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Supportive Care in Cancer

, Volume 28, Issue 1, pp 329–339 | Cite as

Unintentional weight loss, its associated burden, and perceived weight status in people with cancer

  • Eva Y. N. YuenEmail author
  • Alexandra K. Zaleta
  • Shauna McManus
  • Joanne S. Buzaglo
  • Thomas W. LeBlanc
  • Kathryn Hamilton
  • Kevin Stein
Original Article

Abstract

Purpose

Unintentional weight loss (UWL) is a prevalent problem in people with cancer and is associated with poorer psychosocial outcomes. A gap exists in understanding whether and how perceived and/or weight status impacts experiences of UWL. Thus, we sought to examine subjective experiences of UWL in people with cancer, and whether perceived and/or actual weight status impacts these experiences.

Methods

Participants were recruited through Cancer Support Community’s Cancer Experience Registry® and related networks. Participants completed an online survey that included the FAACT Anorexia-Cachexia subscale, and 19 items that captured six themes related to “beliefs and concerns” (positive beliefs, psychosocial impact, physical impact, cancer outcomes, self-esteem, relationships with others). Perceived weight status (PWS) was assessed using a single item. Body mass index (BMI) was calculated using self-reported weight and height measurements.

Results

Of 326 respondents, 114 reported experiencing UWL. Over one-third misperceived their weight, with 29% perceiving weight status as below their BMI status. UWL in those with perceived weight status of overweight/obese was associated with positive beliefs. However, being underweight by BMI or perceiving oneself as underweight were both associated with greater concerns about weight loss. Perceived weight status of underweight compared to normal or overweight/obese weight status was associated with poorer psychosocial well-being, personal control, self-esteem, and relationships with others.

Conclusion

In people with cancer, perceived weight status, rather than BMI, had greater impact on negative “beliefs and concerns” about UWL. Findings suggest assessment of both perceived and actual BMI to address the impact of UWL on psychosocial wellbeing.

Keywords

Unintentional weight loss Cancer Perceived weight status BMI weight status Subjective experiences Patient-reported outcomes 

