The assessment and management of unintentional weight loss associated with cachexia in a primary care setting: a mixed-methods study

INTRODUCTION: Unintentional weight loss (UWL) is the main symptom of cachexia, a multifactorial syndrome associated with advanced disease. Other symptoms include loss of appetite and muscle weakness. UWL in older adults can be caused by many disease processes and nutritional deficiencies. Cachexia is understudied in non-specialist care settings and primary care, as the setting for most healthcare contacts, has the potential to lead on assessing at-risk patients. AIM: The aim of this study is to explore how unintentional weight loss in a cohort of older patients, at risk of severe frailty, is assessed and managed in primary care settings METHODS: This is a mixed-methods sequential explanatory study with four phases - systematic review and narrative synthesis; a quantitative questionnaire and case note review; qualitative semi-structured interviews with patients and caregivers; and findings across the datasets were integrated and analysed using mixed methods approaches. KEY FINDINGS: In primary care settings, weight measurements and loss of appetite were often documented in case notes, but appetite loss was normalised and rationalised by some patients. Participants expressed minimal concern about their UWL if it was sustained and more concern about muscle weakness and changes to their appearance. Living with a spouse or partner increased the likelihood of a clinical response to UWL, being overweight or obese did not. Findings suggest that lack of concern from both patient and healthcare professional perspectives impacted help-seeking behaviour and clinical responses to UWL. Especially when weight loss was not evident, was deemed to be temporary or perceived to be beneficial. CONCLUSIONS: Older patients at risk of severe frailty are being weighed and monitored in primary care settings. However, clinical response to UWL needs to more proactive, timely and alert to the overweight and obese patients where the impact of UWL is hidden.