Abstract
Cancer cachexia is common in patients with oesophagogastric cancer (OG) and is linked to overall survival (OS). One of the key components of cachexia is anorexia; it is not known whether anorexia impacts on OS and there is no method of routine screening in current practice. Diagnosis relies on patients describing the symptoms, clinicians diagnosing anorexia and acting upon it. Patients with oesophageal/gastroesophageal junction or gastric cancer were assessed using the Functional Assessment of Anorexia Cachexia Therapy Anorexia/Cachexia Subscale (FAACT A/CS). FAACT A/CS includes 12 questions validated previously to diagnose anorexia in patients with cancer. Of the 182 patients included, 69% scored ≤37/48 and were considered to be anorexic; FAACT A/CS was a better predictor of OS in metastatic patients than body mass index or weight loss in the six months prior to cancer diagnosis. The median OS of patients with FAACT A/CS scores of >37 was longer than patients with scores of ≤37 (19.3 months vs 6.7 months, Hazard Ratio [HR] 2.9, 95% Confidence Interval [CI] 1.4–6.0, p<0.0001). Patients with performance status (PS) 0–2 and FAACT A/CS >37 had substantially longer OS than those with PS 0–2 and FAACT A/CS ≤37 (18.7 months vs 7.9 months, HR 2.5 (95% CI 1.2–5.1, P<0.0001). The FAACT A/CS questionnaire allows clinicians to identify patients with anorexia who may benefit from early nutrition interventions. Importantly, this is the first study to show the association between anorexia and survival in patients with metastatic OG cancers. This will form the basis of future interventional studies to improve patient outcomes.
Highlights
Cancer cachexia is a condition defined by loss of skeletal muscle mass
There was a strong association between anorexia and weight loss, we demonstrated that these to parameters are not equivalent
Five-year survival rates range from 4% to 30% for patients with nonresectable [16] and resectable disease, respectively [17]
Summary
Cancer cachexia is a condition defined by loss of skeletal muscle mass. Assessing anorexia in patients with cancer abnormal metabolism [1]. This complex interaction results in weight loss and reduces both quality of life and survival outcomes [2]. There are defined stages of cancer cachexia; pre-cachexia, cachexia and refractory cachexia. The refractory stage can be considered as cachexia with very poor prognosis, as it is the cancer disease that defines this stage [1,3]
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