Albumin is an important biochemical marker in palliative cancer care, used for assessment of nutritional status, disease severity and prognosis. Our primary aim was to investigate sex differences in the association between appetite and albumin levels in palliative cancer patients. We also aimed to study associations between appetite and C-reactive protein (CRP), Quality of Life (QoL), pain and fatigue. In the Palliative D-cohort, consisting of 266 men and 264 women, we found a correlation between appetite and albumin; low appetite, measured with the Edmonton Symptom Assessment System, correlated significantly with low albumin in men: (r = −0.33, p < 0.001), but not in women (r = −0.03, p = 0.65). In a regression analysis adjusted for confounding factors, results were similar. Lower appetite was correlated with higher CRP in men (r = 0.27, p < 0.001), but not in women (r = 0.12, p = 0.05). Appetite was correlated with QoL, fatigue and pain in both men and women; those with a low appetite had a low QoL and high fatigue- and pain-scores (p < 0.001). In conclusion, our results indicated possible sex differences in the associations between appetite and albumin, and between appetite and CRP, in palliative care patients. Understanding these associations could provide additional value for clinical practice.

Background: Loss of appetite is a common nutrition symptom in patients with cancer. Understanding the trajectory of appetite could be of clinical use for prognostication in palliative cancer care. Our primary aim was to explore the association between self-assessed appetite and mortality in patients suffering from advanced cancer. Secondary aims included the relation between fatigue, albumin levels and CRP/albumin ratio and mortality. We also aimed to study potential sex-differences in the associations. Methods: Post-hoc analyses were performed using data from the Palliative D-study comprising 530 patients with cancer admitted to palliative care. Appetite and fatigue were assessed with the Edmonton Symptom Assessment System (ESAS). Cox proportional hazards models were used to calculate Hazard ratios (HR) with 95% confidence intervals (CI) for exposures of appetite, fatigue, albumin and CRP/albumin ratio, and time from study inclusion to death or censoring. Analyses were also performed stratified by sex. Results: The follow-up time ranged between 7 to 1420 days. Moderate and poor appetite were significantly associated with a higher mortality rate compared to reporting a good appetite; HR 1.44 (95%CI: 1.16–1.79) and HR 1.78 (95%CI: 1.39–2.29), respectively. A higher mortality rate was also seen among participants reporting severe fatigue compared to those reporting no fatigue; HR 1.84 (95%CI:1.43–2.36). Participants with low albumin levels (< 25 g/L) and those in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75–7.63) and HR 2.66 (95%CI:212–3.35), compared to participants with high albumin levels (> 36 g/L) and those in lowest tertile of CRP/albumin ratio. These associations were more pronounced in men than in women. Conclusion: Poor appetite, severe fatigue, low albumin level and a high CRP/albumin ratio were associated with increased mortality rates among patients with advanced cancer. All these variables might be clinically useful for prognostication in palliative cancer care. Trial registration: Clinicaltrial.gov. Identifier: NCT03038516;31, January 2017.

Weight maintenance is a priority in cancer care, but weight loss is common and a serious concern. This study explores if there are sex differences in the perception of weight loss and its association to health-related quality of life (HRQoL) and body image. Cancer patients admitted to Advanced Medical Home Care were recruited to answer a questionnaire, including characteristics, the HRQoL-questionnaire RAND-36, and a short form of the Body Image Scale. Linear regression analyses stratified by sex and adjusted for age were performed to examine associations between percent weight loss and separate domains of HRQoL and body image score in men and women separately. In total, 99 participants were enrolled, of which 80 had lost weight since diagnosis. In men, an inverse association between weight loss and the HRQoL-domain physical functioning, β = −1.34 (95%CI: −2.44, −0.24), and a positive association with body image distress, β = 0.22 (95%CI: 0.07, 0.37), were found. In women, weight loss was associated with improvement in the HRQoL-domain role limitations due to physical health, β = 2.02 (95%CI: 0.63, 3.41). Following a cancer diagnosis, men appear to experience weight loss more negatively than women do. Recognizing different perceptions of weight loss may be of importance in clinical practice.

