title: Diagnostic criteria for the classification of cancer-associated weight loss.
abstract: OBJECTIVE
  Existing definitions of clinically important weight loss (WL) in patients with cancer are unclear and heterogeneous and do not consider current trends toward obesity.
  
  
  METHODS
  Canadian and European patients with cancer (n = 8,160) formed a population-based data set. Body mass index (BMI) and percent WL (%WL) were recorded, and patients were observed prospectively until death. Data were entered into a multivariable analysis controlling for age, sex, cancer site, stage, and performance status. Relationships for BMI and %WL to overall survival were examined to develop a grading system.
  
  
  RESULTS
  Mean overall %WL was -9.7% ± 8.4% and BMI was 24.4 ± 5.1 kg/m(2), and both %WL and BMI independently predicted survival (P < .01). Differences in survival were observed across five categories of BMI (< 20.0, 20.0 to 21.9, 22.0 to 24.9, 25.0 to 27.9, and ≥ 28.0 kg/m(2); P < .001) and five categories of %WL (-2.5% to -5.9%, -6.0% to -10.9%, -11.0% to -14.9%, ≥ -15.0%, and weight stable (± 2.4%); P < .001). A 5 × 5 matrix representing the five %WL categories within each of the five BMI categories was graded based on median survival and prognostic significance. Weight-stable patients with BMI ≥ 25.0 kg/m(2) (grade 0) had the longest survival (20.9 months; 95% CI, 17.9 to 23.9 months), and %WL values associated with lowered categories of BMI were related to shorter survival (P < .001), as follows: grade 1, 14.6 months (95% CI, 12.9 to 16.2 months); grade 2, 10.8 months (95% CI, 9.7 to 11.9 months); grade 3, 7.6 months (95% CI, 7.0 to 8.2 months); and grade 4, 4.3 months (95% CI, 4.1 to 4.6 months). Survival discrimination by grade was observed within specific cancers, stages, ages, and performance status and in an independent validation sample (n = 2,963).
  
  
  CONCLUSIONS
  A robust grading system incorporating the independent prognostic significance of both BMI and %WL was developed.
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Lisa
authors.initials: L
authors.lastname: Martin
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Pierre
authors.initials: P
authors.lastname: Senesse
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Gioulbasanis
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Sami
authors.initials: S
authors.lastname: Antoun
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Federico
authors.initials: F
authors.lastname: Bozzetti
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Chris
authors.initials: C
authors.lastname: Deans
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Florian
authors.initials: F
authors.lastname: Strasser
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Lene
authors.initials: L
authors.lastname: Thoresen
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: R Thomas
authors.initials: RT
authors.lastname: Jagoe
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Chasen
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Kent
authors.initials: K
authors.lastname: Lundholm
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bosaeus
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Fearon
authors.affiliation: Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden. vickie.baracos@ualberta.ca.
authors.forename: Vickie E
authors.initials: VE
authors.lastname: Baracos
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002100:Cachexia / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D002170:Canada; D016208:Databases, Factual / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D011159:Population Surveillance / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D015431:Weight Loss / Q000502:physiology*