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Erschienen in: Supportive Care in Cancer 6/2013

01.06.2013 | Original Article

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

verfasst von: Ola Wallengren, Kent Lundholm, Ingvar Bosaeus

Erschienen in: Supportive Care in Cancer | Ausgabe 6/2013

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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.
Literatur
1.
Zurück zum Zitat Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495. doi:10.1016/S1470-2045(10)70218-7 PubMedCrossRef Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495. doi:10.​1016/​S1470-2045(10)70218-7 PubMedCrossRef
2.
Zurück zum Zitat Blum D, Omlin A, Baracos VE, Solheim TS, Tan BH, Stone P, Kaasa S, Fearon K, Strasser F (2011) Cancer cachexia: a systematic literature review of items and domains associated with involuntary weight loss in cancer. Crit Rev Oncol Hematol. doi:10.1016/j.critrevonc.2010.10.004 Blum D, Omlin A, Baracos VE, Solheim TS, Tan BH, Stone P, Kaasa S, Fearon K, Strasser F (2011) Cancer cachexia: a systematic literature review of items and domains associated with involuntary weight loss in cancer. Crit Rev Oncol Hematol. doi:10.​1016/​j.​critrevonc.​2010.​10.​004
5.
Zurück zum Zitat Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D, Wolfe R, Anker SD (2008) Cachexia: a new definition. Clin Nutr 27(6):793–799. doi:10.1016/j.clnu.2008.06.013 PubMedCrossRef Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D, Wolfe R, Anker SD (2008) Cachexia: a new definition. Clin Nutr 27(6):793–799. doi:10.​1016/​j.​clnu.​2008.​06.​013 PubMedCrossRef
6.
Zurück zum Zitat Fearon KC, Voss AC, Hustead DS (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83(6):1345–1350PubMed Fearon KC, Voss AC, Hustead DS (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83(6):1345–1350PubMed
8.
Zurück zum Zitat Baldwin C, Spiro A, Ahern R, Emery PW (2012) Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst 104(5):371–385. doi:10.1093/jnci/djr556 PubMedCrossRef Baldwin C, Spiro A, Ahern R, Emery PW (2012) Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst 104(5):371–385. doi:10.​1093/​jnci/​djr556 PubMedCrossRef
9.
Zurück zum Zitat Elia M, Bokhorst-de V, van der Schueren MA, Garvey J, Goedhart A, Lundholm K, Nitenberg G, Stratton RJ (2006) Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: a systematic review. Int J Oncol 28(1):5–23PubMed Elia M, Bokhorst-de V, van der Schueren MA, Garvey J, Goedhart A, Lundholm K, Nitenberg G, Stratton RJ (2006) Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: a systematic review. Int J Oncol 28(1):5–23PubMed
10.
Zurück zum Zitat Lundholm K, Daneryd P, Bosaeus I, Korner U, Lindholm E (2004) Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: effects on survival, metabolism, and function. Cancer 100(9):1967–1977PubMedCrossRef Lundholm K, Daneryd P, Bosaeus I, Korner U, Lindholm E (2004) Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: effects on survival, metabolism, and function. Cancer 100(9):1967–1977PubMedCrossRef
11.
12.
Zurück zum Zitat Mantovani G, Maccio A, Madeddu C, Serpe R, Antoni G, Massa E, Dessi M, Panzone F (2010) Phase II nonrandomized study of the efficacy and safety of COX-2 inhibitor celecoxib on patients with cancer cachexia. J Mol Med (Berl) 88(1):85–92. doi:10.1007/s00109-009-0547-z CrossRef Mantovani G, Maccio A, Madeddu C, Serpe R, Antoni G, Massa E, Dessi M, Panzone F (2010) Phase II nonrandomized study of the efficacy and safety of COX-2 inhibitor celecoxib on patients with cancer cachexia. J Mol Med (Berl) 88(1):85–92. doi:10.​1007/​s00109-009-0547-z CrossRef
14.
Zurück zum Zitat Fearon KC, Barber MD, Moses AG, Ahmedzai SH, Taylor GS, Tisdale MJ, Murray GD (2006) Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. J Clin Oncol 24(21):3401–3407. doi:10.1200/JCO.2005.04.5724 PubMedCrossRef Fearon KC, Barber MD, Moses AG, Ahmedzai SH, Taylor GS, Tisdale MJ, Murray GD (2006) Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. J Clin Oncol 24(21):3401–3407. doi:10.​1200/​JCO.​2005.​04.​5724 PubMedCrossRef
16.
Zurück zum Zitat Thoresen L, Frykholm G, Lydersen S, Ulveland H, Baracos V, Prado CM, Birdsell L, Falkmer U (2012) Nutritional status, cachexia and survival in patients with advanced colorectal carcinoma. Different assessment criteria for nutritional status provide unequal results. Clin Nutr. doi:10.1016/j.clnu.2012.05.009 Thoresen L, Frykholm G, Lydersen S, Ulveland H, Baracos V, Prado CM, Birdsell L, Falkmer U (2012) Nutritional status, cachexia and survival in patients with advanced colorectal carcinoma. Different assessment criteria for nutritional status provide unequal results. Clin Nutr. doi:10.​1016/​j.​clnu.​2012.​05.​009
17.
