Evaluation of nutritional status in advanced metastatic cancer

Abstract

Consecutive cancer referrals to a palliative medicine program were evaluated to assess nutritional status using a standard protocol. The study included 352 patients (180 men, 172 women; median age 61 years, range 22–94 years). The most common diagnosis was lung cancer. All had metastatic disease, 139 with gastrointestinal involvement. The most common gastrointestinal symptoms were weight loss (n=307), anorexia (n=285), and early satiety (n=243). Of those with any weight loss, 71% had lost ≥10% of their pre-illness weight. The most common factor identified which might have contributed to weight loss was hypophagia (n=275/307). Men had lost weight more often and to a greater extent than women. Triceps skinfold (TSF) was measured in 337: 51% had values that suggested severe fat deficiency. Upper mid-arm muscle area (AMA) was measured in 349: 30% had evidence of significant muscle mass reduction. The body mass index (BMI) was normal or increased in most patients. Calculated resting energy expenditure (REE) (n=324) was high in 41%. C-reactive protein was elevated in 74% of those measured (n=50). We conclude that: (1) most of this group of cancer patients referred to palliative medicine had severe weight loss; (2) there was a gender difference in the severity and type of weight loss; (3) males lost more weight overall and more muscle than females; (4) males with any degree of weight loss had a higher REE than females; (5) a significant correlation existed between the time from diagnosis to death and the severity of weight loss in the prior month; (6) BMI was normal in most patients, suggesting precancer diagnosis obesity; and (7) both TSF and AMA correlated well with body composition of both fat and protein as determined by bioelectrical impedance.