Background: Women with lipedema have an abnormal accumulation of adipose tissue that leads to pain and reduced quality of life (QoL). The impact of lipedema on body image and QoL remains largely unknown. The aim of this study is to explore Health-Related QoL (HR-QoL) and body image in women with lipedema and compare it to healthy women without lipedema as well as women with advanced cancer. Methods: This comparative study included women with lipedema (n = 104), healthy women without lipedema (healthy controls) (n = 42), and an exploratory group of women with advanced cancer (n = 44). HR-QoL was assessed using RAND-36, body image concern was evaluated with the Body Shape Questionnaire (BSQ), and symptoms were assessed with Edmonton Symptom Assessment System (ESAS). Results: In total, 190 women were included. Women with lipedema had significantly lower HR-QoL compared to healthy women without lipedema across all eight dimensions ( p < 0.001). Women with lipedema had HR-QoL scores comparable to those of women with advanced cancer in four dimensions: physical functioning, bodily pain, and emotional problems. In the general health dimension, women with lipedema had even lower scores than women with advanced cancer (p < 0.05). Body image concerns were significantly greater in the lipedema group than in healthy controls ( p = 0.001). Women with lipedema experienced significantly more symptoms than healthy controls, including more pain, fatigue, depression, anxiety, loss of appetite, dyspnea and reduced QoL (<0.001 for all). Conclusion: Women with lipedema had as low HR-QoL as women with advanced cancer in several dimensions, significant body image concerns and high symptom burden. These findings underscore the need to develop targeted health care initiatives for these patients.

Background: Loss of appetite and weight loss are major concerns in patients with pancreatic cancer. The aim of this study was to evaluate the associations of corticosteroid therapy with weight change and appetite in the long term, in patients with advanced pancreatic cancer. Methods: This was a post hoc analysis of the previously performed randomized, controlled MISTRAL trial in patients with advanced pancreatic cancer. Data on weight and appetite at baseline and after approximately 1, 2, 3 and 4 months were used. The association between corticosteroid exposure and weight change was calculated using mixed linear regression, models adjusted for sex, age, randomization arm and performance status. Appetite was analyzed comparing those without and with corticosteroids during 3 days before appetite assessment. Results: Two hundred forty-four patients (121 women) were included. Patients who received corticosteroid therapy at any time during the 4 months had less appetite ( p < 0.001), lower performance status ( p < 0.001) and lower BMI ( p < 0.05) compared to those not receiving corticosteroids. Patients receiving corticosteroids had a larger weight loss of on average 1.48% during a month of follow-up compared to those not receiving corticosteroids ( β − 1.48, 95% CI = − 2.11 to − 0.84). Patients exposed to corticosteroids reported poorer appetite at every time point than those not exposed. Conclusion: In long-term follow-up, corticosteroid treatment was associated with greater weight loss and poorer appetite among patients with advanced pancreatic cancer. These findings may partly be explained by a higher symptom burden among patients receiving corticosteroids. Future prospective trials are warranted to clarify the effect of long-term corticosteroid treatment on weight and appetite.

Background: Unintentional weight loss is prevalent in advanced cancer and maintaining weight is critical to improve clinical outcomes. Body image plays a significant role in how weight loss is perceived. A previous Swedish study showed that men with advanced cancer had a negative perception of cancer-induced weight loss whereas women perceived the weight loss more positively. Objectives: The aim of the GRACE study (Global Research on Appearance in Cancer) is to study gender differences in the perception of body image during cancer-induced weight loss. Second, we aim to explore cross-country differences in perceptions of body image. Methods and analysis: This is a study protocol for a multi-centre, cross-sectional study across six countries (Sweden, Chile, New Zealand, Switzerland, the United States and Vietnam) spanning five continents. We aim to recruit 50 women and 50 men with advanced cancer from each country, targeting 600 people in total. Data will be collected through a structured digital questionnaire covering perceived body image measured with the Body Image Scale (BIS), demographics, anthropometrics, weight history, disease-related symptoms and dietary intake. Data collection started in 2025. Patients are enrolled at each site following ethical approval. The primary endpoint is difference in BIS-score between men and women. A difference of 3 BIS points between groups will be considered clinically significant. For statistical analysis, multivariable linear regression will be used, including country as a fixed effect to account for between-country differences. We will also perform secondary, exploratory analyses examining between-country variation in the gender difference in BIS. Ethics and dissemination: Ethical approval has been obtained from all of the participating countries. Results will be disseminated through peer-reviewed publications and conference presentations. Trial registration number: ClinicalTrials.gov ( NCT07195448 ).