{
  "abstract": "Background Unintentional weight loss is prevalent in advanced cancer and maintaining weight is critical to improve clinical outcomes. Body image plays a significant role in how weight loss is perceived. A previous Swedish study showed that men with advanced cancer had a negative perception of cancer-induced weight loss whereas women perceived the weight loss more positively.Objectives The aim of the GRACE study (Global Research on Appearance in Cancer) is to study gender differences in the perception of body image during cancer-induced weight loss. Second, we aim to explore cross-country differences in perceptions of body image.Methods and analysis This is a study protocol for a multi-centre, cross-sectional study across six countries (Sweden, Chile, New Zealand, Switzerland, the United States and Vietnam) spanning five continents. We aim to recruit 50 women and 50 men with advanced cancer from each country, targeting 600 people in total. Data will be collected through a structured digital questionnaire covering perceived body image measured with the Body Image Scale (BIS), demographics, anthropometrics, weight history, disease-related symptoms and dietary intake. Data collection started in 2025. Patients are enrolled at each site following ethical approval. The primary endpoint is difference in BIS-score between men and women. A difference of 3 BIS points between groups will be considered clinically significant. For statistical analysis, multivariable linear regression will be used, including country as a fixed effect to account for between-country differences. We will also perform secondary, exploratory analyses examining between-country variation in the gender difference in BIS.Ethics and dissemination Ethical approval has been obtained from all of the participating countries. Results will be disseminated through peer-reviewed publications and conference presentations.Trial registration number ClinicalTrials.gov ( NCT07195448).",
  "authors": [
    {
      "affiliations": [
        "Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden"
      ],
      "name": "Charlotte Goodrose-Flores"
    },
    {
      "affiliations": [
        "Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Stephanie Bonn"
    },
    {
      "affiliations": [
        "Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Ylva Trolle Lagerros"
    },
    {
      "affiliations": [
        "Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany"
      ],
      "name": "Jann Arends"
    },
    {
      "affiliations": [
        "Department of Radiation-Oncology, Competence Center Palliative Care, University Hospital Zurich, Zürich, Switzerland"
      ],
      "name": "David Blum"
    },
    {
      "affiliations": [
        "Carrera Nutrición y Dietética, Escuela Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Santiago Metropolitan Region, Chile"
      ],
      "name": "Constanza Figueroa Donoso"
    },
    {
      "affiliations": [
        "School of Mathematics, Science, and Engineering, Department of Nutrition, University of the Incarnate Word, San Antonio, Texas, USA"
      ],
      "name": "Heather Frazier"
    },
    {
      "affiliations": [
        "Palliative Medicine, Harbour Hospice, Auckland, New Zealand"
      ],
      "name": "Ssu-An Lin"
    },
    {
      "affiliations": [
        "Palliative Medicine, Harbour Hospice, Auckland, New Zealand"
      ],
      "name": "Eugenia Romboli"
    },
    {
      "affiliations": [
        "Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam"
      ],
      "name": "Minh Hoang Van"
    },
    {
      "affiliations": [
        "Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam"
      ],
      "name": "Ngoc Bao Nguyen"
    },
    {
      "affiliations": [
        "Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam"
      ],
      "name": "Van Nguyen"
    },
    {
      "affiliations": [
        "Centro para la Prevención y Control del Cáncer (CECAN), Santiago, Chile",
        "Sección Medicina Paliativa, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Santiago Metropolitan Region, Chile"
      ],
      "name": "Pedro Emilio Perez-Cruz"
    },
    {
      "affiliations": [
        "Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden",
        "Palliative Medicine, Stockholms Sjukhem, Stockholm, Sweden"
      ],
      "name": "Linda Bjorkhem-Bergman"
    }
  ],
  "title": "Cross-sectional study of gender differences in the perception of body image during cancer-induced weight loss: study protocol for the GRACE study (Global Research on Appearance in Cancer)",
  "uid": "8e324452-f9f2-5aac-8450-a5a12d44cd72"
}