Diagnostic Criteria for the Classification of Cancer-Associated Weight Loss

Martin, Lisa W.; Sénesse, Pierre; Gioulbasanis, Ioannis; Antoun, Sami; Bozzetti, Federico; Deans, Chris; Strasser, Florian; Thoresen, Lene; Jagoe, R. Thomas; Chasen, Martin; Lundholm, Kent; Bosæus, Ingvar; Fearon, Kenneth; Baracos, Vickie E.

doi:10.1200/jco.2014.56.1894

Cited by 586 publications

(535 citation statements)

References 33 publications

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“…However, the difference did not reach statistical significance, although weight loss grade 2 showed a tendency towards significance. Failure to reach significance may be due to the smaller sample in the present study compared with the study by Martin et al 12 …”

Section: Discussioncontrasting

confidence: 71%

“…Weight loss grade was assessed and given a score of 0–4 by combining weight loss and BMI (Table 1). 12 …”

Section: Methodsmentioning

confidence: 99%

“…Another important step forward was made when Martin et al 12 confirmed that severity of weight loss depends on the concurrent depletion of fat and muscle reserves. They showed that weight loss, adjusted for concurrent BMI, predicted survival; patients with a low degree of weight loss and a high BMI had the best prognosis, and those with a high degree of weight loss and a low BMI had the worst prognosis.…”

Section: Introductionmentioning

confidence: 99%

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The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis

Vagnildhaug

Blum

Wilcock

et al. 2017

J cachexia sarcopenia muscle

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BackgroundA body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression.MethodsAn international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0–4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains [anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade.ResultsOne thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS ≤ 70). The overall effect of the WLGS on survival was significant as expressed by change in −2 log likelihood (P < 0.001) and persisted after adjustment for age, sex, and cancer type and stage (P < 0.001). Median survival decreased across the weight loss grades ranging from 407 days (95% CI 312–502)—weight loss grade 0 to 119 days (95% CI 93–145)—weight loss grade 4. All cachexia domains significantly deteriorated with increasing weight loss grade, and deterioration was greatest for dietary intake, with a difference corresponding to 0.87 standard deviations between weight loss grades 0 and 4. The addition of KPS, anorexia, and physical and emotional functioning improved the prognostic accuracy of the WLGS. Likelihood of cachexia progression was greater in patients with weight loss grade 2 (39%) than that with weight loss grade 0 (19%) or 1 (22%).ConclusionsThe WLGS is related to survival, cachexia domains, and the likelihood of progression. Adding certain cachexia domains to the WLGS improves prognostic accuracy.

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Section: Discussioncontrasting

confidence: 71%

“…Weight loss grade was assessed and given a score of 0–4 by combining weight loss and BMI (Table 1). 12 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis

Vagnildhaug

Blum

Wilcock

et al. 2017

J cachexia sarcopenia muscle

Self Cite

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“…The situation is further complicated by the obesity epidemic that has been progressively worsening in recent times. Adiposity is an established risk factor for cancer, and recent studies have reported that between 40% and 60% of cancer patients are overweight or obese, even in the setting of metastatic disease 4, 17, 18, 65, 66. Irrespective of BMI, hidden malnutrition can be present, yields adverse clinical consequences, and needs to be identified and addressed 18…”

Section: Discussionmentioning

confidence: 99%

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Bhuachalla

Daly

Power

et al. 2017

J cachexia sarcopenia muscle

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BackgroundNutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis).MethodsA prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria.ResultsA total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT‐identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as ‘low nutritional risk’, respectively. The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘low nutritional risk’ by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2–2.8, P = 0.007).ConclusionsHigh numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients.

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“…Robust data show that the severity of weight loss is a reliable, yet negative, prognostic factor in cancer patients and in other clinical conditions as well (16) . However, BMI also influences survival in cancer patients, higher BMI being associated with longer survival (16) . In order to obtain a more accurate classification of weight loss, and therefore of cachexia, which encompasses muscle and fat mass changes, Martin et al classified a large cohort of cancer patients (n 8160) not only according to the severity of weight loss but BMI as well (16) .…”

Section: Bmi As a Contributory Factor In Determining Outcomementioning

confidence: 99%

Cachexia: clinical features when inflammation drives malnutrition

2015

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Diagnostic Criteria for the Classification of Cancer-Associated Weight Loss

Abstract: A robust grading system incorporating the independent prognostic significance of both BMI and %WL was developed.

Cited by 586 publications

References 33 publications

The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis

The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Cachexia: clinical features when inflammation drives malnutrition

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