Clinical significance of weight changes at diagnosis in solid tumours

  • Niamh O’Donoghue
  • Shiva Shrotriya
  • Aynur Aktas
  • Barbara Hullihen
  • Serkan Ayvaz
  • Bassam Estfan
  • Declan Walsh
Original Article



Weight changes occur throughout the cancer trajectory. Most research has focused on changes during or after treatment, so clinical significance of change at diagnosis remains unclear. This study aimed to determine prevalence, predictors and prognostic significance of weight changes at diagnosis in outpatients with solid tumours presenting to a tertiary academic medical centre.


A retrospective study of the electronic medical record was conducted (n = 6477). Those with weight recorded within 6 months of cancer diagnosis (pre-diagnosis, T0) and 2 subsequent weights (diagnosis, T1; final visit, T2) were identified (n = 4258). Percentage weight change was categorised into four bands (0.1–2.4%; 2.5–5%; 5.01–9.9%; ≥ 10%) for gain and loss. A stable category was also included.


Mean age is 61 ± 12.5 years. Common tumour sites: breast (17%; n = 725), prostate (16%; n = 664), lung (14%; n = 599). 15% (n = 652) had metastatic disease at T1. 98% (n = 4159) had weight change at T1. Head & neck and upper gastrointestinal cancers were significantly associated with weight loss (p < 0.001). Worst survival occurred with ≥ 10% weight gain or ≥ 10% weight loss. Overweight or obese body mass index with any percentage weight change band was associated with better overall survival.


Most had evidence of clinically significant weight changes at diagnosis. Weight loss at diagnosis was associated with a higher risk of further weight loss. A detailed weight history at cancer diagnosis is essential to identify and intervene for those most at risk of weight change-related early mortality.


Cancer Prognosis Survival Weight gain Weight loss 



We would like to thank Katy Tobin, PhD, Assistant Professor of Biostatistics, Trinity College Dublin and Siobhan Scarlett, Data Manager, The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin for their assistance with statistical analysis.

Compliance with ethical standards

Ethical approval

Institutional Review Board approval was granted for this study.

