Maintaining health and well-being is crucial to how well patients do respond to cancer treatments. Unfortunately, cachexia, or unintentional weight loss, is a major concern for many people with advanced cancer. A new study from Japan has shown that lower rates of cachexia, particularly with a prevalence of less than 40-50%, are related to shorter overall survival (OS) rates. The study also showed that the diagnostic criteria used to detect cachexia may affect the prevalence of reported cachexia.

People with advanced heart disease or cancer often face serious health challenges. Cachexia, an involuntary weight loss, affects about 11% to 71% of cancer patients. This condition can disrupt essential chemotherapy, decrease quality of life, and reduce overall survival (OS)—the length of time cancer patients live after being diagnosed or starting treatment. Cachexia results in a continuous loss of muscle mass, with or without fat loss, that cannot be remedied by conventional nutritional support, creating ongoing difficulties in daily activities. There are different diagnostic methods for detecting cachexia, each predicting different survival outcomes. However, the lack of a consistent diagnostic approach creates challenges for assessing the prevalence of cachexia and its real impact on survival rates.

To bridge this gap, Mr. Tomoya Takaoka, a registered dietitian at the Division of Clinical Nutrition at Shinshu University Hospital, Japan, collaborated 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 the diagnosis of cachexia on OS in cancer patients. Lead author Takaoka explains: “If prevalence and OS are affected by differences in diagnostic criteria for cachexia, we consider this to be an obstacle in adapting research findings 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 study was registered with PROSPERO (CRD42023435474), a database for systematic reviews, to ensure transparency and adherence to research standards. They found that cachexia affected about 52% of patients in North America and Europe and about 29% in Asia. Overall, the overall prevalence of cachexia in cancer patients was 33%. However, this rate varied significantly, ranging from approximately 13% to 56%, depending on the specific diagnostic criteria used.

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

What was the impact of different diagnostic criteria for cancer cachexia on patient outcomes? The team addressed this question through a meta-analysis exploring how the diagnosis of cachexia affected OS in cancer patients. They found that OS varied with the prevalence of cachexia. Cachexia was associated with a higher risk of death compared with patients without cachexia, which varied with the definitive criteria used (Fearon 2011 criteria had a lower hazard 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 increased 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.

Outlining the important findings of their study, Takaoka points out: “Definitive criteria for cachexia should match the purpose of the diagnosis. When the goal is to screen individuals at risk for cachexia, broader, high-prevalence criteria are most appropriate. Conversely, when the goal is to identify a high-risk population for treatment, stricter, low-prevalence criteria are more specific. In clinical practice, this measure may help identify patients who need intensive treatment for 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 paves 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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