Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes

Rhys White,Hafez Ahmed,Christine Baldwin,Robert Grant,C Elizabeth Weekes

doi:10.1007/s00520-019-05259-1

Abstract

PurposeCancer cachexia (CC) is a syndrome characterised by an ongoing loss of skeletal muscle mass associated with reduced tolerance to treatment. This study explored the prevalence and severity of CC in advanced non-small cell lung cancer (NSCLC) patients and determined its relationship with chemotherapy outcomes.MethodsCC was classified into a four-stage model: no cachexia, pre-cachexia (PC), cachexia and refractory cachexia (RC) with categorisation determined from biochemical and body composition and performance assessment. Associations between the stage of cachexia and chemotherapy outcomes including radiological response, the number of chemotherapy cycles completed and the number of cycles delayed or dose reduced were explored.ResultsTwenty-four patients were included with 4 (18%) classified as having no cachexia, 4 (18%) PC, 3 (14%) cachexia (13.6%), and 11 (50%) RC. No association was observed between the stage of cachexia and the radiological response to chemotherapy number of cycles delayed or the number of cycle’s dose reduced; however, there was an association with the number of cycles completed (p = 0.030). An association between C-reactive protein (CRP) and the number of chemotherapy cycles completed (p = 0.044) and the number of dose reductions (p = 0.044) was also identified.ConclusionsLimited conclusions can be drawn given the small sample size. However, the majority of patients presented with some degree of cachexia at diagnosis. A relationship was identified between the increasing severity of cachexia and a lower number of chemotherapy cycles completed, as well as between CRP and the number of chemotherapy cycles completed and the number of dose reductions required, and therefore warrants further exploration in larger studies.

Highlights

Cancer cachexia (CC) is a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass, with or without loss of fat mass that cannot be fully reversed by conventional nutritional support, which leads to progressive functional impairment [1]
The results are suggestive of a high prevalence of cachexia in advanced stage non-small cell lung cancer (NSCLC) patients with a majority presenting with some degree of cachexia at diagnosis
The cachexia assessment tool was able to categorise all patients with complete data sets into an appropriate stage of cachexia; this study was not able to provide any validation in terms of how the different stages of cachexia predicted outcome to chemotherapy

Summary

Introduction

Cancer cachexia (CC) is a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass, with or without loss of fat mass that cannot be fully reversed by conventional nutritional support, which leads to progressive functional impairment [1]. It is associated with reduced quality of life; tolerance to treatment modalities, such as chemotherapy; and survival [2]. An international consensus group agreed a definition and classification framework that described cachexia as a continuum with three stages of clinical relevance that might be seen in one patient: pre-cachexia (PC), cachexia and refractory cachexia (RC) [1]. Other parameters thought to play a role in cachexia, such as anorexia and systemic inflammation, are discussed, but these parameters require further exploration to determine whether they should form part of the classification criteria

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