Zurück zum Zitat Lundholm K, Daneryd P, Korner U, Hyltander A, Bosaeus I (2004) Evidence that long-term COX-treatment improves energy homeostasis and body composition in cancer patients with progressive cachexia. Int J Oncol 24(3):505–512PubMed Lundholm K, Daneryd P, Korner U, Hyltander A, Bosaeus I (2004) Evidence that long-term COX-treatment improves energy homeostasis and body composition in cancer patients with progressive cachexia. Int J Oncol 24(3):505–512PubMed
18.
Zurück zum Zitat Daneryd P, Svanberg E, Korner U, Lindholm E, Sandstrom R, Brevinge H, Pettersson C, Bosaeus I, Lundholm K (1998) Protection of metabolic and exercise capacity in unselected weight-losing cancer patients following treatment with recombinant erythropoietin: a randomized prospective study. Cancer Res 58(23):5374–5379PubMed Daneryd P, Svanberg E, Korner U, Lindholm E, Sandstrom R, Brevinge H, Pettersson C, Bosaeus I, Lundholm K (1998) Protection of metabolic and exercise capacity in unselected weight-losing cancer patients following treatment with recombinant erythropoietin: a randomized prospective study. Cancer Res 58(23):5374–5379PubMed
20.
Zurück zum Zitat Lundholm K, Korner U, Gunnebo L, Sixt-Ammilon P, Fouladiun M, Daneryd P, Bosaeus I (2007) Insulin treatment in cancer cachexia: effects on survival, metabolism, and physical functioning. Clin Cancer Res 13(9):2699–2706. doi:10.1158/1078-0432.CCR-06-2720 PubMedCrossRef Lundholm K, Korner U, Gunnebo L, Sixt-Ammilon P, Fouladiun M, Daneryd P, Bosaeus I (2007) Insulin treatment in cancer cachexia: effects on survival, metabolism, and physical functioning. Clin Cancer Res 13(9):2699–2706. doi:10.​1158/​1078-0432.​CCR-06-2720 PubMedCrossRef
21.
Zurück zum Zitat Symreng T (1982) Arm anthropometry in a large reference population and in surgical patients. Clin Nutr 1(3):211–219PubMedCrossRef Symreng T (1982) Arm anthropometry in a large reference population and in surgical patients. Clin Nutr 1(3):211–219PubMedCrossRef
22.
Zurück zum Zitat Persson H, Bennegard K, Lundberg PA, Svaninger G, Lundholm K (1985) Thyroid hormones in conditions of chronic malnutrition. A study with special reference to cancer cachexia. Ann Surg 201(1):45–52PubMed Persson H, Bennegard K, Lundberg PA, Svaninger G, Lundholm K (1985) Thyroid hormones in conditions of chronic malnutrition. A study with special reference to cancer cachexia. Ann Surg 201(1):45–52PubMed
23.
Zurück zum Zitat Håglin L, Hagman U, Nilsson M (1995) Evaluation of the meal model "Matmallen". A means of estimating consumed amounts of food. Scandinavian Journal of Nutrition 39:79–83 Håglin L, Hagman U, Nilsson M (1995) Evaluation of the meal model "Matmallen". A means of estimating consumed amounts of food. Scandinavian Journal of Nutrition 39:79–83
24.
Zurück zum Zitat Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376PubMedCrossRef Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376PubMedCrossRef
26.
Zurück zum Zitat Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144PubMed Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144PubMed
27.
Zurück zum Zitat Quinten C, Coens C, Mauer M, Comte S, Sprangers MA, Cleeland C, Osoba D, Bjordal K, Bottomley A (2009) Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol 10(9):865–871. doi:10.1016/S1470-2045(09)70200-1 PubMedCrossRef Quinten C, Coens C, Mauer M, Comte S, Sprangers MA, Cleeland C, Osoba D, Bjordal K, Bottomley A (2009) Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol 10(9):865–871. doi:10.​1016/​S1470-2045(09)70200-1 PubMedCrossRef
28.
Zurück zum Zitat Trajkovic-Vidakovic M, de Graeff A, Voest EE, Teunissen SCCM (2012) Symptoms tell it all: a systematic review of the value of symptom assessment to predict survival in advanced cancer patients. Critical Reviews in Oncology/Hematology (0) Trajkovic-Vidakovic M, de Graeff A, Voest EE, Teunissen SCCM (2012) Symptoms tell it all: a systematic review of the value of symptom assessment to predict survival in advanced cancer patients. Critical Reviews in Oncology/Hematology (0)
29.
Zurück zum Zitat Marin Caro MM, Laviano A, Pichard C (2007) Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 26(3):289–301PubMedCrossRef Marin Caro MM, Laviano A, Pichard C (2007) Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 26(3):289–301PubMedCrossRef
32.
Zurück zum Zitat Vigano A, Del Fabbro E, Bruera E, Borod M (2012) The cachexia clinic: from staging to managing nutritional and functional problems in advanced cancer patients. Crit Rev Oncog 17(3):293–304PubMedCrossRef Vigano A, Del Fabbro E, Bruera E, Borod M (2012) The cachexia clinic: from staging to managing nutritional and functional problems in advanced cancer patients. Crit Rev Oncog 17(3):293–304PubMedCrossRef
Metadaten
Titel
Diagnostic criteria of cancer cachexia: relation to quality of life, exercise capacity and survival in unselected palliative care patients
verfasst von
Ola Wallengren
Kent Lundholm
Ingvar Bosaeus
Publikationsdatum
01.06.2013
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 6/2013
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-012-1697-z

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