Background Up to 80% of people with advanced cancer experience cachexia and of these most have accompanying anorexia, characterised by poor appetite and weight loss. Cachexia has profound psychosocial impact on patients and families including negative emotions associated with reduced food intake and involuntary weight loss, and the social consequences of these symptoms. Weight loss can be unacknowledged by healthcare professionals (HCPs), even in settings where patients are weighed regularly. Little is known about the meaning of weight loss from the patient’s perspective, and what support patients expect from HCPs.

Aim(s) • To describe the experience of weight loss in people with advanced cancer and explore what psychosocial support they believe HCPs could provide

• To make recommendations for clinical practice.

Methods Individual, semi-structured interviews with hospice patients diagnosed with advanced cancer and who had expressed distress around weight loss, analysed using thematic content analysis.

Results Nine patients took part. Participants described the emotional impact of weight loss as an indicator of overall deterioration or impending death. Concerns about weight loss were perceived to be unacknowledged by HCPs, and participants would welcome more opportunities to discuss their fears. Findings were categorised into four themes:

• The meaning of weight loss to the person

• A changed relationship with food

• The experience of being weighed as ‘a tick box exercise’

• ‘Listen to me’ – a message for healthcare professionals.

Conclusions HCPs should acknowledge weight loss in patients with advanced cancer to explore the impact and meaning. Increased awareness of the impact of cachexia and communication skills training may enable these difficult conversations to take place. With appropriate emotional and social support, patients and their families can identify and address what is important to them, which may reduce distress and improve quality of life.