A preliminary study of attitudes toward the assessment and management of cancer cachexia among medical oncologists and nurses.

Abstract

44 Background: A recent international consensus on the definition and classification of the cancer anorexia / cachexia syndrome (CACS) will facilitate clinical trial design, development of practice guidelines, and routine clinical management. Non-pharmacological interventions such as dietary counseling and promising new drugs have demonstrated improved outcomes in preliminary trials. Management of nutritional impact symptoms such as severe pain, depression, early satiety and chronic nausea also produce weight gain. These important advances contrast with the apparent low priority given to this condition by oncological societies worldwide. Our objective was to evaluate the attitudes of medical oncologists and nurses in the assessment and management of CACS in non-small cell lung cancer. Methods: Surveys were administered electronically to US-based, community medical oncologists (n=76 respondents) and oncology nurses (n=25), members of the Sermo research database which includes over 275,000 active healthcare providers, pre-qualified through telephone or online screening. A proprietary MedPulse tool achieved random geographic distribution of respondents through a staged query–response process. Results: 67% of medical oncologists selected weight loss as the most important criterion for diagnosing CACS in their daily practice, consistent with the consensus definition. However, only 4% of respondents described CACS as inevitable or very likely to develop in patients maintaining good performance status through first-line therapy. Community providers identified the management of symptoms that affect appetite as very important (58.8%), important (31.4%) or somewhat important (7.8%), but only 9.8% indicated they currently use a formal tool to evaluate these symptoms. 72% would consider using a brief assessment tool in clinical practice. Conclusions: Our surveys suggest community oncologists recognize the core criteria for the diagnosis of CACS, although there may be under-recognition of the condition’s prevalence. There is considerable interest in adopting a brief symptom assessment tool for screening, management and referral of affected or at-risk patients.