title: Use of routinely available clinical, nutritional, and functional criteria to classify cachexia in advanced cancer patients.
abstract: Cachexia is a highly prevalent syndrome in cancer and chronic diseases. However, due to the heterogeneous features of cancer cachexia, its identification and classification challenge clinical practitioners.
  
  
  
  To determine the clinical relevance of a cancer cachexia classification system in advanced cancer patients.
  
  
  
  Beginning with the four-stage classification system proposed for cachexia [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca) and refractory cachexia (RCa)], we assigned patients to these cachexia stages according to five classification criteria available in clinical practice: 1) biochemistry (high C-reactive protein or leukocytes, or hypoalbuminemia, or anemia), 2) food intake (normal/decreased), weight loss: 3) moderate (≤5%) or 4) significant (>5%/past six months) and 5) performance status (Eastern Cooperative Oncology Group Performance Status ≥ 3). We then determined if symptom severity, body composition changes, functional levels, hospitalizations and survival rates varied significantly across cachexia stages.
  
  
  
  Two-hundred and ninety-seven advanced cancer patients with primary gastrointestinal and lung tumors were included. Patients were classified into Ca (36%), PCa and RCa (21%, respectively) and NCa (15%). Significant (p < 0.05) differences were observed among cachexia stages for most of the outcome measures (symptoms, body composition, handgrip strength, emergency room visits and length of hospital stays) according to cachexia severity. Survival also differed between cachexia stages (except between PCa and Ca).
  
  
  
  Five clinical criteria can be used to stage cancer cachexia patients and predict important clinical, nutritional and functional outcomes. The lack of statistical difference between PCa and Ca in almost all clinical outcomes examined suggests either that the PCa group includes patients already affected by early cachexia or that more precise criteria are needed to differentiate PCa from Ca patients. More studies are required to validate these findings.
authors: McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; Supportive and Palliative Care, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada. Electronic address: antonio.vigano@mcgill.ca.
authors: Antonio A L
authors: AAL
authors: Vigano
authors: Geriatric Medicine, McGill University Health Centre, Royal Victoria Hospital, Room H6.61, 687 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada. Electronic address: jose.morais@mcgill.ca.
authors: José A
authors: JA
authors: Morais
authors: McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; School of Dietetics and Human Nutrition, McGill University, Macdonald-Stewart Building, Macdonald Campus, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada; Centre Hospitalier Universitaire Vaudois, Service d'endocrinologie, diabétologie et métabolisme, Nutrition clinique, Bureau 08/112, Rue du Bugnon 46, 1011, Lausanne, Switzerland. Electronic address: lorella.ciutto@gmail.com.
authors: Lorella
authors: L
authors: Ciutto
authors: Department of Radiology, McGill University Health Centre, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada. Electronic address: rosenthall@bell.net.
authors: Leonard
authors: L
authors: Rosenthall
authors: McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; School of Dietetics and Human Nutrition, McGill University, Macdonald-Stewart Building, Macdonald Campus, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada. Electronic address: jonathan.ditomasso@mail.mcgill.ca.
authors: Jonathan
authors: J
authors: di Tomasso
authors: McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada. Electronic address: sarahkhan1655@gmail.com.
authors: Sarah
authors: S
authors: Khan
authors: McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada. Electronic address: henry.olders@mcgill.ca.
authors: Henry
authors: H
authors: Olders
authors: Supportive and Palliative Care, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada. Electronic address: mannyborod@gmail.com.
authors: Manuel
authors: M
authors: Borod
authors: McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; Department of Exercise Science, Concordia University, The Richard J. Renaud Science Complex, Room SP-165-03, 7141 Sherbrooke Street West, Montreal, Quebec, H4B 1R6, Canada. Electronic address: kilgour.exci@gmail.com.
authors: Robert D
authors: RD
authors: Kilgour
mesh_terms: D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000209:etiology; D001823:Body Composition; D002097:C-Reactive Protein / Q000378:metabolism; D002100:Cachexia / Q000175:diagnosis* / Q000209:etiology; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D034141:Hypoalbuminemia / Q000175:diagnosis / Q000209:etiology; D007962:Leukocytes / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D015431:Weight Loss
chemical_list: D002097:C-Reactive Protein
keywords: Body composition; Cachexia; Cancer; Classification; Survival