Brief Report|Articles in Press, 100496

Racial, Ethnic, and Socioeconomic Characteristics Independently Predict for Cachexia Risk and Associated Survival Outcomes in Stage IV Non-Small Cell Lung Cancer: A Brief Report

Open AccessPublished:March 10, 2023DOI:
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      Cancer cachexia, seen in more than a third of patients with non-small cell lung cancer (NSCLC), directly leads to functional and survival detriments. As screening and interventions for cachexia and NSCLC improve, deficits in healthcare access and quality among patients disadvantaged by race and socioeconomic factors must be addressed.


      We retrospectively evaluated 957 patients diagnosed with stage IV NSCLC between 2014-2020 in Dallas, Texas. Cachexia was retrospectively assessed by applying criteria for substantial unintentional weight loss in the time leading up to cancer diagnosis. Non-parametric, parametric, multivariate logistic regression, and Kaplan-Meier analyses were conducted to evaluate for variables with significant associations with cachexia incidence and survival.


      In multivariate analysis including age, sex, comorbidities, BMI, risk behaviors, and tumor histology, Black race and Hispanic ethnicity independently associated with more than a 70% increased risk of presenting with cachexia at the time of NSCLC diagnosis (P<0.05). When private insurance status was included as a covariate, this association was diminished for Hispanic patients only. Black patients presented with stage IV disease at an average of approximately 3 years younger than White patients (Kruskal-Wallis P=0.0012; T-test P=0.0002). Cachexia status at diagnosis consistently predicted for survival detriments, further highlighting the importance of addressing differential cachexia risk across race/ethnicity.


      Fundamentally, our findings reveal elevated cachexia risk in Black and Hispanic stage IV NSCLC patients with associated survival detriments. These differences are not fully accounted for by traditional determinants of health and suggest novel avenues for addressing oncologic health inequities.