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Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial
  1. Iain Phillips1,2,
  2. Lindsey Allan3,
  3. Adele Hug3,
  4. Naomi Westran3,
  5. Claudia Heinemann4,
  6. Madeleine Hewish5,
  7. Ajay Mehta5,
  8. Helen Saxby5 and
  9. Veni Ezhil5
  1. 1Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
  2. 2College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
  3. 3Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
  4. 4Department of Nutrition and Dietetics, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
  5. 5St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
  1. Correspondence to Dr Iain Phillips, Edinburgh Cancer Centre, Western General Hospital, Edinburgh EH4 2XU, UK; iain.phillips{at}


Introduction European Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention.

Methods In this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA),

Results 96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention.

Conclusion A large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.

  • lung
  • anorexia
  • cachexia
  • supportive care
  • quality of life

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  • Contributors All authors contributed to trial design and patient recruitment. The manuscript was prepared by IP, LA, AH and NW. It was reviewed by the other authors.

  • Funding This work was partially supported by an Educational grant from Chugai Pharma UK, which funded extra time spent carrying out and writing up the DAIL study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Camberwell St Giles Research Ethics Committee, London (reference 16/LO/2143).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified data are currently held by Royal Surrey County Hospital Research department.