Clinical significance of weight changes at diagnosis in solid tumours

Abstract

Purpose: Weight changes occur throughout the cancer trajectory. Most research has focused on changes during or after treatment, so clinical significance of change at diagnosis remains unclear. This study aimed to determine prevalence, predictors and prognostic significance of weight changes at diagnosis in outpatients with solid tumours presenting to a tertiary academic medical centre.

Methods: A retrospective study of the electronic medical record was conducted (n = 6477). Those with weight recorded within 6 months of cancer diagnosis (pre-diagnosis, T₀) and 2 subsequent weights (diagnosis, T₁; final visit, T₂) were identified (n = 4258). Percentage weight change was categorised into four bands (0.1-2.4%; 2.5-5%; 5.01-9.9%; ≥ 10%) for gain and loss. A stable category was also included.

Results: Mean age is 61 ± 12.5 years. Common tumour sites: breast (17%; n = 725), prostate (16%; n = 664), lung (14%; n = 599). 15% (n = 652) had metastatic disease at T₁. 98% (n = 4159) had weight change at T₁. Head & neck and upper gastrointestinal cancers were significantly associated with weight loss (p < 0.001). Worst survival occurred with ≥ 10% weight gain or ≥ 10% weight loss. Overweight or obese body mass index with any percentage weight change band was associated with better overall survival.

Conclusions: Most had evidence of clinically significant weight changes at diagnosis. Weight loss at diagnosis was associated with a higher risk of further weight loss. A detailed weight history at cancer diagnosis is essential to identify and intervene for those most at risk of weight change-related early mortality.

Keywords: Cancer; Prognosis; Survival; Weight gain; Weight loss.