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The detection and assessment of malnutrition, sarcopenia and cachexia, in older adults with cancer

Bullock, Alexandra Faye


Alexandra Faye Bullock


Lewis Paton


Background: Older adults with cancer are a complex and growing population requiring tailored care to achieve optimum treatment outcomes. However, their care is complicated by underrecognised
and under-treated nutrition-related wasting disorders: malnutrition, sarcopenia, and cachexia.
Aim: I aimed to understand better the prevalence, detection, assessment, and patients’ experiences of malnutrition, sarcopenia, and cachexia in older adults with cancer.
Methods: I conducted three studies: i) a systematic review with narrative synthesis and metaanalysis investigating markers of malnutrition in older adults with cancer, ii) a systematic review with a qualitative synthesis investigating patients’ views and experiences of
malnutrition screening, and iii) a mixed-methods study screening for the three conditions, with concurrent qualitative interviews, to determine the feasibility of screening for, and the prevalence and overlap of, malnutrition, sarcopenia, and cachexia in a group of older adults with cancer, and to investigate patients’ views and experiences of the conditions, and the screening processes. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes. A modified critical interpretive synthesis was used to integrate overall thesis findings.
Findings: Review findings highlighted the homogeneity of markers of malnutrition in older adults with cancer. Decreased food intake and Prognostic Nutrition Index (PNI) were significantly associated with patient outcomes, but PNI, and other markers, could not distinguish between inflammatory or energy-deficient causes of weight loss. A lack of patient understanding of the causes and consequences of malnutrition was identified in the second review. Mixed-methods quantitative data show malnutrition, sarcopenia, and cachexia to be highly prevalent, overlapping conditions, with more than one condition coexisting in 57%. Screening tools identified established disease rather than ‘risk’. However, although common, nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients’ perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities.
Conclusion: Perceptions, identification, and management of these conditions needs to improve; with their importance recognised by clinicians and patients so those truly ‘at risk’ are identified whilst conditions are more remediable to interventions.


Bullock, A. F. (2022). The detection and assessment of malnutrition, sarcopenia and cachexia, in older adults with cancer. (Thesis). Hull York Medical School. Retrieved from

Thesis Type Thesis
Deposit Date Dec 15, 2023
Publicly Available Date Dec 15, 2023
Keywords Medicine
Public URL
Additional Information Hull York Medical School
University of Hull and University of York
Award Date May 1, 2022


Thesis (3.3 Mb)

Copyright Statement
© 2022 Alexandra Faye Bullock. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

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