Hypermetabolism and symptom burden in advanced cancer patients evaluated in a cachexia clinic

Rony Dev, David Hui, Gary Chisholm, Marvin Delgado-Guay, Shalini Dalal, Egidio Del Fabbro, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Background: Elevated resting energy expenditure (REE) may contribute to weight loss and symptom burden in cancer patients. Aims: The aim of this study was to compare the velocity of weight loss, symptom burden (fatigue, insomnia, anxiety, and anorexia—combined score as measured by the Edmonton Symptom Assessment Score), high-sensitivity C-reactive protein, and survival among cancer patients referred to a cachexia clinic with hypermetabolism, elevated REE > 110% of predicted, with normal REE. Methods: A retrospective analysis of 60 advanced cancer patients evaluated in a cachexia clinic for either >5% weight loss or anorexia who underwent indirect calorimetry to measure REE. Patients were dichotomized to either elevated or normal REE. Descriptive statistics were generated, and a two-sample Student's t-tests were used to compare the outcomes between the groups. Kaplan–Meier and Cox regression methodology were used to examine the survival times between groups. Results: Thirty-seven patients (62%) were men, 41 (68%) were White, 59 (98%) solid tumours, predominantly 23 gastrointestinal cancers (38%), with a median age of 60 (95% confidence interval 57.0–62.9). Thirty-five patients (58%) were hypermetabolic. Non-Caucasian patients were more likely to have high REE [odds ratio = 6.17 (1.56, 24.8), P = 0.01]. No statistical difference regarding age, cancer type, gender, active treatment with chemotherapy, and/or radiation between hypermetabolic and normal REE was noted. The velocity of weight loss over a 3 month period (−8.5 kg vs. −7.2 kg, P = 0.68), C-reactive protein (37.3 vs. 55.6 mg/L, P = 0.70), symptom burden (4.2 vs. 4.5, P = 0.54), and survival (288 vs. 276 days, P = 0.68) was not significantly different between high vs. normal REE, respectively. Conclusion: Hypermetabolism is common in cancer patients with weight loss and noted to be more frequent in non-Caucasian patients. No association among velocity of weight loss, symptom burden, C-reactive protein, and survival was noted in advanced cancer patients with elevated REE.

Original languageEnglish (US)
Pages (from-to)95-98
Number of pages4
JournalJournal of Cachexia, Sarcopenia and Muscle
StatePublished - 2015
Externally publishedYes


  • Advanced cancer
  • Cachexia
  • Hypermetabolism
  • Palliative care
  • Symptoms

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physiology (medical)


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