Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model-a study based on data from an international multicentre project (EPCRC-CSA)

Blum, David and Stene, G. B. and Solheim, T. S. and Fayers, P. and Hjermstad, M. J. and Baracos, V. E. and Fearon, K. and Strasser, F. and Kaasa, S. and Lieve, Van den Block and Koen, Meeussen and Brearley, Sarah and Augusto, Caraceni and Joachim, Cohen and Massimo, Costantini and Anneke, Francke and Richard, Harding and Higginson, Irene J. and Stein, Kaasa and Karen, Linden and Guido, Miccinesi and Bregje, Onwuteaka Philipsen and Koen, Pardon and Roeline, Pasman and Sophie, Pautex and Payne, Sheila and Luc, Deliens (2014) Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model-a study based on data from an international multicentre project (EPCRC-CSA). Annals of Oncology, 25 (8): mdu086. pp. 1635-1642. ISSN 0923-7534

Abstract

Background: Weight loss limits cancer therapy, quality of life and survival. Common diagnostic criteria and a framework for a classification system for cancer cachexia were recently agreed upon by international consensus. Specific assessment domains (stores, intake, catabolism and function) were proposed. The aim of this study is to validate this diagnostic criteria (two groups: model 1) and examine a four-group (model 2) classification system regarding these domains as well as survival. Patients and methods: Data from an international patient sample with advanced cancer (N = 1070) were analysed. In model 1, the diagnostic criteria for cancer cachexia [weight loss/body mass index (BMI)] were used. Model 2 classified patients into four groups 0-III, according to weight loss/BMI as a framework for cachexia stages. The cachexia domains, survival and sociodemographic/medical variables were compared across models. Results: Eight hundred and sixty-one patients were included. Model 1 consisted of 399 cachectic and 462 non-cachectic patients. Cachectic patients had significantly higher levels of inflammation, lower nutritional intake and performance status and shorter survival. In model 2, differences were not consistent; appetite loss did not differ between group III and IV, and performance status not between group 0 and I. Survival was shorter in group II and III compared with other groups. By adding other cachexia domains to the model, survival differences were demonstrated. Conclusion: The diagnostic criteria based on weight loss and BMI distinguish between cachectic and non-cachectic patients concerning all domains (intake, catabolism and function) and is associated with survival. In order to guide cachexia treatment a four-group classification model needs additional domains to discriminate between cachexia stages.