Participative design of a support questionnaire for the process of diagnosing anorexia-caquexia syndorme (ACS) in cancer patients

Abstract

19662 Background: Early treatment of the anorexia-cachexia syndrome (ACS) provides a significant benefit for cancer patients, hence the need for early diagnosis. Currently available tools are complex, hampering their systematic application in clinical practice and treatment does not begin until moderate-to-severe states of malnutrition are reached. After holding 20 workshops between 2003–2005 involving about 150 Spanish oncologists, it was concluded that the ACS diagnosis should be based on questionnaires, anthropometric assessment and analytical determination, hence the need for design a brief and efficient questionnaire to support the process of diagnosing ACS in cancer patients. Methods: Between February and June 2006, 9 working sessions were held and 123 oncologists consulted to assess the symptoms and diagnostic tests required for the evaluation of ACS. In all sessions a preliminary presentation was given on the conclusions of the workshops held over the previous two years, followed by a structured discussion that was facilitated by a moderator using the Metaplan work method. Results: Questions achieving a consensus of over 75% were deemed as essential. Included among the questions to be answered by the patients are: anorexia (79.7%), dysphagia (78.9%) and vomiting/nausea (79.7%). The physician’s set of questions include: evolution of body weight determined by weight loss >10% (94.3%); stage of the disease (80.5%), considering stage IV to be an alert sign of ACS; the location of the neoplasia (78.9%), with head and neck, esophagus, pancreas, biliary ducts and stomach being the most prevalent neoplasia locations among these patients and albumin level (77.2%), being suspected ACS diagnosis on 2.1 mg/dl or less. It was agreed that the questionnaire should be a simple tool, phrased in easy-to- understand language and formulated with short (92%) and few (85%)questions and to keep the format simple, making it easier to fill in (36.5%). The inclusion of closed “Yes/No” type answers was regarded positively. Conclusions: The proposed ACS diagnosis questionnaire meets the expectations set at the start of the project. We are currently carrying out a validation process in order to ensure its reproducibility. No significant financial relationships to disclose.