{
  "abstract": "Unintentional weight loss (UWL) can be defined as weight loss that is significant (i.e. outside the range of normal daily fluctuations in weight) and unplanned. UWL is an expected or explainable outcome of a number of conditions including many cancers, endocrine conditions such as hyperthyroidism, and depression. Our team’s focus is upon patients who present with UWL that is initially unexplained, and which requires further clinical evaluation and diagnostic testing to identify a cause. Our focus is upon cancer. There is no universally accepted criterion for UWL. Common criteria include 5% weight loss in one month or 10% weight loss in 6 months.We know that UWL is common, with an annual incidence of approximately 7% among all adults and 27% among frail adults age ≥65 years. Unfortunately, UWL is grossly underrecognized in general practice, with nearly 80% of cases missed.Despite the frequency and potential seriousness of the problem, evidence-based guidance for diagnostic evaluation of UWL has been lacking. Our overall goal was to fill this gap in evidence. We developed a computable phenotype to identify patients with UWL and exclude patients with known causes (e.g. prior diagnosis of cancer). Next, we applied the phenotype to a large repository of electronic health records. Among patients in whom UWL was recognized, we identified physician diagnostic practices, including laboratory tests, imaging, and procedures. We assessed the usefulness of these practices based on rates of abnormal findings related to UWL. Principal findings include a low physician recognition rate (38%), a very high proportion of weight loss that is intentional (97%) and regain of lost weight in a large proportion of patients(45.9%). Physician diagnostic practices were highly variable. We evaluated the usefulness of commonly obtained laboratory tests (e.g. CBC, TSH), imaging tests (CT abdomen) or procedures (endoscopy, colonoscopy) to inform the diagnosis of UWL. Based on these findings we drafted a set of diagnostic practice recommendations and presented these to a clinician stakeholder panel prior to finalization.Workshop participants will be split into small groups and asked to review one of three different case studies of patients with UWL. They will be asked to summarize a rational approach that can include further clinical or laboratory evaluation, etc. Groups will then present their work to the larger group and an open discussion will follow. The results of our team’s analytical work, as well as a detailed presentation of our methods will follow. Finally, the recommendations from our evidence-informed consensus panel will be presented. This will be followed by an open discussion and question and answer session. In particular, we will discuss the causes of overly aggressive diagnostic evaluation and solutions to prevent overdiagnosis.",
  "authors": [
    {
      "affiliations": [
        "Case Western Reserve University School of Medicine, Cleveland, USA",
        "University Hospitals of Cleveland, Cleveland, USA"
      ],
      "name": "Goutham Rao"
    }
  ],
  "title": "018 Unintentional weight loss (UWL)",
  "uid": "a93c311c-6a9e-5c2e-a8c5-cd56f16f15d2"
}