Advertisement

Supportive Care in Cancer

, Volume 20, Issue 2, pp 301–309 | Cite as

Weight loss in cancer patients: a plea for a better awareness of the issue

  • Luigi MarianiEmail author
  • Salvatore Lo Vullo
  • Federico Bozzetti
  • on behalf of the SCRINIO Working Group
Original Article

Abstract

Purpose

Although weight loss is of both prognostic and predictive relevance in oncologic patients, its assessment is often neglected. Aims of the present investigation were to define the prevalence and severity of weight loss in adult outpatients with a variety of solid tumors, and determine the association patterns with patient-, cancer-, and therapy-related factors.

Methods

Among an outpatient series of 1,556 cancer patients, weight loss information was obtained for 1,540 patients. Weight loss was analyzed by means of multiple regression models, logistic models, and nomograms, according to age, gender, site of primary, UICC stage, Eastern Cooperative Oncology Group (ECOG) performance status, therapy, and symptoms type and degree.

Results

Weight loss, relative to usual body weight, was 7.1% on average in the whole series, and clinically significant (≥10%) in 589 patients (38%). Factors most strongly associated with WL were site of primary, ECOG performance status, anorexia syndrome, and fatigue. These, together with oncologic therapy, were important factors for predicting significant weight loss.

Conclusions

Weight loss turned out to be frequent and clinically significant. We believe that this sign should deserve major attention by the oncologists to pursue the benefits that early nutritional support prospectively yields in terms of quality of life and clinical outcome improvement.

Keywords

Cancer cachexia Neoplasm Nomogram Nutritional support Weight loss 

Notes

Acknowledgments

The authors declare that no funding supported this study.

The authors acknowledge Nestlé HealthCare for their help in the collection of data from the SCRINIO Centers.

Participating centers and principal collaborators of the SCRINIO Working Group: Asti, Ospedale Card. Massaia: ML Amerio; Belo Horizonte (BRA), University Hospital: I Correia; Candiolo, ASO Mauriziano-Presidio IRCCS: L Rovera, R Bianco, P D’Elia; Cagliari, Ospedale Universitario: G Mantovani, E Massa, C Madeddu; Jeddah (Saudi Arabia), King Faisal Specialist Hospital and Research Center: A. Magzoub Hussein, S Eshki, K Bajunaid; Lucca, Presidio Ospedaliero: M Pellegrini, GR Barsanti, M Battistoni; Massa Carrara, ASL 1: A Giannoni, L Sturlese; Massa Carrara, Ospedale: C Pennucci; Milano, Fondazione IRCCS Istituto Nazionale Tumori: C Gavazzi, C Arcovio, L Licitra; Milano, Istituto Europeo di Oncologia: R Biffi, D Papis, MG Zampino; Orbassano, AOU S. Luigi Gonzaga: P Avagnina, M Tinivella, C Fenoglio; Padova, Ospedale S. Antonio USSL 16: P Magnanini; Pavia, Fondazione IRCCS Policlinico San Matteo: R Caccialanza, B Cameletti, S Rocca; Pinerolo, ASL 10 - Ospedale Civile: V Sidoti, GM Rovera; Prato, Ospedale Misericordia e Dolce: F Bozzetti, A DiLeo; Roma, Ospedale San Pietro Fatebenefratelli: G Capuano, I Pavese, M Tosti; Roma, Ospedale S. Eugenio: G Sandri, P Pizzichino, GM Giorgetti; Rozzano, Istituto Clinico Humanitas: L Cozzaglio, L Despini; Siena, Az. Osp. Universitaria Senese “Le Scotte”: L Di Cosmo; Tolmezzo, Ospedale S. Antonio Abate: E Vigevani; Torino, Ospedale S. Giovanni Battista: E Finocchiaro.

Ethics approval

All participating institutions got the approval of local Ethics Committee to study protocol and informed consent form.

Conflict of interest

None.

