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Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies?

Abstract

The aim of this study was to examine whether weight loss at presentation, in patients who were to receive chemotherapy for gastrointestinal carcinomas, influences outcome and whether nutritional intervention would be worthwhile. This study was a retrospective review of prospectively gathered data. The outcomes of patients with or without weight loss and treated for locally advanced or metastatic tumours of the oesophagus, stomach, pancreas, colon or rectum were compared. In 1555 such consecutive patients treated over a 6-year period, weight loss at presentation was reported more commonly by men than women (51 versus 44%, P = 0.01). Although patients with weight loss received lower chemotherapy doses initially, they developed more frequent and more severe dose limiting toxicity--specifically plantar-palmar syndrome (P < 0.0001) and stomatitis (P < 0.0001)--than patients without weight loss. Consequently, patients with weight loss on average received 1 month (18%) less treatment (P < 0.0001). Weight loss correlated with shorter failure-free (P < 0.0001, hazard ratio = 1.25) and overall survival (P < 0.0001, hazard ratio = 1.63), decreased response (P = 0.006), quality of life (P < 0.0001) and performance status (P < 0.0001). Patients who stopped losing weight had better overall survival (P = 0.0004). Weight loss at presentation was an independent prognostic variable (hazard ratio = 1.43). The poorer outcome from treatment in patients with weight loss appears to occur because they receive significantly less chemotherapy and develop more toxicity rather than any specifically reduced tumour responsiveness to treatment. These findings provide a rationale for attempting randomised nutritional intervention studies in these patients.

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  • Authors+Show Affiliations

    ,

    Gastrointestinal Unit, Royal Marsden Hospital, Sutton, Surrey, U.K.

    , ,

    Source

    MeSH

    Adenocarcinoma
    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Antimetabolites, Antineoplastic
    Carcinoma, Squamous Cell
    Colorectal Neoplasms
    Disease-Free Survival
    Esophageal Neoplasms
    Female
    Fluorouracil
    Gastrointestinal Neoplasms
    Humans
    Male
    Middle Aged
    Pancreatic Neoplasms
    Prospective Studies
    Quality of Life
    Retrospective Studies
    Stomach Neoplasms
    Survival Analysis
    Time Factors
    Treatment Failure
    Weight Loss

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    9713300

    Citation

    Andreyev, H J., et al. "Why Do Patients With Weight Loss Have a Worse Outcome when Undergoing Chemotherapy for Gastrointestinal Malignancies?" European Journal of Cancer (Oxford, England : 1990), vol. 34, no. 4, 1998, pp. 503-9.
    Andreyev HJ, Norman AR, Oates J, et al. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4):503-9.
    Andreyev, H. J., Norman, A. R., Oates, J., & Cunningham, D. (1998). Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? European Journal of Cancer (Oxford, England : 1990), 34(4), pp. 503-9.
    Andreyev HJ, et al. Why Do Patients With Weight Loss Have a Worse Outcome when Undergoing Chemotherapy for Gastrointestinal Malignancies. Eur J Cancer. 1998;34(4):503-9. PubMed PMID: 9713300.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? AU - Andreyev,H J, AU - Norman,A R, AU - Oates,J, AU - Cunningham,D, PY - 1998/8/26/pubmed PY - 1998/8/26/medline PY - 1998/8/26/entrez SP - 503 EP - 9 JF - European journal of cancer (Oxford, England : 1990) JO - Eur. J. Cancer VL - 34 IS - 4 N2 - The aim of this study was to examine whether weight loss at presentation, in patients who were to receive chemotherapy for gastrointestinal carcinomas, influences outcome and whether nutritional intervention would be worthwhile. This study was a retrospective review of prospectively gathered data. The outcomes of patients with or without weight loss and treated for locally advanced or metastatic tumours of the oesophagus, stomach, pancreas, colon or rectum were compared. In 1555 such consecutive patients treated over a 6-year period, weight loss at presentation was reported more commonly by men than women (51 versus 44%, P = 0.01). Although patients with weight loss received lower chemotherapy doses initially, they developed more frequent and more severe dose limiting toxicity--specifically plantar-palmar syndrome (P < 0.0001) and stomatitis (P < 0.0001)--than patients without weight loss. Consequently, patients with weight loss on average received 1 month (18%) less treatment (P < 0.0001). Weight loss correlated with shorter failure-free (P < 0.0001, hazard ratio = 1.25) and overall survival (P < 0.0001, hazard ratio = 1.63), decreased response (P = 0.006), quality of life (P < 0.0001) and performance status (P < 0.0001). Patients who stopped losing weight had better overall survival (P = 0.0004). Weight loss at presentation was an independent prognostic variable (hazard ratio = 1.43). The poorer outcome from treatment in patients with weight loss appears to occur because they receive significantly less chemotherapy and develop more toxicity rather than any specifically reduced tumour responsiveness to treatment. These findings provide a rationale for attempting randomised nutritional intervention studies in these patients. SN - 0959-8049 UR - https://www.unboundmedicine.com/medline/citation/9713300/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959804997100909 DB - PRIME DP - Unbound Medicine ER -