The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancer

Abstract Background Weight loss (WL) has long been recognized as an important factor associated with reduced quality of life (QoL) and reduced survival in patients with cancer. The body mass index (BMI)‐adjusted weight loss grading system (WLGS) has been shown to be associated with reduced survival....

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Main Authors: Louise Daly, Ross Dolan, Derek Power, Éadaoin Ní Bhuachalla, Wei Sim, Marie Fallon, Samantha Cushen, Claribel Simmons, Donald C. McMillan, Barry J. Laird, Aoife Ryan
Format: Article
Language:English
Published: Wiley 2020-02-01
Series:Journal of Cachexia, Sarcopenia and Muscle
Subjects:
Online Access:https://doi.org/10.1002/jcsm.12499
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record_format Article
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language English
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author Louise Daly
Ross Dolan
Derek Power
Éadaoin Ní Bhuachalla
Wei Sim
Marie Fallon
Samantha Cushen
Claribel Simmons
Donald C. McMillan
Barry J. Laird
Aoife Ryan
spellingShingle Louise Daly
Ross Dolan
Derek Power
Éadaoin Ní Bhuachalla
Wei Sim
Marie Fallon
Samantha Cushen
Claribel Simmons
Donald C. McMillan
Barry J. Laird
Aoife Ryan
The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancer
Journal of Cachexia, Sarcopenia and Muscle
Cancer
Malnutrition
Weight loss
Cachexia
Quality of life
Survival
author_facet Louise Daly
Ross Dolan
Derek Power
Éadaoin Ní Bhuachalla
Wei Sim
Marie Fallon
Samantha Cushen
Claribel Simmons
Donald C. McMillan
Barry J. Laird
Aoife Ryan
author_sort Louise Daly
title The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancer
title_short The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancer
title_full The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancer
title_fullStr The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancer
title_full_unstemmed The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancer
title_sort relationship between the bmi‐adjusted weight loss grading system and quality of life in patients with incurable cancer
publisher Wiley
series Journal of Cachexia, Sarcopenia and Muscle
issn 2190-5991
2190-6009
publishDate 2020-02-01
description Abstract Background Weight loss (WL) has long been recognized as an important factor associated with reduced quality of life (QoL) and reduced survival in patients with cancer. The body mass index (BMI)‐adjusted weight loss grading system (WLGS) has been shown to be associated with reduced survival. However, its impact on QoL has not been established. The aim of this study was to assess the relationship between this WLGS and QoL in patients with advanced cancer. Methods A biobank analysis was undertaken of adult patients with advanced cancer. Data collected included patient demographics, Eastern Cooperative Oncology Group performance status, and anthropometric parameters (BMI and %WL). Patients were categorized according to the BMI‐adjusted WLGS into one of five distinct WL grades (grades 0–4). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐C30. The Kruskal–Wallis test and multivariate logistic regression analyses were used to assess the relationship between the WLGS and QoL scores. Overall survival was assessed using Kaplan–Meier curve and Cox proportional hazard models. Results A total of 1027 patients were assessed (51% male, median age: 66 years). Gastrointestinal cancer was most prevalent (40%), and 87% of patients had metastatic disease. Half (58%) of patients had a WL grade of 0–1, while 12%, 20%, and 10% had WL grades of 2, 3, and 4, respectively. Increasing WL grades were significantly associated with poorer QoL functioning and symptoms scales (all P < 0.05). Physical, role, and emotional functioning decreased by a median of >20 points between WL grade 0 and WL grade 4, while appetite loss, pain, dyspnoea, and fatigue increased by a median score >20 points, indicative of a large clinical significant difference. Increasing WL grades were associated with deteriorating QoL summary score. WL grades 2, 3, and 4 were independently associated with a QoL summary score below the median (<77.7) [odds ratio (OR) 1.69, P = 0.034; OR 2.06, P = 0.001; OR 4.29, P < 0.001, respectively]. WL grades 3 and 4 were independently associated with reduced overall survival [hazard ratio 1.54 (95% confidence interval: 1.22–1.93), P < 0.001 and hazard ratio 1.87 (95% confidence interval: 1.42–2.45), P < 0.001, respectively]. Conclusions Our findings support that the WLGS is useful in identifying patients at risk of poor QoL that deteriorates with increasing WL grades. WL grade 4 is independently associated with a particularly worse prognosis and increased symptom burden. Identification and early referral to palliative care services may benefit these patients.
