Page 16 - Diagnosis and clinical consequences of cachexia in patients with advanced cancer Susanne Blauwhoff-Buskermolen

Chapter 1
addition of these factors to the diagnostic framework of pre-cachexia will improve the diagnosis of pre-cachexia.
Panel 1: Classi cation of cachexia stages
Pre-cachexia (1)
- Unintentional weight loss ≤5% of usual body weight during the last 6 months AND
- Chronic or recurrent systemic inflammatory response AND
- Anorexia or anorexia-related symptoms
Cachexia (2)
- Unintentional weight loss >5% over the past 6 months OR
- BMI <20 and any degree of weight loss >2% OR
- Low muscle mass and any degree of weight loss >2%
Other features such as inflammation or decreased food intake may also be present
Refractory cachexia (2)
- Variable degree of BMI and amount of weight loss and presence of other features
- Cancer not responsive to treatment
- Low performance score
- <3 months expected survival
The cut-off value for weight loss used to de ne the cachectic stage, ≥5% in the past year (33), is stricter than the cut-off value in the screening tool for malnutrition currently used in Dutch hospitals (35). Unknown is whether ≥5% weight loss in the past year identi es patients at risk for further deterioration in nutritional and clinical status.
Although assessment of systemic in ammation and food intake was also advised in the cachectic stage, consensus on the role for these features and the methods to measure these items was not reached (2).
To determine muscle mass, four options to measure muscle mass were advised: mid upper arm muscle area by anthropometry (men <32 cm2, women <18 cm2); appendicular skeletal muscle index determined by dual energy x-ray absorptiometry (men <7.26 kg/m2; women <5.45 kg/m2); lumbar skeletal muscle index determined by CT imaging (men <55 cm2/m2; women <39 cm2/m2); whole body fat-free mass index without bone determined by bioelectrical impedance (men <14.6 kg/m2;
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