Abstract
BackgroundEarly intervention against cachexia necessitates a predictive model. The aims of this study were to identify predictors of cachexia development and to create and evaluate accuracy of a predictive model based on these predictors.MethodsA secondary analysis of a prospective, observational, multicentre study was conducted. Patients, who attended a palliative care programme, had incurable cancer and did not have cachexia at baseline, were amenable to the analysis. Cachexia was defined as weight loss (WL) > 5% (6 months) or WL > 2% and body mass index< 20 kg/m2. Clinical and demographic markers were evaluated as possible predictors with Cox analysis. A classification and regression tree analysis was used to create a model based on optimal combinations and cut-offs of significant predictors for cachexia development, and accuracy was evaluated with a calibration plot, Harrell’s c-statistic and receiver operating characteristic curve analysis.ResultsSix-hundred-twenty-eight patients were included in the analysis. Median age was 65 years (IQR 17), 359(57%) were female and median Karnofsky performance status was 70(IQR 10). Median follow-up was 109 days (IQR 108), and 159 (25%) patients developed cachexia. Initial WL, cancer type, appetite and chronic obstructive pulmonary disease were significant predictors (p ≤ 0.04). A five-level model was created with each level carrying an increasing risk of cachexia development. For Risk-level 1-patients (WL < 3%, breast or hematologic cancer and no or little appetite loss), median time to cachexia development was not reached, while Risk-level 5-patients (WL 3–5%) had a median time to cachexia development of 51 days. Accuracy of cachexia predictions at 3 months was 76%.ConclusionImportant predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia.Trial registrationClinicalTrials.gov Identifier: NCT01362816.
Highlights
Intervention against cachexia necessitates a predictive model
Cachexia is present in up to half of patients with cancer [1]. It adversely affects the well-being of many patients with cancer by inducing progressive weight loss as well as impairing appetite, physical function and quality of life [2]
European Palliative Care Cancer Symptom study (EPCCS) was a prospective observational study conducted by the European Palliative Care Research Centre (PRC) and the European Association for Palliative Care (EAPC) Research Network
Summary
Intervention against cachexia necessitates a predictive model. The aims of this study were to identify predictors of cachexia development and to create and evaluate accuracy of a predictive model based on these predictors. Cachexia is present in up to half of patients with cancer [1]. It adversely affects the well-being of many patients with cancer by inducing progressive weight loss as well as impairing appetite, physical function and quality of life [2]. Corticosteroids have been shown to improve fatigue [4] and progestins have improved weight loss, lack of positive effects on lean body mass, physical function or nutritional intake means that these agents have limited clinical benefits [5]. Selective androgen receptor modulators and ghrelin agonists have been examined in this area, lack of demonstrable effects on lean body mass and/or function mean that these have not been granted regulatory approval for the treatment of cachexia [6, 7]
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