Weight Loss: An Important but Often Overlooked Clue for the Diagnosis of Cancer

One of the primary goals of care for cancer patients is to detect growth and or recurrence as early as possible. We retrospectively evaluated unexplained weight loss of 5% or more as an indicator of cancer growth or recurrence in patients who were followed in a hematology/oncology clinic. In addition, we noted the frequency of physician recognition of the weight loss as well as the time delay from the onset of weight loss to detection of new cancer/metastasis.

A search of the data base in the electronic medical record identified 90 cancer patients whose weight had decreased by 5 % or more over a maximal time period of 3 years. Weight loss in 30 of the patients could be explained as intentional (diet, exercise, gastric bypass) or because of advanced cancer or diuresis or documentation error. These 30 patients were excluded from the analysis.

The 60 included patients were evaluated on serial clinic visits, average 5.5 visits per patient. Weight loss of 5% or more that was not addressed on the first two visits was categorized as a missed clue. This occurred in 52 of the 60 (86%) patients. Among the 52 patients 11 (21%) had new cancers with weight loss documented in the medical record, but overlooked by their physician. Of the remaining 8 patients whose weight loss was addressed 3 (37%) had new cancers. The reasons for the weight loss in the remaining patients without new cancers were due to side effects of chemotherapy, dysphagia, recent hospitalization, infection and unknown. In patients whose weight loss was not noted after 2 clinic visits the time lag between the onset of weight loss and diagnosis of advancing cancer varied from 0.5 months to 29 months with a mean delay of 8.9 months. This compares with a mean delay of 0.9 months in those 8 patients whose evaluation was initiated as soon as their weight loss was documented in the chart (p=0.03).

1. Weight loss in 23% of hematology/oncology patients was associated with cancer growth or recurrence. 2. The importance of weight loss as a clue to the diagnosis of a new cancer or to cancer progression is frequently not appreciated resulting in a significant delay in initiating diagnostic investigations.

No relevant conflicts of interest to declare.