Cachexia: A Tool to Identify It Earlier May Improve Survival

Antonio Vigano, MD

Antonio Vigano, MD

Researchers from Canada’s McGill University have developed a tool that can detect early signs of cachexia in patients with cancer, a condition characterized by muscle loss, anorexia, and weakness that is often associated with poor responses to anticancer therapies, increased hospitalizations, and poses a major burden for patients and their caregivers.

“We are losing many patients, not because of their cancer, but because their bodies have undergone important metabolic changes,” Antonio Vigano, MD, the study’s lead author and director of the Cancer Rehabilitation Program and Cachexia Clinic at McGill University, explained in a statement.

“In other words, they have simply stopped functioning correctly. In severe stages of cachexia, weight loss becomes very important and nutrients can no longer be absorbed or used properly by cancer patients.”

The study, published in the journal Clinical Nutrition, assigned 297 patients with advanced gastrointestinal or lung tumors to 1 of a 4-stage classification for cachexia:

• Non-cachexia (NCa)
• Pre-cachexia (PCa)
• Cachexia (Ca)
• Refractory cachexia (RCa)

The assignments were based on the following 5 routinely available clinical measures and laboratory tests:

• Biochemistry (high C-reactive protein or leukocytes, hypoalbuminemia, or anemia)
• Food intake (normal/decreased)
• Moderate weight loss (less than or equal to 5%)
• Significant weight loss (more than 5%)
• Performance status (Eastern Cooperative Oncology Group Performance Status ≥ 3)

Based on their classification, 36% of patients followed in this study were designated Ca, 21% each were classified PCa and RCa, and 15% as NCa. The authors noted that significant differences were observed among cachexia stages for most of the outcome measures (symptoms, body composition, handgrip strength, emergency room visits, and length of hospital stays) according to cachexia severity (P <.05). Patient survival also differed between the various stages, except between PCa and Ca.

Despite recent advancements in research, cachexia remains very difficult to alleviate or treat, and researchers hope that a better diagnostic tool will address this unmet need. Patients with cachexia eventually experience a decline of their overall health to a point where it cannot be reversed by eating more or taking nutritional supplements.

“Cachexia gets worse with time and the longer we wait to address it, the harder it is to treat,” said Vigano. "Effectively diagnosing cachexia when still in its early stages can make an enormous difference for a cancer patient’s prognosis and quality of life. In order to save more lives, we need practical and accessible tools that can be effectively used by clinicians in their routine practice to identify patients with cachexia."

The researchers hope their tool will be available for healthcare practitioners within the next few years or sooner and that it can be deployed in other chronic disease settings where patients are negatively impacted by weight loss, such as AIDS and multiple sclerosis. Vigano and his research colleagues are also participating in studies to develop treatments for cachexia.

Reference

Vigano AL, Morais JA, Ciutto L, et al. Use of routinely available clinical, nutritional, and functional criteria to classify cachexia in advanced cancer patients [published online November 4, 2016]. Clin Nutrition.

Surabhi Dangi-Garimella, PhD, is a writer and editor for the American Journal of Managed Care, Evidence-Based Oncology. Read more at AJMC.com.