Cachexia decoded: why diagnosis is important in ca

Maintaining good health and well-being is critical to patient well-being respond to cancer treatments. Unfortunately, cachexia, or involuntary weight loss, is a major concern for many people with advanced cancer. A new study from Japan has shown that lower cachexia rates, especially at a prevalence of less than 40-50%, are associated with shorter overall survival (OS) rates. The study also showed that the diagnostic criteria used for the detection of cachexia may influence the reported prevalence of cachexia.

People with advanced heart disease or cancer often face serious health problems. Cachexia, an involuntary weight loss, affects approximately 11% to 71% of cancer patients. This condition can interfere with essential chemotherapy, reduce quality of life, and reduce overall survival (OS) – the length of time cancer patients live after being diagnosed or starting treatment. Cachexia leads to a continuous loss of muscle mass, with or without fat loss, that cannot be corrected by conventional nutritional support, causing ongoing difficulties in daily activities. Several diagnostic methods exist for the detection of cachexia, each predicting different survival outcomes. However, the lack of a consistent diagnostic approach poses challenges in assessing the prevalence of cachexia and its actual impact on survival rates.

To bridge this gap, Mr. Tomoya Takaoka, a registered dietitian at the Department of Clinical Nutrition at Shinshu University Hospital, Japan, worked with Dr. Daiki Watanabe, assistant professor at Waseda University, And Dr. Akinori Yaegashi, Assistant Professor at Hokkaido Bunkyo University. Their findings were made available online on August 8, 2024 and published in Volume 15, Issue 9 of the journal Advances in nutrition on September 1, 2024.

They aimed to understand the impact of cachexia diagnosis on OS in cancer patients. The lead author, Takaoka, explains: “If prevalence and OS are influenced by differences in diagnostic criteria for cachexia, we consider this an obstacle to adapting research results to clinical practice.”

The research team conducted a systematic review of studies published in PubMed and Web of Science, estimating the prevalence of cachexia among cancer patients based on data from 125 articles published in 16 countries. This trial was registered with PROSPERO (CRD42023435474), a database for systematic reviews, to ensure transparency and compliance with research standards. They found that cachexia affected about 52% of patients in North America and Europe and about 29% in Asia. Overall, the global prevalence of cachexia in cancer patients was 33%. However, this percentage varied considerably, ranging from approximately 13% to 56% depending on the specific diagnostic criteria used.

The 2011 Fearon criteria (developed by the European Palliative Care Research Collaborative) are most commonly used for diagnosing cachexia, while the 2008 Evans criteria are less commonly used. The prevalence of cachexia is significantly higher in the Fearon criteria than in the Evans criteria. It is less common when factors such as reduced energy intake, loss of appetite, inflammation, low muscle strength or fatigue are taken into account. “Figuring out the impact of different diagnostic criteria would allow us to select individuals with possible cachexia from a large population or identify people with cachexia who are at high risk of death, leading to appropriate treatment.Takaoka explains.

What was the impact of the different diagnostic criteria for cancer cachexia on patient outcomes? The team answered this question through a meta-analysis examining how the diagnosis of cachexia affected OS in cancer patients. They found that the operating system varied depending on the prevalence of cachexia. Cachexia was associated with a higher risk of death compared to patients without cachexia, which varied in the final criteria used (the Fearon 2011 criteria had a lower risk ratio for OS than the other criteria). The results showed that the risk of death was significantly higher when the prevalence of cachexia was low, but remained stable at 40% to 50%. In general, a higher risk of cachexia is associated with poor survival in cancer patients, meaning that as the risk of cachexia increases, the chances of survival decrease.

Takaoka highlights the important findings of their research: “The final criteria for cachexia should correspond to the purpose of the diagnosis. When the goal is to screen individuals at risk for cachexia, the broader high-prevalence criteria are most appropriate. Conversely, when the goal is to identify a high-risk population for treatment, the stricter low-prevalence criteria are more specific. In clinical practice, this measure may help identify patients requiring intensive treatment of cachexia, including dietary changes and medications.”

Overall, this study highlights the importance of understanding the relationship between diagnostic criteria and patient survival. We hope this will pave the way for improved treatment guidelines for cachexia in cancer patients to improve response to therapies and OS.

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About Shinshu University

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