Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross‐sectional survey (NutriAgeCancer)

Abstract

Background Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality. Methods A French nationwide cross‐sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality. Results Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79–87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49–55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up‐and‐go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05–2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications. Conclusions More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.

Understanding Cancer Cachexia and Its Implications in Upper Gastrointestinal Cancers

“…Furthermore, weight loss was independently associated with poor survival. Other contemporary studies have assessed the variation in cachexia prevalence [16][17][18]. While heterogeneity in definitions and cohorts limit the accuracy with which results can be synthesised, higher rates of cachexia have consistently been noted in OG, hepatopancreatobiliary, and lung cancers.…”

Identification and management of cancer cachexia in patients: Assessment of healthcare providers' knowledge and practice gaps

“…It is defined as a multifactorial syndrome characterized by skeletal muscle mass loss (with or without loss of fat mass) due to negative protein and energy balance that is driven by a variable combination of reduced food intake and abnormal metabolism 1 . Cancer cachexia is associated with a decrease in patients' quality of life and increased mortality 2–4 . Furthermore, the condition may be responsible for up to 50% of patients suffering and more than 20% of patient deaths 5–9 …”

“… 1 Cancer cachexia is associated with a decrease in patients' quality of life and increased mortality. 2 , 3 , 4 Furthermore, the condition may be responsible for up to 50% of patients suffering and more than 20% of patient deaths. 5 , 6 , 7 , 8 , 9 …”

“I want to get myself as fit as I can and not die just yet” – Perceptions of exercise in people with advanced cancer and cachexia: a qualitative study

“…Cancer cachexia is a multifactorial syndrome characterized by the ongoing loss of muscle mass, with or without the loss of fat mass, that cannot be reversed with conventional nutritional support alone and leads to progressive functional impairment [ 1 ]. Cachexia is prevalent in all cancer types, but tends to disproportionately affect people with more advanced or incurable disease [ 2 , 3 ]. Prominent adverse effects of cancer cachexia include increased mortality [ 4 – 6 ], greater treatment toxicity [ 7 , 8 ], declines in physical function [ 9 , 10 ], and reduced overall quality of life (QoL) [ 11 – 13 ].…”