References

  1. 1.
    Lennard-Jones JE, Arrowsmith H, Davison C, Denham AF, Micklewright A (1995) Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital. Clin Nutr 14:336–340PubMedCrossRefGoogle Scholar
  2. 2.
    Ottery FD (2009) Cancer-related weight loss. In: Walsh D (ed) Palliative medicine. Saunders Elsevier, Philadelphia, pp 732–740Google Scholar
  3. 3.
    Kudsk KA, Tolley EA, DeWitt RC et al (2003) Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr 27:1–9PubMedCrossRefGoogle Scholar
  4. 4.
    Swenerton KD, Legha SS, Smith T et al (1979) Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Res 39:1552–1562PubMedGoogle Scholar
  5. 5.
    Dewys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern cooperative oncology group. Am J Med 69:491–497PubMedCrossRefGoogle Scholar
  6. 6.
    Stanley KE (1980) Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst 65:25–32PubMedGoogle Scholar
  7. 7.
    Pedersen H, Hansen HS, Cederqvist C, Løber J (1982) The prognostic significance of weight loss and its integration in stage-grouping of oesophageal cancer. Acta Chir Scand 148:363–366PubMedGoogle Scholar
  8. 8.
    Fein R, Kelsen DP, Geller N, Bains M, McCormack P, Brennan MF (1985) Adenocarcinoma of the esophagus and gastroesophageal junction. Prognostic factors and results of therapy. Cancer 56:2512–2518PubMedCrossRefGoogle Scholar
  9. 9.
    Gogos CA, Ginopoulos P, Salsa B, Apostolidou E, Zoumbos NC, Kalfarentzos F (1998) Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy: a randomized control trial. Cancer 82:395–402PubMedCrossRefGoogle Scholar
  10. 10.
    Lai SL, Perng RP (1998) Impact of nutritional status on the survival of lung cancer patients. Zhonghua Yi Xue Za Zhi (Taipei) 61:134–140Google Scholar
  11. 11.
    Edington J, Winter PD, Coles SJ, Gale CR, Martyn CN (1999) Outcomes of undernutrition in patients in the community with cancer or cardiovascular disease. Proc Nutr Soc 58:655–661PubMedCrossRefGoogle Scholar
  12. 12.
    van Bokhorst-de van der Schuer, van Leeuwen PA, Kuik DJ et al (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527PubMedCrossRefGoogle Scholar
  13. 13.
    Bosaeus I, Daneryd P, Lundholm K (2002) Dietary intake, resting energy expenditure, weight loss and survival in cancer patients. J Nutr 132(Suppl 11):S3465–S3466Google Scholar
  14. 14.
    Hauser CA, Stockler MR, Tattersall MH (2006) Prognostic factors in patients with recently diagnosed incurable cancer: a systematic review. Support Care Cancer 14:999–1011PubMedCrossRefGoogle Scholar
  15. 15.
    Stratton RJ, Green CJ, Elia M (2003) Disease-related malnutrition: an evidence-based approach to treatment. CABI, Oxford, pp 20–21Google Scholar
  16. 16.
    Di Fiore F, Lecleire S, Pop D et al (2007) Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol 102:2557–2563PubMedCrossRefGoogle Scholar
  17. 17.
    Tewari N, Martin-Ucar AE, Black E et al (2007) Nutritional status affects long term survival after lobectomy for lung cancer. Lung Cancer 57:389–394PubMedCrossRefGoogle Scholar
  18. 18.
    Bachmann J, Heiligensetzer M, Krakowski-Roosen H, Büchler MW, Friess H, Meb M (2008) Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg 12:1193–1201PubMedCrossRefGoogle Scholar
  19. 19.
    Tubiana M, Attié E, Flamant R, Gérard-Marchant R, Hayat M (1971) Prognostic factors in 454 cases of Hodgkin’s disease. Cancer Res 31:1801–1810PubMedGoogle Scholar
  20. 20.
    Ovesen L, Allingstrup L, Hannibal J, Mortensen EL, Hansen OP (1993) Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. J Clin Oncol 11:2043–2049PubMedGoogle Scholar
  21. 21.
