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A prospective study examining cachexia predictors in patients with incurable cancer

Ola Magne Vagnildhaug, Cinzia Brunelli, Marianne J Hjermstad, Florian Strasser, Vickie Baracos, Andrew Wilcock, Maria Nabal, Stein Kaasa, Barry Laird & Tora S Solheim

abstract

BACKGROUND
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.

METHODS
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.

RESULTS
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 was 76%.

CONCLUSION
Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia.

TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01362816 .
   
citation 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.
   
type journal paper/review (English)
date of publishing 04-06-2019
journal title BMC Palliat Care (18/1)
ISSN electronic 1472-684X
pages 46
PubMed 31164115
DOI 10.1186/s12904-019-0429-2