Supportive Care in Cancer

, 15:39 | Cite as

Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation

  • U. Khalid
  • A. Spiro
  • C. BaldwinEmail author
  • B. Sharma
  • C. McGough
  • A. R. Norman
  • T. Eisen
  • M. E. R. O’Brien
  • D. Cunningham
  • H. J. N. Andreyev
Original Article



Weight loss is an independent prognostic factor for decreased survival in cancer patients. The effectiveness of treatment is impaired in patients with weight loss. The aetiology of this weight loss is complex and poorly characterised. Decreased calorie intake may be important. The reasons for decreased intake are unknown.

Aims and methods

To determine in adult patients with cancer, who had not started chemotherapy or radiotherapy, the prevalence of symptoms which carry a risk to nutritional status and how these relate to weight loss, tumour burden and primary tumour site. New patients referred for treatment of any form of gastrointestinal (GI) cancer, non-small cell lung cancer or lung mesothelioma completed a validated questionnaire recording symptoms contributing to weight loss (Patient-generated Subjective Global Assessment—PG-SGA). In a subset of patients without metastatic disease, computed tomography scans were assessed to determine tumour burden.


Between August and October 2004, 122 patients with GI and 29 with lung cancers were recruited. There were 48% of GI and 28% of lung cancer patients who had lost weight. Sixty-two percent of the patients had one or more symptoms at presentation. The frequency of symptoms varied according to the site of disease. The most common symptom at all tumour sites was loss of appetite (38%). There was a weak but significant correlation between the number of symptoms and amount of weight loss (r=0.347). Patients reporting a reduced food intake had more symptoms than patients who had not lost weight. Tumour burden did not correlate with weight loss.


The symptoms in cancer patients occur across different types of primary tumours, may affect food intake and have a part in causing weight loss. More information on the role of symptom management in improving nutritional status is needed.


Weight loss Symptoms Nutritional status PG-SGA Tumour burden Gastrointestinal cancer Lung cancer 



This study was approved by the Research and Ethics committees of the Royal Marsden Hospital and was supported by funds provided by the Rank Nutrition Fund, The Henry Smith Foundation, and the Trustees of the Chelsea and Westminster Hospital, UK.


  1. 1.
    DeWys WD, Begg, C, Lavin, PT, Band PR, Bennett JM, Bertino JR, Cohen MR, Douglass HO, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 69(October):491–497PubMedCrossRefGoogle Scholar
  2. 2.
    Andreyev HJN, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34(4):503–509PubMedCrossRefGoogle Scholar
  3. 3.
    Ovesen L, Hannibal J, Mortensen E (1993) The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast, and ovary. Nutr Cancer 19(2):159–167PubMedCrossRefGoogle Scholar
  4. 4.
    Studley HO (2001) Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. 1936. Nutr Hosp 16(4):141–143PubMedGoogle Scholar
  5. 5.
    Lennard-Jones J (1992) A positive approach to nutrition as treatment. Kings Fund Center, LondonGoogle Scholar
  6. 6.
    Isenring EA, Capra S, Bauer J (2004) Nutritional intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91(3):447–452PubMedCrossRefGoogle Scholar
  7. 7.
    Ross PJ, Ashely S, Norton A, Priest K, Waters JS, Eisen T, Smith IE, O’Brien MER (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 90:1905–1911PubMedCrossRefGoogle Scholar
  8. 8.
    Grosvenor M, Bulcavage L, Chelbowski R (1989) Symptoms potentially influencing weight loss in a cancer population. Correlations with primary site, nutritional status, and chemotherapy administration. Cancer 15:330–334CrossRefGoogle Scholar
  9. 9.
    Ottery FD (1998) Volunteer network accrues more than 1900 patients in 6 months to validate standardised nutritional triage. ASCOGoogle Scholar
  10. 10.
    Segura A, Pardo J, Jara C, Zugazabeitia L, Carulla J, de las Penas R, Garcia-Cabrera E, Azuara ML, Casado J, Gomez-Candela C (2005) An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer. Clin Nutr 24(5):801–814PubMedCrossRefGoogle Scholar
  11. 11.
    Donnelly S, Walsh D, Rybicki L (1995) The symptoms of advanced cancer: identification of clinical and research priorities by assessment of prevalence and severity. J Palliat Care 11(1):27–32PubMedGoogle Scholar
  12. 12.
    Walsh D, Rybicki L, Nelson KA, Donnelly S (2002) Symptoms and prognosis in advanced cancer. Support Care Cancer 10:385–388PubMedCrossRefGoogle Scholar
  13. 13.
    Sarhill N, Mahmoud F, Walsh D, Nelson KA, Komurcu S, Davis M, LeGrand S, Abdullah O, Rybicki L (2003) Evaluation of nutritional status in advanced metastatic cancer. Support Care Cancer 11:652–659PubMedCrossRefGoogle Scholar
  14. 14.
    Ravasco P, Monteiro-Grillo I, Vidal PM (2003) Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol) 15(8):443–450Google Scholar
  15. 15.
    Fordy C, Glover C, Henderson DC, Summerbell C, Wharton R, Allen-Mersh TG (1999) Contribution of diet, tumour volume and patient-related factors to weight loss in patients with colorectal liver metastases. Br J Surg 86(5):639–644PubMedCrossRefGoogle Scholar
  16. 16.
    Bozzetti R, Boracchi P, Costa A, Cozzaglio L, Battista A, Giori A, La Monica G, Silvestrina R (1995) Relationship between nutritional status and tumor growth in humans. Tumori 81:1–6PubMedGoogle Scholar
  17. 17.
    Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56:779–785PubMedCrossRefGoogle Scholar
  18. 18.
    Kirkova J, Davis MP, Walsh D, Tiernan E, O’Leary N, LeGrand SB et al (2006) Cancer symptom assessment instruments. J Clin Oncol 24(9):1459–1473PubMedCrossRefGoogle Scholar
  19. 19.
    Schuit KW, Sleijfer DT, Meijler WJ, Otter R, Schakenraad J, van den Bergh FCM et al (1998) Symptoms and functional status of patients with disseminated cancer visiting outpatient departments. J Pain Symptom Manage 16(5):290–297PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • U. Khalid
    • 1
  • A. Spiro
    • 1
  • C. Baldwin
    • 1
    Email author
  • B. Sharma
    • 2
  • C. McGough
    • 1
  • A. R. Norman
    • 4
  • T. Eisen
    • 3
  • M. E. R. O’Brien
    • 3
  • D. Cunningham
    • 4
  • H. J. N. Andreyev
    • 4
  1. 1.Division of MedicineImperial College LondonLondonUK
  2. 2.Department of RadiologyThe Royal Marsden HospitalLondonUK
  3. 3.Lung UnitsThe Royal Marsden HospitalLondonUK
  4. 4.Gastrointestinal UnitsThe Royal Marsden HospitalLondonUK

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