Notes

Funding information

Support for this study was provided by Helsinn Therapeutics, Inc.; research support was granted to the Cancer Support Community and not individual study authors. Cancer Support Community retains full control of all primary data.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495CrossRefGoogle Scholar
  2. 2.
    Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F (2014) Prevalence of malnutrition and current use of nutrition support in patients with cancer. J Parenter Enter Nutr 38(2):196–204CrossRefGoogle Scholar
  3. 3.
    Sanchez-Lara K, Ugalde-Morales E, Motola-Kuba D, Green D (2013) Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy. Br J Nutr 109(5):894–897CrossRefGoogle Scholar
  4. 4.
    Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR et al (1980) Prognostic effect of weight loss prior tochemotherapy in cancer patients. Am J Med 69(4):491–497CrossRefGoogle Scholar
  5. 5.
    Van Cutsem E, Arends J (2005) The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 9(Suppl 2):S51–S63CrossRefGoogle Scholar
  6. 6.
    Silver HJ, Dietrich MS, Murphy BA (2007) Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy. Head Neck 29(10):893–900CrossRefGoogle Scholar
  7. 7.
    Fearon KC, Glass DJ, Guttridge DCJC (2012) Cancer cachexia: mediators, signaling, and metabolic pathways. Cell Metab 16(2):153–166CrossRefGoogle Scholar
  8. 8.
    Arrieta O, Michel Ortega RM, Villanueva-Rodriguez G, Serna-Thome MG, Flores-Estrada D, Diaz-Romero C et al (2010) Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer 10(1):50CrossRefGoogle Scholar
  9. 9.
    Ryan AM, Power DG, Daly L, Cushen SJ, Ni Bhuachalla E, Prado CM (2016) Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc 75(2):199–211CrossRefGoogle Scholar
  10. 10.
    Cooper C, Burden ST, Cheng H (2015) Molassiotis AJJoc, sarcopenia, muscle. Understanding and managing cancer-related weight loss and anorexia: insights from a systematic review of qualitative research. J Cachexia Sarcopenia Muscle 6(1):99–111CrossRefGoogle Scholar
  11. 11.
    Stamataki Z, Burden S, Molassiotis A (2011) Weight changes in oncology patients during the first year after diagnosis: a qualitative investigation of the patients' experiences. Cancer Nurs 34(5):401–409CrossRefGoogle Scholar
  12. 12.
    Langius JA, van Dijk AM, Doornaert P, Kruizenga HM, Langendijk JA, Leemans CR et al (2013) More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutr Cancer 65(1):76–83Google Scholar
  13. 13.
    Head BA, Heitz L, Keeney C, Myers J, Appana SN, Studts JL, Bumpous J, Pfeifer M (2011) The relationship between weight loss and health-related quality of life in persons treated for head and neck cancer. Support Care Cancer 19(10):1511–1518CrossRefGoogle Scholar
  14. 14.
    Van Liew JR, Brock RL, Christensen AJ, Karnell LH, Pagedar NA, Funk GF (2017) Weight loss after head and neck cancer: a dynamic relationship with depressive symptoms. Head Neck 39(2):370–379CrossRefGoogle Scholar
  15. 15.
    Rodriguez AM, Braverman J, Aggarwal D, Friend J, Duus E (2017) The experience of weight loss and its associated burden in patients with non-small cell lung cancer: results of an online survey. JCSM Clin Rep 2:e00018. https://jcsm-clinical-reports.info/index.php/jcsm-cr/article/view/18. Accessed 3 Nov 2018
  16. 16.
    Hopkinson J, Wright D, Corner J (2006) Exploring the experience of weight loss in people with advanced cancer. J Adv Nurs 54(3):304–312CrossRefGoogle Scholar
  17. 17.
    Reid J, McKenna H, Fitzsimons D, McCance T (2009) The experience of cancer cachexia: a qualitative study of advanced cancer patients and their family members. Int J Nurs Stud 46(5):606–616CrossRefGoogle Scholar
  18. 18.
    Park S, Lee S, Hwang J, Kwon J-W (2017) The impact of weight misperception on health-related quality of life in Korean adults (KNHANES 2007–2014): a community-based cross-sectional study. BMJ Open 7(6):e016098CrossRefGoogle Scholar
  19. 19.
    Hayward J, Millar L, Petersen S, Swinburn B, Lewis AJ (2014) When ignorance is bliss: weight perception, body mass index and quality of life in adolescents. Int J Obes 38(10):1328–1334CrossRefGoogle Scholar
  20. 20.
    Burke MA, Heiland FW, Nadler CM (2010) From “overweight” to “about right”: evidence of a generational shift in body weight norms. Obesity. 18(6):1226–1234CrossRefGoogle Scholar
  21. 21.
    Herman KM, Hopman WM, Rosenberg MW (2013) Self-rated health and life satisfaction among Canadian adults: associations of perceived weight status versus BMI. Qual Life Res 22(10):2693–2705CrossRefGoogle Scholar
