients feel during treatment remains less understood. For Dr. Lopez, that distinction is critical. Survival tells one story. Symptom burden tells another, more immediate and human one.
Frequently Asked Questions
What is the Prognostic Nutritional Index?
The Prognostic Nutritional Index, or PNI, is a measure calculated from two routine laboratory values: albumin and lymphocyte count.
What are researchers trying to predict?
They are evaluating whether pretreatment clinical and nutritional markers can help predict patient-reported symptom burden during and after chemotherapy.
How are symptoms being measured?
The study uses PRO-CTCAE, a validated tool that captures treatment-related symptoms directly from patients.
Is PNI ready to guide chemotherapy care?
Not yet. The study is evaluating its predictive value, and the findings would need validation before they could support clinical risk stratification.
How Are Chemotherapy Symptoms Being Measured?
No single metric can fully capture how the body responds to chemotherapy. Nutrition, inflammation and immune function operate like interconnected systems, each influencing the other.
“There is growing recognition that no single marker fully captures the complexity of nutrition-inflammation-immune interactions in oncology,” Dr. Lopez said.
To better reflect that complexity, the study incorporates additional measures, including Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength and diet quality. Together, these tools provide a more complete view of a patient’s health and resilience.
To understand treatment impact, the research relies on patient-reported outcomes using a validated tool called PRO-CTCAE. This approach captures symptoms directly from patients, rather than relying solely on clinical observation.
“We look across a range of chemotherapy-related symptoms, including gastrointestinal symptoms, systemic symptoms and neurologic or musculoskeletal symptoms,” Dr. Lopez said. “This gives us a broad, patient-centered view of treatment-related toxicity across symptom domains.”
The result is a more comprehensive picture of how chemotherapy is experienced, not just how it is delivered.
Data is Leveraged Across Studies
A key strength of the study lies in its scale. Through the ENICTO consortium, Dr. Lopez and her colleagues are combining data from multiple clinical trials studying a variety of cancers from across the U.S., including TEAL, THRIVE-65, TNT and ACTION.
“The strength of this project really comes from being able to combine data across multiple ENICTO trials,” Dr. Lopez said. “Having this structure gives us a much more robust and generalizable dataset than any one trial alone.”
By harmonizing data across diverse populations and treatment settings, researchers can uncover patterns that would otherwise remain hidden. This kind of large-scale analysis reflects a broader shift toward data-driven and AI-enabled approaches in oncology.
Toward More Personalized Support
The implications extend beyond research. In clinical practice, supportive care resources are limited, and not every patient can receive the same level of intervention. Identifying high-risk patients earlier could help clinicians prioritize care and intervene sooner.
“If validated, these findings could support more proactive, data-driven risk stratification prior to chemotherapy initiation,” Dr. Lopez said.
Dr. Tracy Crane says Sylvester research looks to identify ways to intervene early, and effectively, on behalf of patients.
Tracy Crane, Ph.D., RDN, director of lifestyle medicine, prevention and digital health at Sylvester, associate professor of medical oncology at the Miller School and a co-investigator on the project as one of the principal investigators for TEAL, emphasized the importance of that shift.
“This type of work is essential because it helps us move from reactive care to proactive care,” Dr. Crane said. “When we can anticipate which patients are more vulnerable, we can intervene earlier and support them more effectively throughout treatment.”
The goal of Dr. Lopez’s research is not to eliminate the challenges of chemotherapy, but to make them more predictable and manageable. Better data could help patients and clinicians prepare for what lies ahead. By turning routine clinical information into actionable insight, her work reflects a growing shift in oncology to consider how patients live during treatment. In that shift, cancer care becomes more precise, more proactive and more human.
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Tags: cancer research, cancer survivorship, chemotherapy, Division of Medical Oncology, Dr. Melissa Lopez, Dr. Tracy Crane, nutrition, Sylvester Comprehensive Cancer Center, Sylvester Survivorship and Supportive Care Institute