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Pretreatment Cancer-Associated Weight Loss and Prognosis

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Key Points

  • Pretreatment weight loss was observed across all disease stages.
  • Pretreatment weight loss was independently associated with poorer overall survival.

In a study reported in the Journal of Oncology Practice, Gannavarapu et al found that substantial unintentional weight loss prior to treatment is common among patients with cancer across stages of disease and is associated with poorer outcome.

Study Details

The retrospective cohort study included 3,180 adult patients with lung or gastrointestinal (including colorectal, liver, and pancreatic) cancer consecutively treated at The University of Texas Southwestern Medical Center between January 2006 and December 2013. Pretreatment cancer-associated weight loss was based on the international consensus definition of cachexia. Overt cancer-associated weight loss was defined as unintentional weight loss > 5% within 6 months preceding cancer diagnosis in patients with body mass index (BMI)  ≥ 20 kg/m2 or unintentional weight loss > 2% in patients with lower BMI; minimal weight loss was defined as unintentional weight loss not meeting criteria for overt weight loss.

Prevalence of Weight Loss

Overt weight loss was observed in 1,083 patients (34.1%) at cancer diagnosis. Minimal weight loss was identified in 116 patients (3.6%). Pretreatment weight loss was found in 17.6%, 25.8%, 36.6%, and 43.3% of stage I, II, III, and IV cancers. Overt weight loss was identified in 30.4% of patients with non–small cell lung cancer; 38.0% of those with small cell lung cancer; 56.5% of those with gastroesophageal cancers; 24.3% of those with hepatobiliary cancers; 53.2% of those with pancreatic cancer; 27.6% of those with colorectal cancer; and 26.1% of those with anal cancer.

Pretreatment weight loss was associated with reduced overall survival in analysis adjusting for disease stage, tumor size, tumor grade, comorbidity, age, sex, and tobacco use history (hazard ratio = 1.26, 95% confidence interval [CI] = 1.13–1.39). The median survival of patients with no weight loss, minimal weight loss, and overt weight loss at diagnosis was 28.2, 17.5, and 13.6 months (P <.001). Survival among patients with no weight loss and those with minimal weight loss was similar in the first year after diagnosis and diverged thereafter.

The investigators concluded, “Pretreatment cancer-associated weight loss is common, even in early-stage disease, and is independently associated with reduced survival. Minimal weight loss represents a clinically distinct entity with an associated overall survival intermediate to that of no weight loss and overt wasting. Early diagnosis and treatment of cancer-associated wasting offers a novel therapeutic avenue for reducing cancer mortality.”

The study was supported in part by grants from the National Center for Advancing Translational Sciences.

Puneeth Iyengar, MD, PhD, of The University of Texas Southwestern Medical Center, Dallas, is the corresponding author for the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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