Biology and Management of Lung Cancer

Volume 11 of the series Cancer Treatment and Research pp 125-142

Lung Cancer Cachexia

  • Rowan T. Chlebowski
  • , David Heber
  • , Jerome B. Block

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Weight loss in patients with advanced lung carcinoma has been recognized clinically for many years. However, only recently has the prognostic significance of weight loss in patients with this disease been identified. In one report by Costa and co-workers [1] the incidence, timing, and severity of weight loss in a total of 479 patients with lung cancer was related to patient survival. At their initial clinical presentation, 47% of lung cancer patients had lost at least 5% of their usual body weight. The survival of these patients was significantly less than that of patients not experiencing weight loss, even when corrected for factors such as age, sex, extent of disease, cell type and performance score [1]. An analysis of 1,026 patients from the Eastern Cooperative Oncology Group revealed evidence of weight loss during the previous 6 months in 57% of small cell and 61% of non-small cell lung cancer patients [2]. In both categories of lung cancer, median survival was significantly decreased for patients experiencing antecedent weight loss prior to protocol chemotherapy: 34 weeks vs 27 weeks in small cell; 20 weeks vs 14 weeks in non-small cell. The influence of weight loss on survival in these large reports exceeds the current influence of chemotherapy on survival in non-small cell disease. Thus, weight loss at the time of clinical presentation is an important, independent factor prognostic of survival in patients with lung cancer.