Body mass index but not percentage weight loss was associated with the race/ethnicity of patients with advanced lung cancer: a cross-sectional study.

Abstract

Background: Patients with cancer often experience weight loss, which contributes to a decreased quality of life and signals a poor prognosis. The objective of this retrospective study is to investigate whether the self-reported race/ethnicity of patients undergoing palliative care is associated with weight loss.

Methods: The charts of 1,253 patients with advanced lung cancer who had a Palliative Medicine consultation, during 2022, were identified and random sample of 94 Asian, 94 Black, 87 Hispanic and 91 non-Hispanic-White patients were selected for evaluation. Patient demographics, the Eastern Cooperative Oncology Group (ECOG) performance status, body mass index (BMI), weight history, symptom burden measured by the Edmonton Symptom Assessment System (ESAS), cancer treatments provided (chemotherapy, radiation, surgery, or immunotherapy), prescription of appetite stimulants [megestrol acetate, steroids, olanzapine, cannabinoids, metoclopramide, or mirtazapine), and nutritional laboratory markers (albumin, protein level, neutrophile-to-lymphocyte ratio (NLR)] were collected. Univariate and multivariable regression linear analysis were performed to explore whether a patient's self-identified race/ethnicity was an independent predictor of weight loss.

Results: Among the different self-identified racial/ethnic groups of patients, no significant differences in age, gender, appetite stimulants received, and NLR were noted. The Asian and Hispanic cohort had significantly lower weight and BMI at first encounter, Palliative Medicine consultation, and final recorded visit compared to all other groups (P<0.01). The median time from the first encounter to the last recorded weight was 6.7 months for the whole cohort. Asian patients had significantly less total weight loss (8.2 kg) compared to Black (13.4 kg), Hispanic (9.1 kg), and non-Hispanic White (10.2 kg) patients (P=0.04); but all four groups experienced similar proportion of weight loss (%) (12.8 vs. 14.9 vs. 12.2 vs. 12.9; P=0.79), respectively. Asian patients had a higher median household income (P<0.001), less likely to live alone (P=0.02), and more likely to be married or have a significant other (P<0.001). In a multivariate analysis, the weight at first encounter but not race/ethnicity was the only independent predictor of percentage weight loss.

Conclusions: In patients with advanced lung cancer, BMI and total weight loss but not percentage change in weight was significantly associated with self-identified race/ethnicity at the time of Palliative Medicine consultation. On multivariate analysis, the percentage loss in weight was significantly influenced by the weight at first encounter but not race/ethnicity. Racial/ethnic variations in BMI but not percentage weight loss should be accounted for when diagnosing cancer cachexia and more research is needed.