title: Definition and classification of cancer cachexia: an international consensus.
abstract: To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m(2)) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages--precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management.
authors.affiliation: Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK. k.fearon@ed.ac.uk
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fearon
authors.forename: Florian
authors.initials: F
authors.lastname: Strasser
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bosaeus
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Robin L
authors.initials: RL
authors.lastname: Fainsinger
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
authors.forename: Charles
authors.initials: C
authors.lastname: Loprinzi
authors.forename: Neil
authors.initials: N
authors.lastname: MacDonald
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mantovani
authors.forename: Mellar
authors.initials: M
authors.lastname: Davis
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
authors.forename: Faith
authors.initials: F
authors.lastname: Ottery
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.forename: Paula
authors.initials: P
authors.lastname: Ravasco
authors.forename: Declan
authors.initials: D
authors.lastname: Walsh
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcock
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.forename: Vickie E
authors.initials: VE
authors.lastname: Baracos
mesh_terms: D000855:Anorexia; D002100:Cachexia / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D003697:Delphi Technique; D002149:Energy Intake; D004734:Energy Metabolism; D005104:Expert Testimony; D017144:Focus Groups; D006801:Humans; D007391:International Cooperation; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000378:metabolism / Q000503:physiopathology*; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology; D055948:Sarcopenia / Q000209:etiology; D012720:Severity of Illness Index; D013577:Syndrome; D015431:Weight Loss