WHY DO PATIENTS WITH WEIGHT-LOSS HAVE A WORSE OUTCOME WHEN UNDERGOINGCHEMOTHERAPY FOR GASTROINTESTINAL MALIGNANCIES

The aim of this study was to examine whether weight loss at presentati on, in patients who were to receive chemotherapy for gastrointestinal carcinomas, influences outcome and whether nutritional intervention wo uld be worthwhile. This study was a retrospective review of prospectiv ely gathered data. The outcomes of patients with or without weight los s and treated for locally advanced or metastatic tumours of the oesoph agus, stomach, pancreas, colon or rectum were compared. In 1555 such c onsecutive patients treated over a 6-year period, weight loss at prese ntation was reported more commonly by men than women (51 versus 44%, P = 0.01). Although patients with weight loss received lower chemothera py doses initially, they developed more frequent and more severe dose limiting toxicity-specifically plantar-palmar syndrome (P < 0.0001) an d stomatitis (P < 0.0001)-than patients without weight loss. Consequen tly, patients with weight loss on average received 1 month (18%) less treatment (P < 0.0001). Weight loss correlated with shorter failure-fr ee (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 stoppe d 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 a ttempting randomised nutritional intervention studies in these patient s. (C) 1998 Elsevier Science Ltd. All rights reserved.