Early intervention against cachexia necessitates a predictive model.
The aims of this study were to identify predictors of cachexia
development and to create and evaluate accuracy of a predictive
model based on these predictors.
A secondary analysis of a prospective, observational, multicentre
study was conducted. Patients, who attended a palliative care
programme, had incurable cancer and did not have cachexia at
baseline, were amenable to the analysis. Cachexia was defined as
weight loss (WL) > 5% (6 months) or
WL > 2% and body mass
index< 20 kg/m. Clinical and demographic markers
were evaluated as possible predictors with Cox analysis. A
classification and regression tree analysis was used to create a
model based on optimal combinations and cut-offs of significant
predictors for cachexia development, and accuracy was evaluated with
a calibration plot, Harrell's c-statistic and receiver operating
characteristic curve analysis.
Six-hundred-twenty-eight patients were included in the analysis.
Median age was 65 years (IQR 17), 359(57%) were female and
median Karnofsky performance status was 70(IQR 10). Median follow-up
was 109 days (IQR 108), and 159 (25%) patients developed
cachexia. Initial WL, cancer type, appetite and chronic obstructive
pulmonary disease were significant predictors
(p ≤ 0.04). A five-level model was created with each
level carrying an increasing risk of cachexia development. For
Risk-level 1-patients (WL < 3%, breast or
hematologic cancer and no or little appetite loss), median time to
cachexia development was not reached, while Risk-level 5-patients
(WL 3-5%) had a median time to cachexia development of
51 days. Accuracy of cachexia predictions at 3 months
Important predictors of cachexia have been identified and used to
construct a predictive model of cancer cachexia.
ClinicalTrials.gov Identifier: NCT01362816 .
Vagnildhaug O M, Brunelli C, Hjermstad M J, Strasser F, Baracos V,
Wilcock A, Nabal M, Kaasa S, Laird B, Solheim T S. A prospective
study examining cachexia predictors in patients with incurable
cancer. BMC Palliat Care 2019; 18:46.