The clinical picture of cachexia: a mosaic of different parameters (experience of 503 patients)

Schwarz et al. BMC Cancer The clinical picture of cachexia: a mosaic of different parameters (experience of 503 patients) S. Schwarz 2 O. Prokopchuk 0 K. Esefeld 2 S. Gröschel 0 J. Bachmann 0 S. Lorenzen 1 H. Friess 0 M. Halle 2 M. E. Martignoni 0 0 Department of Surgery, Klinikum rechts der Isar, Technical University , Munich , Germany 1 Department of Hematology and Oncology, Klinikum rechts der Isar, Technical University , Munich , Germany 2 Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technical University , Munich , Germany Background: Despite our growing knowledge about the pathomechanisms of cancer cachexia, a whole clinical picture of the cachectic patient is still missing. Our objective was to evaluate the clinical characteristics in cancer patients with and without cachexia to get the whole picture of a cachectic patient. Methods: Cancer patients of the University Clinic “Klinikum rechts der Isar” with gastrointestinal, gynecological, hematopoietic, lung and some other tumors were offered the possibility to take part in the treatment concept including a nutrition intervention and an individual training program according to their capability. We now report on the first 503 patients at the time of inclusion in the program between March 2011 and October 2015. We described clinical characteristics such as physical activity, quality of life, clinical dates and food intake. Results: Of 503 patients with cancer, 131 patients (26.0%) were identified as cachectic, 369 (73.4%) as non-cachectic. The change in cachexia were 23% reduced capacity performance (108 Watt for non-cachectic-patients and 83 Watt for cachectic patients) and 12% reduced relative performance (1.53 Watt/kg for non-cachectic and 1.34 Watt/kg for cachectic patients) in ergometry test. 75.6% of non-cachectic and 54.3% of cachectic patients still received curative treatment. Conclusion: Cancer cachectic patients have multiple symptoms such as anemia, impaired kidney function and impaired liver function with elements of mild cholestasis, lower performance and a poorer quality of life in the EORTC questionnaire. Our study reveals biochemical and clinical specific features of cancer cachectic patients. Cancer cachexia; Clinical parameters; Clinical picture - Background Ongoing cachexia represents a significant factor affecting the quality of life and prognosis of cancer patients. Cachexia is present in up to 40% in early stages of patients with gastrointestinal cancers and may be involved in up to 80% cancer deaths. However, it is still difficult to identify cachectic patients, as 40–60% of cancer patients are overweight or obese, even in advanced cancer [1]. But what do we know about clinical features of cachexia patient? Cachectic patients usually but not always demonstrate lower body mass index (BMI), which is associated with an increased risk of tumor progression [2, 3]. At the same time, other groups report that BMI is not a prognostic factor for cancer cachexia in a cohort of patients with 17% obese, 35% overweight, 36% normal weight, and 12% underweight persons [4]. Cancer cachectic patients experience numerous complications including reduced effectiveness of chemotherapy [5, 6], reduced mobility, and reduced functionality of muscle-dependent systems, such as the respiratory and cardiovascular systems, leading to decreased quality of life and survival [7–9]. Especially in older population, cancer cachexia clinical features are key predictors of one-year mortality [10]. There is a strong correlation between decreased quality of life scores and © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. decreased physical activity, which is strongly related to weight loss [11]. It was demonstrated that cachectic patients present lower protein, albumins, and hemoglobin levels [12]. Notably, cachexia is not an incurable situation. The important message is that weight-losing patients with unresectable pancreatic cancer can attenuate their weight loss after eight weeks of intensive nutrition intervention, and weight stabilization is associated with prolonged survival and improved quality of life [13]. However, despite our growing knowledge about the pathomechanisms of this symptom complex, a whole picture of the cachectic patient is still missing. Some studies aim to define diagnostic criteria of cancer cachexia [14]. Usually, diagnostic tools for cachexi (...truncated)