Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers?

Our plain-English summary of Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers?, by P.J. Ross, S. Ashley, A. Norton, et al (British Journal of Cancer, 2004).

The study

• Authors: P.J. Ross, S. Ashley, A. Norton, K. Priest, J.S. Waters, T. Eisen, I.E. Smith, M.E. O'Brien
• Journal: British Journal of Cancer
• Published: 2004;90(10):1905-11
• Cited by: 342 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

To examine whether weight loss at presentation influences outcome in patients who received chemotherapy for lung cancer or mesothelioma. Multivariate analysis of prospectively collected data 1994-2001. Data were available for age, gender, performance status, histology, stage, response, toxicity, progression-free and overall survival. The outcomes of patients with or without weight loss treated with chemotherapy for small cell lung cancer (SCLC; n=290), stages III and IV non-small-cell lung cancer (NSCLC; n=418), or mesothelioma (n=72) were compared. Weight loss was reported by 59, 58 and 76% of patients with SCLC, NSCLC and mesothelioma, respectively. Patients with weight loss and NSCLC (P=0.003) or mesothelioma (P=0.05) more frequently failed to complete at least three cycles of chemotherapy. Anaemia as a toxicity occurred significantly more frequently in NSCLC patients with weight loss (P=0.0003). The incidence of other toxicities was not significantly affected by weight loss. NSCLC patients with weight loss had fewer symptomatic responses (P=0.001). Mesothelioma patients with weight loss had fewer symptomatic (P=0.03) and objective responses (P=0.05). Weight loss was an independent predictor of shorter overall survival for patients with SCLC (P=0.003, relative risk (RR)=1.5), NSCLC (P=0.009, RR=1.33) and mesothelioma (P=0.03, RR=1.92) and an independent predictor of progression-free survival in patients with SCLC (P=0.01, RR=1.43). In conclusion, weight loss as a symptom of lung cancer predicts for toxicity from treatment and shorter survival.

In plain English

Researchers at the Royal Marsden Hospital lung unit in the UK reviewed prospectively recorded data on 780 patients given chemotherapy between 1994 and March 2001. The group included 290 with small cell lung cancer, 418 with stage III or IV non-small-cell lung cancer and 72 with mesothelioma. They compared patients who said they had lost weight at their first visit with those who said they had not. Weight loss was reported by 76% of the mesothelioma patients. Among mesothelioma patients, those with weight loss had fewer tumour responses (9% vs 29%) and fewer symptom improvements (33% vs 65%), and their median overall survival was 5 months compared with 12 months. After allowing for other factors such as performance status, weight loss remained linked to shorter survival in all three groups (mesothelioma RR 1.9, 95% CI 1.1 to 3.5). In non-small-cell lung cancer, weight loss was linked to more severe anaemia and fewer patients completing three cycles. The authors concluded that weight loss predicts toxicity and shorter survival. They noted that it remains to be shown whether weight loss is simply a marker of poor prognosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Analysis of data recorded prospectively on a hospital research database, with multivariate (Cox) survival analysis
• Who was studied: 780 patients treated with chemotherapy by the Royal Marsden Hospital lung unit (Sutton, UK), 1994 to March 2001: 290 with small cell lung cancer (SCLC), 418 with stage III or IV non-small-cell lung cancer (NSCLC), 72 with mesothelioma; median age 63 years, 64% male
• Exposure: Weight loss at presentation, as reported by the patient, compared with no reported weight loss; also, in patients who had lost weight, weight stabilisation versus continued weight loss during the first 63 days of chemotherapy. Asbestos exposure was not studied.
• Main results:
  • Weight loss was reported by 171 of 290 SCLC patients (59%), 244 of 418 NSCLC patients (58%) and 55 of 72 mesothelioma patients (76%). Weight loss was reported more often with mesothelioma than with SCLC or NSCLC.
  • Across all patients, 67% (315) with weight loss completed three cycles of chemotherapy, compared with 81% (210) without weight loss. In NSCLC the figures were 64% vs 78%, attributed to early disease progression. In mesothelioma, weight loss was also associated with fewer patients completing at least three cycles. In SCLC the difference (77 vs 84%) was not significant.
  • NSCLC patients with weight loss were significantly more likely to develop severe anaemia as a toxicity (grade 3 to 4: 6.5% vs 1.9%, P = 0.0003). Anaemia was not more common with weight loss in SCLC or mesothelioma, and no differences in other toxicities were observed.
  • In mesothelioma, patients with weight loss had a lower objective response rate (9% vs 29%, P = 0.05) and fewer symptomatic responses (33% vs 65%, P = 0.03). In NSCLC, symptomatic responses were 44% vs 60% (P = 0.004), with no significant difference in objective response.
  • Median overall survival was shorter with weight loss than without: SCLC 8 vs 11 months (P = 0.0003), NSCLC 6 vs 9 months (P less than 0.0001), mesothelioma 5 vs 12 months (P = 0.025).
  • In multivariate analysis, weight loss remained a prognostic factor for overall survival. The relative risks were 1.5 (95% CI 1.0 to 1.9) in SCLC, 1.3 (95% CI 1.1 to 1.7) in NSCLC, and 1.9 (95% CI 1.1 to 3.5) in mesothelioma.
  • For progression-free survival, weight loss raised the relative risk of progression in SCLC (1.4, 95% CI 1.0 to 1.8). It was not a prognostic factor in NSCLC. No factors significantly predicted progression-free survival in mesothelioma, where the unadjusted difference (3 vs 6 months, P = 0.11) was not statistically significant.
  • Weight over the first 63 days was recorded for 198 of the 470 patients with weight loss. In NSCLC, weight stabilisation was associated with longer progression-free survival (5 to 7 months) and overall survival (7 to 9 months). In SCLC it was not. Only three mesothelioma patients had weight stabilisation, and this did not affect survival.
• The authors' conclusion: The authors concluded that weight loss as a symptom of lung cancer predicts toxicity from treatment and shorter survival. They called for randomised studies of nutritional intervention, initially in NSCLC patients.
• Limitations the authors state:
  • It was not known whether patients with weight loss had received any nutritional intervention.
  • The study could not show whether weight loss is only a marker of poor prognosis or whether it itself reduces the ability to treat patients effectively.
  • Radiotherapy given after chemotherapy was not included in the analysis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, Lung Cancer, Mesothelioma, Multivariate Analysis, Performance Status, Histology, Overall Survival, Small Cell Lung Cancer.

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