title: The assessment of anorexia in patients with cancer: cut-off values for the FAACT-A/CS and the VAS for appetite.
abstract: OBJECTIVE
  Anorexia is a frequently observed symptom in patients with cancer and is associated with limited food intake and decreased quality of life. Diagnostic instruments such as the Anorexia/Cachexia Subscale (A/CS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire and the visual analog scale (VAS) for appetite have been recommended in the assessment of anorexia, but validated cut-off values are lacking. This study aimed to obtain cut-off values of these instruments for the assessment of anorexia in patients with cancer.
  
  
  METHODS
  The FAACT-A/CS and the VAS for appetite were administered to patients with cancer before start of chemotherapy. As reference standard for anorexia, two external criteria were used: (1) a cut-off value of ≥2 on the anorexia symptom scale of the EORTC QLQ C-30 and (2) the question "Do you experience a decreased appetite?" (yes/no). ROC curves were used to examine the optimal cut-off values for the FAACT-A/CS and VAS.
  
  
  RESULTS
  A total of 273 patients (58 % male; 64.0 ± 10.6 years) were included. The median score on the FAACT-A/CS was 38 (IQR 32-42) points and 77 (IQR 47-93) points on the VAS. Considering both external criteria, the optimal cut-off value for the FAACT-A/CS was ≤37 (sensitivity (se) 80 %, specificity (sp) 81 %, positive predictive value (PV(+)) 79 %, negative predictive value (PV(-)) 82 %) and for the VAS was ≤70 (se 76 %, sp 83 %, PV(+) 80 %, PV(-) 79 %).
  
  
  CONCLUSIONS
  For the assessment of anorexia in patients with cancer, our study suggests cut-off values of ≤37 for the FAACT-A/CS and ≤70 for the VAS. Future studies should confirm our findings in other patient samples.
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. s.buskermolen@vumc.nl.|Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands. s.buskermolen@vumc.nl.
authors.forename: S
authors.initials: S
authors.lastname: Blauwhoff-Buskermolen
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Ruijgrok
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|Department of Health Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: R W
authors.initials: RW
authors.lastname: Ostelo
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: H C W
authors.initials: HCW
authors.lastname: de Vet
authors.affiliation: Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: H M W
authors.initials: HMW
authors.lastname: Verheul
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.|Faculty of Health and Social Studies, Department of Nutrition, Sports and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: M A E
authors.initials: MAE
authors.lastname: de van der Schueren
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.|Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands.
authors.forename: J A E
authors.initials: JAE
authors.lastname: Langius
mesh_terms: D000855:Anorexia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D001066:Appetite / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011788:Quality of Life; D011795:Surveys and Questionnaires; D064232:Visual Analog Scale
keywords: Anorexia; Appetite; Cancer; Cut-off values; Questionnaire