Informed consent

This study met the criteria for waiver of informed consent.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Mardas M, Stelmach-Mardas M, Madry R (2017) Body weight changes in patients undergoing chemotherapy for ovarian cancer influence progression-free and overall survival. Support Care Cancer 25(3):795–800CrossRefGoogle Scholar
  2. 2.
    Backes FJ, Nagel CI, Bussewitz E, Donner J, Hade E, Salani R (2011) The impact of body weight on ovarian cancer outcomes. Int J Gynecol Cancer 21(9):1601–1605CrossRefGoogle Scholar
  3. 3.
    Chen X, Lu W, Zheng W, Gu K, Chen Z, Zheng Y, Shu XO (2010) Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat 122(3):823–833CrossRefGoogle Scholar
  4. 4.
    Prado CM, Sawyer MB, Ghosh S, Lieffers JR, Esfandiari N, Antoun S, Baracos VE (2013) Central tenet of cancer cachexia therapy: do patients with advanced cancer have exploitable anabolic potential? Am J Clin Nutr 98(4):1012–1019CrossRefGoogle Scholar
  5. 5.
    Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, 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. Eastern Cooperative Oncology Group. Am J Med 69(4):491–497CrossRefGoogle Scholar
  6. 6.
    Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K et al (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 15(8):2920–2926CrossRefGoogle Scholar
  7. 7.
    Aapro M, Arends J, Bozzetti F, Fearon K, Grunberg SM, Herrstedt J, Hopkinson J, Jacquelin-Ravel N, Jatoi A, Kaasa S, Strasser F, ESMO (European School of Medical Oncology) (2014) Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol 25(8):1492–1499CrossRefGoogle Scholar
  8. 8.
    Barret M, Antoun S, Dalban C, Malka D, Mansourbakht T, Zaanan A, Latko E, Taieb J (2014) Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer 66(4):583–589CrossRefGoogle Scholar
  9. 9.
    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(4):431–434CrossRefGoogle Scholar
  10. 10.
    Churm D, Andrew IM, Holden K, Hildreth AJ, Hawkins C (2009) A questionnaire study of the approach to the anorexia-cachexia syndrome in patients with cancer by staff in a district general hospital. Support Care Cancer 17(5):503–507CrossRefGoogle Scholar
  11. 11.
    Langer CJ, Hoffman JP, Ottery FD (2001) Clinical significance of weight loss in cancer patients: rationale for the use of anabolic agents in the treatment of cancer-related cachexia. Nutrition 17(1 Suppl):S1–S20CrossRefGoogle Scholar
  12. 12.
    Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495CrossRefGoogle Scholar
  13. 13.
    Strasser F, Audisio R, Laviano A, Georgiou N, Fearon KC (2016) Supportive and palliative nutritional care for cancer patients (pts) with malnutrition and cachexia – a survey of healthcare providers (HCPs). Ann Oncol 27.
  14. 14.
    Del Fabbro E, Jatoi A, Davis M, Fearon K, di Tomasso J, Vigano A (2015) Health professionals’ attitudes toward the detection and management of cancer-related anorexia-cachexia syndrome, and a proposal for standardized assessment. J Community Support Oncol 13(5):181–187CrossRefGoogle Scholar
  15. 15.
    Blum D, Omlin A, Baracos VE, Solheim TS, Tan BH, Stone P et al (2011) Cancer cachexia: a systematic literature review of items and domains associated with involuntary weight loss in cancer. Crit Rev Oncol Hematol 80(1):114–144CrossRefGoogle Scholar
  16. 16.
    Muscaritoli M, Rossi Fanelli F, Molfino A (2016) Perspectives of health care professionals on cancer cachexia: results from three global surveys. Ann Oncol 27(12):2230–2236CrossRefGoogle Scholar
  17. 17.
    Collaborators TGO (2017) Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 377(1):13–27CrossRefGoogle Scholar
  18. 18.
    Del Fabbro E (2015) Current and future care of patients with the cancer anorexia-cachexia syndrome. Am Soc Clin Oncol Educ Book 35:e229–e237CrossRefGoogle Scholar
  19. 19.
    Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy CP, Younessi H, Anker SD, Morley JE (2007) Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 10(4):433–442CrossRefGoogle Scholar
  20. 20.
    Del Fabbro E, Fearon K, Strasser F (2015) Impact of cancer cachexia Elsevier B.V. Accessed 3 July 2017
  21. 21.
    Flegal KM, Kit BK, Orpana H, Graubard BI (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 309(1):71–82CrossRefGoogle Scholar
  22. 22.
    Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M, Lundholm K, Bosaeus I, Fearon KH, Baracos VE (2015) Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol 33(1):90–99CrossRefGoogle Scholar
  23. 23.
    Hess LM, Barakat R, Tian C, Ozols RF, Alberts DS (2007) Weight change during chemotherapy as a potential prognostic factor for stage III epithelial ovarian carcinoma: a gynecologic oncology group study. Gynecol Oncol 107(2):260–265CrossRefGoogle Scholar
  24. 24.
    Ligibel J (2011) Obesity and breast cancer. Oncology 25(11):994–1000PubMedGoogle Scholar
  25. 25.
    Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123(3):627–635CrossRefGoogle Scholar
  26. 26.
    Chen X, Lu W, Gu K, Chen Z, Zheng Y, Zheng W, Shu XO (2011) Weight change and its correlates among breast cancer survivors. Nutr Cancer 63(4):538–548CrossRefGoogle Scholar
  27. 27.
    Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378CrossRefGoogle Scholar
  28. 28.
    Sinicrope FA, Foster NR, Yothers G, Benson A, Seitz JF, Labianca R, Goldberg RM, DeGramont A, O'Connell MJ, Sargent DJ, for the Adjuvant Colon Cancer Endpoints (ACCENT) Group (2013) Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer 119(8):1528–1536CrossRefGoogle Scholar
  29. 29.
    Martin L, Watanabe S, Fainsinger R, Lau F, Ghosh S, Quan H, Atkins M, Fassbender K, Downing GM, Baracos V (2010) Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction. J Clin Oncol 28(28):4376–4383CrossRefGoogle Scholar
  30. 30.
    World Health Organisation (WHO) Global database on body mass index 2006 Accessed 19 August 2017
  31. 31.
    Massetti GM, Dietz WH, Richardson LC (2017) Excessive weight gain, obesity, and cancer: opportunities for clinical intervention. JAMA 318(20):1975–1976CrossRefGoogle Scholar
  32. 32.
    Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31(12):1539–1547CrossRefGoogle Scholar
  33. 33.
    Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36(1):11–48CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of MedicineTrinity College DublinDublinIreland
  2. 2.Academic Department of Palliative Medicine, Education & Research CentreOur Lady’s Hospice & Care ServicesDublinIreland
  3. 3.Department of Solid Tumor OncologyCleveland Clinic Taussig Cancer InstituteClevelandUSA
  4. 4.The Harry R. Horvitz Center for Palliative MedicineCleveland Clinic Taussig Cancer InstituteClevelandUSA
  5. 5.Department of ITD Analytics eResearchThe Cleveland Clinic FoundationClevelandUSA

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