Evaluation of nutritional status in advanced metastatic cancer

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 greater than or equal to10% 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.