1616P The mortality burden of cachexia in patients with non-small cell lung cancer: A systematic literature review

Abstract

Cancer-associated cachexia is a multifactorial wasting disorder that includes anorexia, involuntary weight loss (WL) and decreased skeletal muscle mass, and is an indicator of poor prognosis. As such, international consensus (IC) diagnostic criteria for cancer cachexia have been proposed (Fearon et al., Lancet Oncol 2011;12:489–95). This systematic literature review (SLR) examined the relationship between cachexia and survival in patients with non-small-cell lung cancer (NSCLC). The SLR was conducted following PRISMA guidelines. Embase® and PubMed were searched to identify articles published in English between 1 Jan 2016 and 10 Oct 2021 reporting survival in adults with cancer and cachexia or at risk of cachexia, as defined by IC criteria or a broader definition of any WL. Included publications were of randomized/non-randomized clinical trials and retrospective/prospective observational studies in ≥100 patients with NSCLC. Forty-two publications in patients with NSCLC met eligibility criteria (41 observational studies; 1 pooled analysis of clinical trials). Included studies were primarily from Europe (40%), Asia (21%) or the United States (19%). Twelve studies (29%) reported cachexia using IC criteria and 30 studies reported either any WL or WL >5%. Four studies reported prevalence of cachexia, which ranged from 5.3% to 48.1%. Thirty-one studies reported prevalence of any WL; of these, 16 studies reported prevalence of WL ≥5% (prevalence range: 7.4%–58.9%). An association between survival and cachexia/WL was assessed across 41 studies that used multivariate (n=34) or univariate (n=7) analyses. Cachexia/WL was associated with a statistically significantly poorer survival in 30 of 34 studies (88.2%) that used multivariate analyses. This SLR found that less than a third of studies used the IC criteria to identify cachexia in the context of NSCLC. Nonetheless, cachexia/WL was associated with significantly poorer survival in these patients. An awareness of cachexia in NSCLC would allow early implementation of disease management strategies that may improve prognosis in these patients.