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Diagnostic criteria of cancer cachexia: relation to quality of life, exercise capacity and survival in unselected palliative care patients

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Cachexia is associated with adverse outcomes. There is limited information on the impact of different diagnostic criteria of cachexia on patient centered outcomes.

Methods

We compared the prevalence of reduced quality of life (QoL), physical function and survival in palliative care cancer patients classified by different cachexia criteria. Four hundred and five patients with advanced cancer were included. Cachexia criteria were BMI, weight loss, fatigue, Karnofsky performance score, low handgrip strength, lean tissue depletion (DXA or arm muscle circumference) and abnormal biochemistry (inflammation, anemia or low serum albumin). QoL was assessed with a cancer specific questionnaire (EORTC QLQ-C30) and classified by cluster analysis. Dietary intake was obtained from a 4-day food record. Physical function was measured on a treadmill.

Results

Weight loss >2 %, BMI <20, fatigue and CRP >10 mg/L were associated with adverse QoL, function and symptoms (odds ratios: 2.1, 2.9, 4.0 and 3.1 respectively, P < 0.05 for all). Fatigue, low grip strength and markers of systemic inflammation were associated with short walking distance (P < 0.05). Weight loss > 2 %, fatigue, CRP > 10 mg/L and S-albumin < 32 g/L were associated with shorter survival (hazard ratios: 1.4, 1.6, 2.2 and 2.0 respectively, P < 0.05 for all). The prevalence of cachexia diagnosis varied from 12 to 85 % using different definitions.

Conclusions

Weight loss, fatigue and markers of systemic inflammation were most strongly and consistently associated with adverse QoL, reduced functional abilities, more symptoms and shorter survival. The prevalence of cachexia using different definitions varied widely; indicating a need to further explore and validate diagnostic criteria for cancer cachexia.

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Abbreviations

AMC:

Arm muscle circumference

ASMI:

Appendicular skeletal muscle mass index

BMI:

Body mass index

BW:

Body weight

CRP:

C-reactive protein

ED:

Diet energy density

FMI:

Fat mass index

EORTC:

European Organization for Research and Treatment of Cancer Scale

ESR:

Erythrocyte sedimentation rate

KPS:

Karnofsky performance score

REE:

Resting energy expenditure

QoL:

Quality of life

WL:

Weight loss

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Acknowledgements

Supported by funds for research and development in Västra Götaland, grant no. VGFOUGSB-148001, Swedish Cancer Society (2014) and the Swedish state under the ALF agreement.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden

    Ola Wallengren & Ingvar Bosaeus

  2. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden

    Kent Lundholm

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  1. Ola Wallengren
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  2. Kent Lundholm
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  3. Ingvar Bosaeus
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Correspondence to Ola Wallengren.

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Wallengren, O., Lundholm, K. & Bosaeus, I. Diagnostic criteria of cancer cachexia: relation to quality of life, exercise capacity and survival in unselected palliative care patients. Support Care Cancer 21, 1569–1577 (2013). https://doi.org/10.1007/s00520-012-1697-z

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  • DOI: https://doi.org/10.1007/s00520-012-1697-z

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