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The cancer anorexia-cachexia syndrome: myth or reality?

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Abstract

Background

Controversy exists as what constitutes the cancer anorexia-cachexia syndrome (CACS), and whether it truly is a distinct clinical disorder. In this study, we aimed to: (1) assess if CACS is a distinct clinical disorder, (2) identify the symptoms characteristic of CACS, (3) evaluate CACS impact on patient outcomes (symptom burden and survival time from referral).

Methods

Consecutive patients referred to palliative medicine were assessed by 38-symptom questionnaire. Demographics, Eastern Cooperative Oncology Group (ECOG), disease and extent, and survival were recorded. CACS, defined as anorexia plus weight loss (>10% of pre-illness weight). For analysis, patients were divided into four groups: (1) group CACS; (2) group A (only anorexia, NO >10% pre-illness weight loss); (3) group WL (weight loss >10% pre-illness weight only but NO anorexia); and (4) group N (NO weight loss >10% pre-illness weight and NO anorexia). Symptoms present in ≥5%, and patients with complete data were analyzed.

Results

Four hundred eighty-four patients had complete data, metastatic cancer, and 26 symptoms present in ≥5%. Groups had significantly different ECOG, symptom burden, and survival. Significantly different symptom prevalence between groups: dry mouth,*early satiety,*constipation,*nausea,*taste changes,*vomiting,*dysphagia,*fatigue,*weak,*lack of energy, insomnia, dyspnea, depression, hoarseness, and anxiety. The nine symptoms with asterisk were CACS specific. Symptom Burden: CACS independently predicted greatest burden. Survival: Group N had significantly longer survival.

Conclusions

CACS appeared to be a distinct disorder with unique clinical characteristics in our advanced cancer population. Nine other symptoms constituted CACS. CACS independently predicted higher symptom burden. CACS absence predicted longer survival. More evidence is needed to better characterize this syndrome and generate a valid CACS consensus. A comprehensive validated CACS assessment instrument is required.

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Authors and Affiliations

  1. The Harry R Horvitz Center for Palliative Medicine, Department of Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA

    Wael Lasheen & Declan Walsh

  2. Cleveland Clinic, 9500 Euclid Ave.–M76, Cleveland, OH, 44195, USA

    Declan Walsh

Authors
  1. Wael Lasheen
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  2. Declan Walsh
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Corresponding author

Correspondence to Declan Walsh.

Additional information

A World Health Organization Demonstration Project in Palliative Medicine. An ESMO Designated Center of Integrated Oncology and Palliative Care.

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Lasheen, W., Walsh, D. The cancer anorexia-cachexia syndrome: myth or reality?. Support Care Cancer 18, 265–272 (2010). https://doi.org/10.1007/s00520-009-0772-6

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  • DOI: https://doi.org/10.1007/s00520-009-0772-6

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