  22. 22.
    Heard C, Scuffham PA, Ratcliffe J, Whitty JA (2017) The association between misperceptions around weight status and quality of life in adults in Australia. Health Qual Life Outcomes 15(1):53CrossRefGoogle Scholar
  23. 23.
    Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL (1972) Indices of relative weight and obesity. J Chronic Dis 25(6):329–343CrossRefGoogle Scholar
  24. 24.
    Centers for Disease Control and Prevention. About Adult BMI. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Definition. Accessed 7 Oct 2018
  25. 25.
    WHO (2000) Obesity: preventing and managing the global epidemic. World Health Organization, GenevaGoogle Scholar
  26. 26.
    Garrow JS, Webster J (1985) Quetelet's index (W/H2) as a measure of fatness. Int J Obes 9(2):147–153PubMedGoogle Scholar
  27. 27.
    Ribaudo JM, Cella D, Hahn EA, Lloyd SR, Tchekmedyian NS, Von Roenn J et al (2001) Re-validation and shortening of the functional assessment of anorexia/cachexia therapy (FAACT) questionnaire. Qual Life Res Int J Qual Life Asp Treat Care Rehab 9(10):1137–1146Google Scholar
  28. 28.
    LeBlanc TW, Samsa GP, Wolf SP, Locke SC, Cella DF, Abernethy AP (2015) Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS). Support Care Cancer 23(8):2341–2347CrossRefGoogle Scholar
  29. 29.
    IBM Corp (2016) IBM SPSS statistics for windows, version 24.0. IBM Corp., ArmonkGoogle Scholar
  30. 30.
    Strasser F, Binswanger J, Cerny T, Kesselring A (2007) Fighting a losing battle: eating-related distress of men with advanced cancer and their female partners. A mixed-methods study. Palliat Med 21(2):129–137CrossRefGoogle Scholar
  31. 31.
    Gorber SC, Tremblay M, Moher D, Gorber BJO (2007) A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 8(4):307–326CrossRefGoogle Scholar
  32. 32.
    Yaemsiri S, Slining MM, Agarwal SK (2011) Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003–2008 Study. Int J Obes 35(8):1063–1070CrossRefGoogle Scholar
  33. 33.
    Lin CJ, DeRoo LA, Jacobs SR, Sandler DP (2012) Accuracy and reliability of self-reported weight and height in the Sister Study. Public Health Nutr 15(6):989–999CrossRefGoogle Scholar
  34. 34.
    Neff R, McCann GA, Carpenter KM, Cohn DE, Noria S, Mikami D et al (2014) Is bariatric surgery an option for women with gynecologic cancer? Examining weight loss counseling practices and training among gynecologic oncology providers. Gynecol Oncol 134(3):540–545CrossRefGoogle Scholar
  35. 35.
    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
  36. 36.
    Protani MM, Nagle CM, Webb PM (2012) Obesity and ovarian cancer survival: a systematic review and meta-analysis. Cancer Prev Res (Phila) 5(7):901–910CrossRefGoogle Scholar
  37. 37.
    Allott EH, Masko EM, Freedland SJ (2013) Obesity and prostate cancer: weighing the evidence. Eur Urol 63(5):800–809CrossRefGoogle Scholar
  38. 38.
    Bracci PM (2012) Obesity and pancreatic cancer: overview of epidemiologic evidence and biologic mechanisms. Mol Carcinog 51(1):53–63CrossRefGoogle Scholar
  39. 39.
    Rhondali W, Chisholm GB, Daneshmand M, Allo J, Kang D-H, Filbet M, Hui D, Fingeret MC, Bruera E (2013) Association between body image dissatisfaction and weight loss among patients with advanced cancer and their caregivers: a preliminary report. J Pain Symptom Manag 45(6):1039–1049CrossRefGoogle Scholar
  40. 40.
    Hopkinson JB (2014) Psychosocial impact of cancer cachexia. J Cachexia Sarcopenia Muscle 5(2):89–94CrossRefGoogle Scholar
  41. 41.
    Prado C, Mourtzakis M, Baracos V, Reiman T, Sawyer M, McCargar L (2010) Overweight and obese patients with solid tumors may have sarcopenia, poor prognosis and early features of cachexia. Int J Body Compos Res 8(1):7–15Google Scholar
  42. 42.
    Kim YJ, Austin SV, Subramanian SV, Kawachi I (2018) Body weight perception, disordered weight control behaviors, and depressive symptoms among Korean adults: The Korea National Health and Nutrition Examination Survey 2014. PLoS One 13(6):1–20CrossRefGoogle Scholar
  43. 43.
    Kim M, Lee HM (2010) Overestimation of own body weights in female university students: associations with lifestyles, weight control behaviors and depression. Nutr Res Pract 4(6):499–506CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cancer Support CommunityResearch and Training InstitutePhiladelphiaUSA
  2. 2.Vector Oncology AIBostonUSA
  3. 3.Duke Cancer Institute, School of MedicineDuke UniversityDurhamUSA
  4. 4.Carol G Simon Cancer CenterMorristown Medical CenterMorristownUSA

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