    Aviles A, Yañez J, López T, García EL, Guzmán R, Díaz-Maqueo JC (1995) Malnutrition as an adverse prognostic factor in patients with diffuse large cell lymphoma. Arch Med Res 26:31–34PubMedGoogle Scholar
  22. 22.
    Andreyev HJ, 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 34:503–509PubMedCrossRefGoogle Scholar
  23. 23.
    Mitry E, Douillard JY, Van Cutsem E et al (2004) Predictive factors of survival in patients with advanced colorectal cancer: an individual data analysis of 602 patients included in irinotecan phase III trials. Ann Oncol 15:1013–1017PubMedCrossRefGoogle Scholar
  24. 24.
    Ross PJ, Ashley S, Norton A et al (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 90:1905–1911PubMedCrossRefGoogle Scholar
  25. 25.
    O’Gorman P, McMillan DC, McArdle CS (1998) Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients. Nutr Cancer 32:76–80PubMedCrossRefGoogle Scholar
  26. 26.
    Persson CR, Johansson BB, Sjöden PO, Glimelius BL (2002) A randomized study of nutritional support in patients with colorectal and gastric cancer. Nutr Cancer 42:48–58PubMedCrossRefGoogle Scholar
  27. 27.
    Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12(Suppl 1):S15–S19PubMedGoogle Scholar
  28. 28.
    Detsky AS, McLaughlin JR, Baker JP et al (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13PubMedCrossRefGoogle Scholar
  29. 29.
    Stratton RJ, Hachston A, Londmore D et al (2004) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” (MUST) for adults. Br J Nutr 92:799–808PubMedCrossRefGoogle Scholar
  30. 30.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336PubMedCrossRefGoogle Scholar
  31. 31.
    Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN) (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22:415–421PubMedCrossRefGoogle Scholar
  32. 32.
    Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA (2005) Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr 24:75–82PubMedCrossRefGoogle Scholar
  33. 33.
    Ferguson M, Capra S, Bauer J, Banks M (1999) Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 15:458–464PubMedCrossRefGoogle Scholar
  34. 34.
    Bozzetti F, Mariani L (2009) Defining and classifying cancer cachexia: a proposal by the SCRINIO working group. JPEN J Parenter Enteral Nutr 33:361–367PubMedCrossRefGoogle Scholar
  35. 35.
    Fearon KC, Voss AC, Hustead DS, Cancer Cachexia Study Group (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83:1345–1350PubMedGoogle Scholar
  36. 36.
    Rothenberg ML, Moore MJ, Cripps MC et al (1996) A phase II trial of gemcitabine in patients with 5-FU-refractory pancreas cancer. Ann Oncol 7:347–353PubMedGoogle Scholar
  37. 37.
    Burris HA 3rd, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413PubMedGoogle Scholar
  38. 38.
    Van Cutsem E, Moiseyenko VM, Tjulandin S et al (2006) Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 24:4991–4997PubMedCrossRefGoogle Scholar
  39. 39.
    Ajani JA, Moiseyenko VM, Tjulandin S et al (2007) Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase III trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V-325 study group. J Clin Oncol 25:3205–3209PubMedCrossRefGoogle Scholar
  40. 40.
    Izawa S, Enoki H, Hirakawa Y et al (2007) Lack of body weight measurement is associated with mortality and hospitalization in community-dwelling frail elderly. Clin Nutr 26:764–770PubMedCrossRefGoogle Scholar
  41. 41.
    Bozzetti F, SCRINIO Working Group (2009) Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 17:279–284PubMedCrossRefGoogle Scholar
  42. 42.
    Stewart GD, Skipworth RJ, Fearon KC (2009) The anorexia–cachexia syndrome. In: Walsh D (ed) Palliative Medicine. Saunders Elsevier, Philadelphia, pp 587–595Google Scholar
