title: Health professionals' attitudes toward the detection and management of cancer-related anorexia-cachexia syndrome, and a proposal for standardized assessment.
abstract: BACKGROUND
  The identification and management of patients with cancer anorexia-cachexia syndrome (CACS) can be a challenge despite recent international consensus on the definition of the condition.
  
  
  OBJECTIVE
  To describe the current views and practice patterns of community oncologists and oncology nurses in regard to CACS and to propose a standardized, pragmatic assessment of CACS for oncological practice.
  
  
  METHODS
  Responses from 151 community oncologists and nurses obtained across 5 surveys were analyzed. Questions addressed CACS in general and in patients with non-small-cell lung cancer (NSCLC). Surveys 1-3 were directed at physicians, and surveys 4 and 5 were directed at nurses. Surveys 1, 2, 4, and 5 focused on the recognition and monitoring of CACS, and Survey 3 on symptom management.
  
  
  RESULTS
  67% of medical oncologists in Survey 3 selected weight loss as the most important criterion for diagnosing CACS and cited declining appetite and performance status (PS) as the most bothersome effects for patients and families. Weight maintenance/gain was the primary treatment objective for oncologists. Respondents to surveys 1 and 2 acknowledged the risk for CACS is high (60%) in NSCLC but considered the risk much lower (4%) in patients completing a first course of therapy with good PS. 91% of oncologists in Survey 3 reported that symptoms that had an impact on calorie intake were important/very important, and 73% were willing to consider a symptom assessment instrument that included appetite. Nurses in surveys 4 and 5 reported weight loss and appetite were most commonly used to identify cachexia. They considered responsibility for the initial assessment of cachexia was the oncologist's (32%), followed by the nurse practitioner (28%), and the nurse (16%).
  
  
  CONCLUSIONS
  Most oncologists and nurses recognize the core criteria for the CACS, although there may be under-recognition of the condition's prevalence, particularly earlier in the course of treatment. There is considerable interest in adopting a brief assessment tool for screening, management, and referral of patients who are affected by or at-risk of CACS.
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA. edelfabbro@vcu.edu.
authors.forename: Egidio
authors.initials: E
authors.lastname: Del Fabbro
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Mellar
authors.initials: M
authors.lastname: Davis
authors.affiliation: Western General Hospital, Edinburgh, Scotland, UK.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fearon
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.|McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: di Tomasso
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.|McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vigano
keywords: cachexia; cancer; community oncologists' attitudes; symptom assessment