topic Cancer
Malnutrition
Weight loss
Cachexia
Quality of life
Survival
url https://doi.org/10.1002/jcsm.12499
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spelling doaj-4201989b101f4619acd1cfe28ebe4c282020-11-25T01:13:27ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092020-02-0111116016810.1002/jcsm.12499The relationship between the BMI‐adjusted weight loss grading system and quality of life in patients with incurable cancerLouise Daly0Ross Dolan1Derek Power2Éadaoin Ní Bhuachalla3Wei Sim4Marie Fallon5Samantha Cushen6Claribel Simmons7Donald C. McMillan8Barry J. Laird9Aoife Ryan10School of Food and Nutritional Sciences, College of Science, Engineering and Food Science University College Cork Cork IrelandAcademic Unit of Surgery University of Glasgow Glasgow UKDepartment of Medical Oncology Mercy and Cork University Hospital Cork IrelandSchool of Food and Nutritional Sciences, College of Science, Engineering and Food Science University College Cork Cork IrelandAcademic Unit of Surgery University of Glasgow Glasgow UKEdinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh UKSchool of Food and Nutritional Sciences, College of Science, Engineering and Food Science University College Cork Cork IrelandEdinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh UKAcademic Unit of Surgery University of Glasgow Glasgow UKEdinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh UKSchool of Food and Nutritional Sciences, College of Science, Engineering and Food Science University College Cork Cork IrelandAbstract Background Weight loss (WL) has long been recognized as an important factor associated with reduced quality of life (QoL) and reduced survival in patients with cancer. The body mass index (BMI)‐adjusted weight loss grading system (WLGS) has been shown to be associated with reduced survival. However, its impact on QoL has not been established. The aim of this study was to assess the relationship between this WLGS and QoL in patients with advanced cancer. Methods A biobank analysis was undertaken of adult patients with advanced cancer. Data collected included patient demographics, Eastern Cooperative Oncology Group performance status, and anthropometric parameters (BMI and %WL). Patients were categorized according to the BMI‐adjusted WLGS into one of five distinct WL grades (grades 0–4). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐C30. The Kruskal–Wallis test and multivariate logistic regression analyses were used to assess the relationship between the WLGS and QoL scores. Overall survival was assessed using Kaplan–Meier curve and Cox proportional hazard models. Results A total of 1027 patients were assessed (51% male, median age: 66 years). Gastrointestinal cancer was most prevalent (40%), and 87% of patients had metastatic disease. Half (58%) of patients had a WL grade of 0–1, while 12%, 20%, and 10% had WL grades of 2, 3, and 4, respectively. Increasing WL grades were significantly associated with poorer QoL functioning and symptoms scales (all P < 0.05). Physical, role, and emotional functioning decreased by a median of >20 points between WL grade 0 and WL grade 4, while appetite loss, pain, dyspnoea, and fatigue increased by a median score >20 points, indicative of a large clinical significant difference. Increasing WL grades were associated with deteriorating QoL summary score. WL grades 2, 3, and 4 were independently associated with a QoL summary score below the median (<77.7) [odds ratio (OR) 1.69, P = 0.034; OR 2.06, P = 0.001; OR 4.29, P < 0.001, respectively]. WL grades 3 and 4 were independently associated with reduced overall survival [hazard ratio 1.54 (95% confidence interval: 1.22–1.93), P < 0.001 and hazard ratio 1.87 (95% confidence interval: 1.42–2.45), P < 0.001, respectively]. Conclusions Our findings support that the WLGS is useful in identifying patients at risk of poor QoL that deteriorates with increasing WL grades. WL grade 4 is independently associated with a particularly worse prognosis and increased symptom burden. Identification and early referral to palliative care services may benefit these patients.https://doi.org/10.1002/jcsm.12499CancerMalnutritionWeight lossCachexiaQuality of lifeSurvival