Impact of cachexia at diagnosis on radiotherapy utilization and survival in non-small cell lung cancer.

Abstract

133 Background: The presence of cachexia at the time of cancer diagnosis and its influence on disease management and treatment outcomes for patients receiving radiotherapy are poorly described. Here, we assess the role of baseline cachexia in patients with NSCLC on first-line treatment modality and clinical outcomes. Methods: Retrospective review of medical records identified 1,334 patients with NSCLC consecutively treated at a tertiary care health system between 1/1/06 and 12/31/13. Cachexia was defined using the well-accepted and validated international consensus definition. The delivery of radiotherapy and its treatment intent were abstracted. Results: The cohort included a representative group of patients with a median age at diagnosis of 64 years, 47% females, and 32% patients of non-White race. Stage at diagnosis was I, II, III, and IV in 291, 105, 356, and 578 (43.3%) patients, respectively. Cachexia was present at the time of diagnosis in 403 (30.2%) patients including 18%, 14%, 32%, and 39% of stage I, II, III, and IV patients, respectively. Palliative intent radiotherapy was received by significantly more stage IV patients with cachexia (74%) than without cachexia (63%) (X2, P = .01). In contrast, baseline cachexia was not associated with curative intent radiotherapy in stage I-III disease. At a median follow-up of 24 months, 857 deaths have been observed. Cachexia at the time of diagnosis was prognostic for worse survival by stage. For patients with stage IV NSCLC, median survival was 11 months for patients without cachexia but 6 months for patients with cachexia at diagnosis (P < .001). Cachexia remained significant in stage I NSCLC, with median survival of 45 and 67 months with or without cachexia at diagnosis, respectively (P = .03). Conclusions: Cancer cachexia at the time of diagnosis is common in patients with NSCLC even with early stage disease. The presence of cachexia at diagnosis is associated with utilization of radiotherapy as a palliative treatment. However, cachexia at diagnosis of NSCLC, even with early stage disease, is prognostic of worse outcomes despite curative intent radiotherapy.

Cancer cachexia and treatment toxicity

“…Despite the generally worse prognosis associated with cancer cachexia syndrome, this population of patients has significant utilization of radiotherapy [48]. This increased use of radiotherapy is likely related to the fact that patients with metabolic and physiological abnormalities cannot tolerate surgery or systemic agents, making radiotherapy an appealing modality for these patients.…”

Physical exercise at the crossroad between muscle wasting and the immune system: implications for lung cancer cachexia

“…14 In patients with advanced lung cancer, cachexia at diagnosis is associated with shorter survival (n = 226, median OS 11 vs. 6 months, P = 0.03). 14 Muscle depletion represents a negative prognostic factor for patients with unresectable NSCLC (n = 936) undergoing chemo-radiotherapy with curative intent. 36 Cachexia develops and negatively affects the prognosis also in early-stage cancer, even though the caloric intake is still preserved.…”

“…However, cachexia occurs already in patients with stage I non‐small lung cancer (NSCLC), even without any impairment in caloric intake 13 . About 20% of patients with early stage NSCLC present with signs of cachexia 14 . In patients with stage III NSCLC undergoing curative treatment, weight loss was observed already during the first 3 weeks of concurrent chemo‐radiotherapy (CCRT), before any caloric intake decrease was reported 15 .…”

“…Cachexia occurs in about 40% of patients with metastatic NSCLC 6 and in approximately 20% of patients with early stage lung cancer 14 . In patients with advanced lung cancer, cachexia at diagnosis is associated with shorter survival ( n = 226, median OS 11 vs. 6 months, P = 0.03) 14 .…”

“…Cachexia occurs in about 40% of patients with metastatic NSCLC 6 and in approximately 20% of patients with early stage lung cancer 14 . In patients with advanced lung cancer, cachexia at diagnosis is associated with shorter survival ( n = 226, median OS 11 vs. 6 months, P = 0.03) 14 . Muscle depletion represents a negative prognostic factor for patients with unresectable NSCLC ( n = 936) undergoing chemo‐radiotherapy with curative intent 36 .…”