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Ann Thorac Surg 2001;72:348-351
© 2001 The Society of Thoracic Surgeons

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Original article: general thoracic

Do patients with nonmetastatic non-small cell lung cancer demonstrate altered resting energy expenditure?

^a Division of Clinical Nutrition, The New England Medical Center, Tufts University, Boston, Massachusetts, USA
^b Division of Hematology/Oncology, Department of Medicine, The New England Medical Center, Tufts University, Boston, Massachusetts, USA
^c Division of Cardiothoracic Surgery, Department of Surgery, The New England Medical Center, Tufts University, Boston, Massachusetts, USA
^d Nutrition, Exercise Physiology, and Sarcopenia Laboratory, The Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
^e Biostatistics Section, The Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
^f Body Composition Laboratory, The Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA

Accepted for publication May 14, 2001.

Address reprint requests to Dr Jatoi, Division of Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
e-mail: jatoi.aminah{at}mayo.edu

Background. The cancer cachexia syndrome occurs in patients with non-small cell lung cancer (NSCLC) and includes elevated resting energy expenditure (REE). This increase in REE leads to weight loss, which in turn confers a poor prognosis. This study was undertaken to determine whether the cancer cachexia syndrome occurs in patients with nonmetastatic NSCLC.

Methods. In this case-control study, 18 patients with nonmetastatic NSCLC (stages IA to IIIB) were matched to healthy controls on age (± 5 years), gender, and body mass index (± 3 kg/m²). Only 4 cancer patients had experienced > 5% weight loss. Cancer patients and controls were compared on the basis of: (1) unadjusted REE, as measured by indirect calorimetry; (2) REE adjusted for lean body mass, as measured by dual x-ray absorptiometry; (3) REE adjusted for body cell mass, as measured by potassium-40 measurement; and (4) REE adjusted for total body water, as measured by tritiated water dilution.

Results. We observed no significant difference in unadjusted REE or in REE adjusted for total body water. However, with separate adjustments for lean body mass and body cell mass, cancer patients manifested an increase in REE: mean difference ± standard error of the mean: 140 ± 35 kcal/day (p = 0.001) and 173 ± 65 kcal/day (p = 0.032), respectively. Further adjustment for weight loss yielded similarly significant results.

Conclusions. These results suggest that the cancer cachexia syndrome occurs in patients with nonmetastatic NSCLC and raise the question of whether clinical trials that target cancer cachexia should be initiated before weight loss.

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