Hypermetabolism and symptom burden in advanced cancer patients evaluated in a cachexia clinic

Abstract

BackgroundElevated resting energy expenditure (REE) may contribute to weight loss and symptom burden in cancer patients.AimsThe aim of this study was to compare the velocity of weight loss, symptom burden (fatigue, insomnia, anxiety, and anorexia—combined score as measured by the Edmonton Symptom Assessment Score), high-sensitivity C-reactive protein, and survival among cancer patients referred to a cachexia clinic with hypermetabolism, elevated REE > 110% of predicted, with normal REE.MethodsA retrospective analysis of 60 advanced cancer patients evaluated in a cachexia clinic for either >5% weight loss or anorexia who underwent indirect calorimetry to measure REE. Patients were dichotomized to either elevated or normal REE. Descriptive statistics were generated, and a two-sample Student's t-tests were used to compare the outcomes between the groups. Kaplan–Meier and Cox regression methodology were used to examine the survival times between groups.ResultsThirty-seven patients (62%) were men, 41 (68%) were White, 59 (98%) solid tumours, predominantly 23 gastrointestinal cancers (38%), with a median age of 60 (95% confidence interval 57.0–62.9). Thirty-five patients (58%) were hypermetabolic. Non-Caucasian patients were more likely to have high REE [odds ratio = 6.17 (1.56, 24.8), P = 0.01]. No statistical difference regarding age, cancer type, gender, active treatment with chemotherapy, and/or radiation between hypermetabolic and normal REE was noted. The velocity of weight loss over a 3 month period (−8.5 kg vs. −7.2 kg, P = 0.68), C-reactive protein (37.3 vs. 55.6 mg/L, P = 0.70), symptom burden (4.2 vs. 4.5, P = 0.54), and survival (288 vs. 276 days, P = 0.68) was not significantly different between high vs. normal REE, respectively.ConclusionHypermetabolism is common in cancer patients with weight loss and noted to be more frequent in non-Caucasian patients. No association among velocity of weight loss, symptom burden, C-reactive protein, and survival was noted in advanced cancer patients with elevated REE.

Hypermetabolism: should cancer types, pathological stages and races be considered in assessing metabolism and could elevated resting energy expenditure be the therapeutic target in patients with advanced cancer?

“…In this study, hypermetabolism is more common in non-Caucasian patients than in Caucasian patients 1. Interestingly, non-Caucasian healthy subjects had a lower REE compared with Caucasian healthy subjects,5 and a similar trend was observed in obese patients 6.…”

“…In this study, hypermetabolism is more common in non-Caucasian patients than in Caucasian patients. 1 Interestingly, non-Caucasian healthy subjects had a lower REE compared with Caucasian healthy subjects, 5 and a similar trend was observed in obese patients. 6 It is still controversial whether racial background influences metabolic response in various pathophysiological conditions such as obesity, diabetes and cancer cachexia.…”

“…Hypermetabolism, defined as elevated resting energy expenditure (REE), was common in cancer cachectic patients1 as published before in cancer patients2 and might result in poor outcomes.…”

PGC‐1α4 gene expression is suppressed by the IL‐6—MEK—ERK 1/2 MAPK signalling axis and altered by resistance exercise, obesity and muscle injury

“…Skeletal muscle mass maintenance and function are critical for daily living, exercise performance (Beaudart et al 2015) and quality of life. Many conditions are associated with muscle mass loss including, but not limited to obesity, diabetes, ageing, cancer cachexia and HIV/AIDS (Nilsson et al 2010, Scherzer et al 2011, Dev et al 2015, Trombetti et al 2015. Considering the widespread implications of these diseases, the elucidation of the mechanisms governing skeletal muscle mass is critical to promote healthy living.…”

Cancer Cachexia and Related Metabolic Dysfunction

“…The Harris-Benedict equation has been largely used to estimate the energy expenditure in patients with cancer in spite of its limitations to predict energy expenditure in malnourished patients [32]. A predicted resting energy expenditure higher than 110% has been described in 58% of patients with unselected cancer [33] and it has been independently associated with poor prognosis in a recent study with metastatic non-small cell lung cancer (NSCLC) [34]. However, a more appropriated analysis would be to correct measured resting energy expenditure (by indirect calorimetry) for lean body mass (LBM), considering that patients with cancer might present a daily energy consumption of 43.7 kcal/kg [34].…”