Page 15 - Diagnosis and clinical consequences of cachexia in patients with advanced cancer Susanne Blauwhoff-Buskermolen

General introduction
decreased muscle strength, fatigue, anorexia, low muscle mass and biochemical 1 abnormalities (33). The authors suggested to classify the degree of cachexia as
mild, moderate or severe depending on the severity of weight loss (33). In 2010
and 2011, international consensus meetings resulted in two publications on the
diagnosis of cachexia in patients with cancer (1;2). Cancer cachexia was stated to be a continuum with three stages of clinical relevance: pre-cachexia, cachexia and refractory cachexia (Figure 2).
Figure 2. Stages of cancer cachexia (used with permission) (2)
In pre-cachexia, early clinical and metabolic signs can precede substantial involuntary weight loss. The risk of progression to cachexia and refractory cachexia varies and depends on factors such as cancer type and stage, the presence of systemic in ammation, low food intake and lack of response to anticancer therapy. In refractory cachexia, cancer is not responsive to anticancer treatment.This stage is associated with low performance status (WHO score 3 or 4) and a life expectancy shorter than 3 months (2). Panel 1 shows the classi cation of the cachexia stages.
For in ammation, elevated serum levels of in ammatory markers such as C-reactive protein were advised to use. For anorexia, a score of ≤24 on the anorexia/cachexia subscale (A/CS) of the Functional Assessment of Anorexia and Cachexia Therapy (FAACT) questionnaire was advised (1).Alternative measures for anorexia included a visual analogue scale (VAS) for appetite or measurement of food intake (1). For the VAS and FAACT-A/CS, cut-off values to detect anorexia need validation with empirical data.
The prognostic value of the pre-cachectic stage was assessed by Blum and colleagues. They de ned pre-cachexia by: weight loss >1 kg but <5% of usual body weight in the past 6 months (34).They found that, by using these criteria, survival rates were not different from those of patients without cachexia. The authors stated that ‘the pre-cachexia stage might be better de ned by additional factors representing the cachexia domain, for instance CRP and appetite loss’ (34). Unknown is whether
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