Decoding cachexia: why diagnosis matters in ca.

Maintaining good health and well-being is critical to how well patients respond to cancer treatment. Unfortunately, cachexia, or involuntary weight loss, is a serious problem for many people with advanced cancer. A new study from Japan has found that lower rates of cachexia, especially those with a prevalence of less than 40–50%, are associated with shorter overall survival (OS) rates. The study also found that the diagnostic criteria used to identify cachexia may influence the reported prevalence of cachexia.

People with advanced cardiovascular disease or cancer often face serious health problems. Cachexia, involuntary weight loss, occurs in approximately 11–71% of cancer patients. This condition can interfere with necessary chemotherapy, reduce quality of life, and reduce overall survival (OS)—the length of time cancer patients can live after diagnosis or treatment. Cachexia results in persistent loss of muscle mass with or without fat loss that cannot be reversed with traditional nutritional support, resulting in ongoing difficulty with daily activities. Various diagnostic methods are available to detect cachexia, each of which predicts different survival outcomes. However, the lack of a consistent diagnostic approach poses challenges to assessing the prevalence of cachexia and its actual impact on survival.

To fill this gap, Mr. Tomoya Takaoka, Registered Dietitian, Department of Clinical Nutrition, Shinshu University Hospital, Japan, collaborated with Dr. Daiki Watanabe, Associate Professor Waseda University, And Doctor Akinori Yaegashi, Associate Professor at Hokkaido Bunkyo University. Their results were made available online on August 8, 2024, and published in Volume 15, Issue 9 of the journal. Advances in nutrition September 1, 2024

They sought to understand the impact of cachexia diagnosis on overall survival in cancer patients. Lead author Takaoka explains: “If prevalence and OS are affected by differences in diagnostic criteria for cachexia, we believe this represents a barrier to translating research findings into 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 in PROSPERO (CRD42023435474), a database of systematic reviews, to ensure transparency and adherence to research standards. They found that cachexia affects 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 rate varied significantly, from approximately 13% to 56%, depending on the specific diagnostic criteria used.

The Fearon 2011 criteria (developed by the European Palliative Care Research Centre) are the most widely used for diagnosing cachexia, whereas the Evans 2008 criteria are used less frequently. The prevalence of cachexia is significantly higher using the Fearon criteria than using the Evans criteria. It is less common when factors such as decreased energy intake, loss of appetite, inflammation, low muscle strength or fatigue are included. “Analyzing the impact of different diagnostic criteria will allow us to select people with possible cachexia from a larger population or identify people with cachexia who are at high risk of death, leading to appropriate treatment.Takaoka explains.

What is the impact of different diagnostic criteria for cancer cachexia on patient outcomes? The team addressed this question through a meta-analysis examining how a diagnosis of cachexia affects survival in cancer patients. They found that OS varied according to the prevalence of cachexia. Cachexia was associated with a higher risk of death compared with patients without cachexia, which varied depending on the final criteria used (Fearon 2011 criteria had a lower hazard ratio for OS than other criteria). The results showed that the risk of death was significantly higher when the prevalence of cachexia was low, but stabilized at 40–50%. 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.

Highlighting the important results of his research, Takaoka emphasizes: “The final criteria for cachexia must be consistent with the purpose of diagnosis. When the goal is to screen individuals at risk for cachexia, broader high prevalence criteria are best suited. Conversely, when the goal is to identify high-risk groups for treatment, stricter low-prevalence criteria are more specific. In clinical practice, this measure may help identify patients who require intensive treatment for cachexia, including dietary changes and medication.”

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

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