TY - JOUR
T1 - Prevalence and survival impact of pretreatment cancer-associated weight loss
T2 - A tool for guiding early palliative care
AU - Gannavarapu, Bhavani S.
AU - Lau, Steven K.M.
AU - Carter, Kristen
AU - Cannon, Nathan A.
AU - Gao, Ang
AU - Ahn, Chul
AU - Meyer, Jeffrey J.
AU - Sher, David J.
AU - Jatoi, Aminah
AU - Infante, Rodney
AU - Iyengar, Puneeth
N1 - Funding Information:
B.S.G. and S.K.M.L. contributed equally to this work. R.I. and P.I. contributed equally to this work. Supported in part by the National Center for Advancing Translational Sciences Grants No. TL1TR001104 and UL1TR001105. Presented in part at the Association for Clinical and Translational Science 2015 Meeting, Washington, DC, April 16-18, 2015 and the 16th World Conference on Lung Cancer, Denver, CO, September 6-9, 2015. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We thank Alejandra Madrigales and Philip Reeder of the University of Texas Southwestern Tumor Registry for their contributions to this research.
Publisher Copyright:
Copyright © 2018 by American Society of Clinical Oncology.
PY - 2018/2
Y1 - 2018/2
N2 - Purpose Cancer-associated weight loss is associated with poor prognosis in advanced malignancy; however, its pretreatment prevalence and survival impact are inadequately described in large cohorts. Such data, stratified by tumor type and stage, may facilitate the optimal and timely allocation of complementary care, leading to improvements in patient survival and quality of life. Methods We performed a retrospective cohort study of 3,180 consecutively treated adult patients with lung or GI (including colorectal, liver, and pancreatic) cancer. Pretreatment cancer-associated weight loss was based on the international consensus definition of cachexia. Prevalence and survival impact of pretreatment cancer-associated weight loss were evaluated using the Kaplan-Meier method and compared using log-rank test. Results Cancer-associated weight loss was observed at the time of cancer diagnosis in 34.1% of patients. Pretreatment weight loss was documented in 17.6%, 25.8%, 36.6%, and 43.3% of stage I, II, III, and IV cancers, respectively. Wasting was common regardless of tumor type, with prevalence at diagnosis ranging from 27.3% in patients with colorectal cancer to 53.4% in patients with gastroesophageal cancer. Pretreatment weight loss was associated with reduced overall survival after adjusting for stage, size, grade, comorbidity, age, sex, and tobacco history (hazard ratio, 1.26; 95% CI, 1.13 to 1.39). Conclusion 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.
AB - Purpose Cancer-associated weight loss is associated with poor prognosis in advanced malignancy; however, its pretreatment prevalence and survival impact are inadequately described in large cohorts. Such data, stratified by tumor type and stage, may facilitate the optimal and timely allocation of complementary care, leading to improvements in patient survival and quality of life. Methods We performed a retrospective cohort study of 3,180 consecutively treated adult patients with lung or GI (including colorectal, liver, and pancreatic) cancer. Pretreatment cancer-associated weight loss was based on the international consensus definition of cachexia. Prevalence and survival impact of pretreatment cancer-associated weight loss were evaluated using the Kaplan-Meier method and compared using log-rank test. Results Cancer-associated weight loss was observed at the time of cancer diagnosis in 34.1% of patients. Pretreatment weight loss was documented in 17.6%, 25.8%, 36.6%, and 43.3% of stage I, II, III, and IV cancers, respectively. Wasting was common regardless of tumor type, with prevalence at diagnosis ranging from 27.3% in patients with colorectal cancer to 53.4% in patients with gastroesophageal cancer. Pretreatment weight loss was associated with reduced overall survival after adjusting for stage, size, grade, comorbidity, age, sex, and tobacco history (hazard ratio, 1.26; 95% CI, 1.13 to 1.39). Conclusion 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.
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U2 - 10.1200/JOP.2017.025221
DO - 10.1200/JOP.2017.025221
M3 - Article
C2 - 29466074
AN - SCOPUS:85056732623
SN - 1554-7477
VL - 14
SP - e238-e250
JO - Journal of oncology practice
JF - Journal of oncology practice
IS - 4
ER -