title: Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model--a study based on data from an international multicentre project (EPCRC-CSA).
abstract: BACKGROUND
  Weight loss limits cancer therapy, quality of life and survival. Common diagnostic criteria and a framework for a classification system for cancer cachexia were recently agreed upon by international consensus. Specific assessment domains (stores, intake, catabolism and function) were proposed. The aim of this study is to validate this diagnostic criteria (two groups: model 1) and examine a four-group (model 2) classification system regarding these domains as well as survival.
  
  
  METHODS
  Data from an international patient sample with advanced cancer (N = 1070) were analysed. In model 1, the diagnostic criteria for cancer cachexia [weight loss/body mass index (BMI)] were used. Model 2 classified patients into four groups 0-III, according to weight loss/BMI as a framework for cachexia stages. The cachexia domains, survival and sociodemographic/medical variables were compared across models.
  
  
  RESULTS
  Eight hundred and sixty-one patients were included. Model 1 consisted of 399 cachectic and 462 non-cachectic patients. Cachectic patients had significantly higher levels of inflammation, lower nutritional intake and performance status and shorter survival. In model 2, differences were not consistent; appetite loss did not differ between group III and IV, and performance status not between group 0 and I. Survival was shorter in group II and III compared with other groups. By adding other cachexia domains to the model, survival differences were demonstrated.
  
  
  CONCLUSIONS
  The diagnostic criteria based on weight loss and BMI distinguish between cachectic and non-cachectic patients concerning all domains (intake, catabolism and function) and is associated with survival. In order to guide cachexia treatment a four-group classification model needs additional domains to discriminate between cachexia stages.
authors.affiliation: European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim david.blum@ntnu.no.
authors.forename: D
authors.initials: D
authors.lastname: Blum
authors.affiliation: European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: G B
authors.initials: GB
authors.lastname: Stene
authors.affiliation: European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim.
authors.forename: T S
authors.initials: TS
authors.lastname: Solheim
authors.affiliation: European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: P
authors.initials: P
authors.lastname: Fayers
authors.affiliation: European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hjermstad
authors.affiliation: Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Alberta, Canada.
authors.forename: V E
authors.initials: VE
authors.lastname: Baracos
authors.affiliation: Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary, Edinburgh, UK.
authors.forename: K
authors.initials: K
authors.lastname: Fearon
authors.affiliation: European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Department of Internal Medicine and Palliative Center Cantonal Hospital, Oncological Palliative Medicine, Oncology, St Gallen, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Strasser
authors.affiliation: European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim.
authors.forename: S
authors.initials: S
authors.lastname: Kaasa
mesh_terms: D000368:Aged; D000465:Algorithms; D002100:Cachexia / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology*; D032921:Consensus; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D015431:Weight Loss / Q000502:physiology
keywords: cachexia; cancer; classification; validation