  43. 43.
    Harrell FE Jr, Lee KL, Califf RM, Pryor DB, Rosati RA (1984) Regression modelling strategies for improved prognostic prediction. Stat Med 3:143–152PubMedCrossRefGoogle Scholar
  44. 44.
    Bozzetti F, Migliavacca S, Scotti A et al (1982) Impact of cancer, type, site, stage and treatment on the nutritional status of patients. Ann Surg 196:170–179PubMedCrossRefGoogle Scholar
  45. 45.
    Weinsier RL, Hunker EM, Krumdieck CL, Butterworth CE Jr (1979) Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr 32:418–426PubMedGoogle Scholar
  46. 46.
    Hosseini S, Amirkalali B, Nayebi N, Heshmat R, Larijani B (2006) Nutrition status of patients during hospitalization, Tehran, Iran. Nutr Clin Pract 21:518–521PubMedCrossRefGoogle Scholar
  47. 47.
    Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2004) Cancer: disease and nutrition are key determinants of patients’ quality of life. Support Care Cancer 12:246–252PubMedCrossRefGoogle Scholar
  48. 48.
    Hockley JM, Dunlop R, Davies RJ (1988) Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team. Br Med J (Clin Res Ed) 296:1715–1717CrossRefGoogle Scholar
  49. 49.
    Vachon M (1993) Emotional problems in palliative medicine: patient, family and professional. In: Doyle D, Hanks GWC, MacDonald N (eds) The Oxford text of palliative medicine, vol 10, Oxford University Press. Oxford, UK, pp 577–605Google Scholar
  50. 50.
    Curt GA (2000) Impact of fatigue on quality of life in oncology patients. Semin Hematol 37(Suppl 6):S14–S17CrossRefGoogle Scholar
  51. 51.
    Curt GA, Breitbart W, Cella D et al (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5:353–360PubMedCrossRefGoogle Scholar
  52. 52.
    Flechtner H, Bottomley A (2003) Fatigue and quality of life: lessons from the real world. Oncologist 8(Suppl 1):S5–S9CrossRefGoogle Scholar
  53. 53.
    Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2005) Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 23:1431–1438PubMedCrossRefGoogle Scholar
  54. 54.
    Spiro A, Baldwin C, Patterson A, Thomas J, Andreyev HJ (2006) The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br J Cancer 95:431–434PubMedCrossRefGoogle Scholar
  55. 55.
    Shaw JH, Wolfe RR (1988) Whole-body protein kinetics in patients with early and advanced gastrointestinal cancer: the response to glucose infusion and total parenteral nutrition. Surgery 103:148–155PubMedGoogle Scholar
  56. 56.
    Nayel H, el-Ghoneimy E, El-Haddad S (1992) Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Nutrition 8:13–18PubMedGoogle Scholar
  57. 57.
    Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91:447–452PubMedCrossRefGoogle Scholar
  58. 58.
    Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668PubMedCrossRefGoogle Scholar
  59. 59.
    Cerchietti LC, Navigante AH, Castro MA (2007) Effects of eicosapentaenoic and docosahexaenoic n-3 fatty acids from fish oil and preferential Cox-2 inhibition on systemic syndromes in patients with advanced lung cancer. Nutr Cancer 59:14–20PubMedCrossRefGoogle Scholar
  60. 60.
    May PE, Barber A, D’Olimpio JT, Hourihane A, Abumrad NN (2002) Reversal of cancer-related wasting using oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine. Am J Surg 183:471–479PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Luigi Mariani
    • 1
    Email author
  • Salvatore Lo Vullo
    • 1
  • Federico Bozzetti
    • 2
  • on behalf of the SCRINIO Working Group
  1. 1.Unit of Clinical Epidemiology and Trial OrganizationFondazione IRCCS Istituto Nazionale TumoriMilanItaly
  2. 2.Faculty of MedicineUniversity of MilanMilanItaly

Personalised recommendations