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BMC Palliat Care. 2019 Jun 4;18(1):46. doi: 10.1186/s12904-019-0429-2.

A prospective study examining cachexia predictors in patients with incurable cancer.

Author information

1
Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Postbox 8905 MTFS, NO-7491, Trondheim, Norway. ola.m.vagnildhaug@ntnu.no.
2
Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Postboks 3250 Sluppen, NO-7006, Trondheim, Norway. ola.m.vagnildhaug@ntnu.no.
3
Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy.
4
European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Box 4956, Nydalen, 0424, Oslo, Norway.
5
Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, Oncological Palliative Medicine, Section Oncology, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
6
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Cross Cancer Institute 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
7
Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK.
8
Hospital Universitari Arnau de Vilanova and Universidad de Lleida, Av. Alcalde Rovira Roure 80, 25198, Lleida, Spain.
9
Edinburgh Cancer Research UK Centre, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XR, UK.
10
Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Postbox 8905 MTFS, NO-7491, Trondheim, Norway.
11
Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Postboks 3250 Sluppen, NO-7006, Trondheim, Norway.

Abstract

BACKGROUND:

Early 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.

METHODS:

A 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.

RESULTS:

Six-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%.

CONCLUSION:

Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia.

TRIAL REGISTRATION:

ClinicalTrials.gov Identifier: NCT01362816 .

KEYWORDS:

Cachexia; Cancer; Palliative care; Pre-cachexia; Weight loss

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