The Functional Impact of Cancer Cachexia

Many of the consequences of cachexia are likely to impact on patient function but as yet this has not been studied in detail. There is, however, a considerable body of knowledge about the importance of weight loss in relation to clinical end-points and treatment variables. Scott [37] studied patients with inoperable non-small-cell lung cancer -about 40% had at least 5% weight loss and almost 80% an elevated CRP. Weight-losing patients had a significantly lower KPS and overall QoL and greater fatigue and pain. An elevated CRP was independently associated with increased fatigue. In patients with advanced gastrointestinal (GI) cancer receiving palliative chemotherapy, Persson [38] showed that those who were losing weight had a reduced global QoL. In addition, on multi-variate analysis, poor performance status and weight loss were independently related to decreased survival and a lower probability of responding to treatment.

O'Gorman has published a series of studies in advanced GI cancer [39-41]. Patients with more than 5% weight loss had a higher serum CRP, lower serum albumin, lower anthropometry measures, poorer appetite and lower QoL scores. Both low performance status and elevated CRP were associated with adverse survival independent of weight loss. Over a 6-week period, patients losing more than 3% of their body weight had a higher CRP and lower KPS and anthropometry measures. Patients who gained more than 3% body weight had a higher KPS. The authors suggested that a loss or gain of more than 2.5 kg over 6-8 weeks was required to produce a significant change in performance status in weight-losing patients with GI cancer.

In a one-month study of 24 patients with lung cancer, Sarna [42] used the KPS and two patient self-reported tools to show that in those not receiving chemotherapy physical function worsened. In the sample of 24 patients, one third had difficulty walking one block or more, 79% had serious fatigue and 44% difficulty with household chores. Only 21% were completely satisfied with their level of activity.

A recent study by Yadav [43] has looked at 100

ambulant patients with advanced lung cancer. Functional ability was assessed objectively (Simmonds Functional Assessment and 6-minute walk), KPS recorded and standardised questionnaire data collected (using a fatigue scale and a disease-specific tool). The authors concluded that measurable differences in daily tasks were identifiable when patient data were compared with normative data for middle-aged (30-59 years) and older (over 59 years) controls and that objective functional ability was an independent end-point in this patient population. Simmonds Functional Assessment [44] combines a self-reported questionnaire that collects information on symptoms and function and a panel of nine physical tasks (including tying a belt, putting on a sock and walking tests). In the original analysis, a control group out-performed cancer patients and the questionnaire and physical tasks were complementary. It was suggested that the tool could be useful for patient and outcome assessment.

These and other studies support a relationship between weight loss, decreased performance status, increased symptomatology, reduced tolerance and efficacy of palliative chemotherapy and decreased survival. They illustrate the profound impact that cachexia has on the function, well-being and prognosis of patients with advanced cancer.

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