Diagnostic criteria of cachexia and their assessment: decreased muscle strength and fatigue.
OBJECTIVE
The classification of cachexia or wasting disease is currently being revised to improve clinical trial design and clinical care. Decreased muscle strength and fatigue are proposed as diagnostic criteria for cachexia or wasting disease including, but not limited to, cancer. This review discusses their expected value in cancer cachexia.


RESULTS
Fatigue is frequent and multifactorial in cancer patients with limited value to predict cachexia, however, most cachectic patients have fatigue. Its assessment requires multimodal subjective instruments, for outcome monitoring many other fatigue cofactors need to be controlled. Cachexia seems a dominant cause for decreased muscle strength. Most cachectic patients lose muscle strength, usually together with reduced muscle mass. High-individual variability of muscle strength limits its use to longitudinal monitoring. Physical activity monitoring, applying also body-worn sensors, offers additional monitoring tools.


CONCLUSIONS
To diagnose and monitor cachexia, muscle strength should be measured directly, whereas fatigue is seen as a global outcome.
Oncological Palliative Medicine, Division of Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland. Florian.Strasser@kssg.ch
Florian
F
Strasser
D002100:Cachexia / Q000150:complications / Q000175:diagnosis*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D018763:Muscle Fatigue / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology*