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Correlation Between the International Consensus Definition of the Cancer Anorexia Cachexia Syndrome (CACS) and Patient-Centered Outcomes in Advanced Non-Small Cell Lung Cancer

Thomas W. LeBlanc, Ryan D. Nipp, Christel N. Rushing, Greg P. Samsa, Susan C. Locke, Arif H. Kamal, David Cella, Amy P. Aberneth

Journal of Pain and Symptom Management, In Press, Accepted Manuscript, Available online 4 November 2014

Editors‘ comment: Dr Anton Snegovoy

Anorexia-cachexia syndrome (CACS) may be an independent cause of death in 4 out of 20 cancer patients. A concept of anorexia-cachexia has now been elaborated which specifies several stages. Therapy for patients with anorexia-cachexia syndrome is based on this concept. An interesting hypothesis, which is discussed in this article, i s the correlation between the assessment of functional status and the current concept of CACS. The study was performed in patients with metastatic non-small cell lung cancer.

Abstract

Context
The cancer anorexia-cachexia syndrome (CACS) is common in patients with advanced solid tumors and is associated with adverse outcomes including poor quality of life (QOL), impaired functioning, and shortened survival.

Objectives
To apply the recently posed weight-based international consensus CACS definition to a population of patients with advanced non-small cell lung cancer (NSCLC) and explore its impact on patient-reported outcomes.

Methods
Ninety-nine patients participated in up to four study visits over a six-month period. Longitudinal assessments included measures of physical function, QOL, and other clinical variables such as weight and survival.

Results
Patients meeting the consensus CACS criteria at Visit 1 had a significantly shorter median survival (239.5 vs. 446 days; hazard ratio, 2.06, P < 0.05). Physical function was worse in the CACS group (mean Karnofsky Performance Status score 68 vs. 77, Eastern Cooperative Oncology Group Performance Status score 1.8 vs. 1.3, P < 0.05 for both), as was QOL (Functional Assessment of Cancer Therapy-General [FACT-G] Lung Cancer subscale of 17.2 vs. 19.9, Anorexia/Cachexia subscale of 31.4 vs. 37.9, P < 0.05 for both). Differences in the FACT-G and the Functional Assessment of Chronic Illness Therapy-Fatigue subscale approached but did not reach statistical significance. Longitudinally, all measures of physical function and QOL worsened regardless of CACS status, but the rate of decline was more rapid in the CACS group.

Conclusion
The weight-based component of the recently proposed international consensus CACS definition is useful in identifying patients with advanced NSCLC who are likely to have significantly inferior survival and who will develop more precipitous declines in physical function and QOL. This definition may be useful for clinical screening purposes and identify patients with high palliative care needs.

Keywords: Patient outcome assessment; health services research; carcinoma; non-small cell lung

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Cancer cachexia: mechanisms and progress in treatment

Authors: Egidio Del Fabbro, Kenneth Fearon, Florian Strasser

This book was supported by an educational grant from Helsinn Healthcare SA.

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