A Diagnostic Tool for Cachexia in Cancer Patients Could Save Lives

Cancer cachexia is a phenomenon characterized by muscle loss, anorexia, and weakness. A common occurrence in patients with advanced disease, cachexia tends to remain undiagnosed and is an unmet need. Researchers from Canada’s McGill University now have a potential tool that can detect early signs of cachexia in cancer patients, which could impact survival.

“We are losing many cancer patients, not because of their cancer, but because their bodies have undergone important metabolic changes,” Antonio Vigano, MD, lead author of the paper 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 advanced cancer patients being treated for gastrointestinal and 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 clinical criteria:

• 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)

“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."

Of the study patients, 36% were classified as Ca, 21% each as PCa and RCa, and 15% as NCa. The authors wrote that significant (P <.05) 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. Patient survival also differed between the various stages, with those diagnosed at an early stage surviving longer.

According to Vigano, a longer wait time to address cachexia makes it harder to treat the condition.

“Effectively diagnosing cachexia when still in its early stages can make an enormous difference for a cancer patient’s prognosis and quality of life,” he said.

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. doi: http://dx.doi.org/10.1016/j.clnu.2016.09.008.