P1.06-010 Analysis of the Incidence of Cancer Cachexia in Patients with Advanced Lung Cancer at Referral to a Dietitian

Abstract

Lung cancer is the second most common cancer diagnosed in men and women in the UK with a very poor 5 year survival (10%). There is a lack of robust data on the stage of cachexia in which patients with lung cancer present. The severity of cachexia can influence overall outcomes and a patient’s quality of life. Refractory (irreversible) cachexia indicates a poor prognosis. We reviewed all patients diagnosed with metastatic primary lung cancer that were referred to the Macmillan Oncology Dietitians over a 4 year period at the Royal Surrey County Hospital. Reasons for referral commonly included: weight loss, glycemic control in diabetes, decreased oral intake and food texture modification. We compared self-reported usual body weight (UBW) to weight at referral. Patients were defined as cachectic if weight loss was >5% and refractory cachexia if survival was <90 days from dietitian review. 310 patients with incurable lung cancer were reviewed by the dietitian. Mean age was 68.8 (range 36-89). 42% were female, 58% were male. Mean weight loss was 10%. 76% of patients had lost >5% of usual body weight. Mean pre-cancer body mass index (BMI) was 26.9 (kg/m2), mean BMI at referral was 23.0 (kg/m2). Median survival of non-cachectic and cachectic cohorts were different (299 vs 188 days respectively, p=0.0078). 24% (73 patients) had refractory cachexia. Our study shows cachexia is very common (76%) in lung cancer and affects survival. A quarter of patients had refractory cachexia. BMI is an insensitive measure of weight loss. Early symptom control improves survival in lung cancer and this data suggests patients are routinely being referred too late to a dietitian. Cachexia in lung cancer is a significant clinical problem. Could upfront assessment of cachexia improve outcome in patients with advanced lung cancer? We propose to investigate this further.