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A Critical Assessment of the Outcome Measures and Goals of Intervention in Cancer Cachexia

  • Kenneth C. H. Fearon
  • Richard J. E. Skipwoth

Abstract

Cancer cachexia is a multifactorial, multifaceted problem for which there is no uniform pathophysiological or clinical definition [1]. It is generally accepted as a complex syndrome with several cardinal features, including anorexia, early satiety, severe weight loss, muscle wasting, ischaemia, anaemia and oedema [2]. The essential characteristic that distinguishes cachexia from simple starvation is that the features of cachexia cannot be readily reversed by nutritional support alone [3].

Keywords

Total Energy Expenditure Cancer Cachexia Reduce Food Intake Rest Energy Expenditure Cachexia Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Dahele M, Fearon KCH (2004) Research methodology: cancer cachexia syndrome. Palliat Med 18:409–417PubMedCrossRefGoogle Scholar
  2. 2.
    Tisdale MJ (2002) Cachexia in cancer patients. Nat Rev Cancer 2:862–871PubMedCrossRefGoogle Scholar
  3. 3.
    Nixon DW, Lawson DH (1983) Nutritional support of the cancer patient. Hosp Formul 8:616–619Google Scholar
  4. 4.
    Anonymous (1997) Workshop: clinical trials for the treatment of secondary wasting and cachexia: selection of appropriate endpoints. May 22–23, BethesdaGoogle Scholar
  5. 5.
    Burns CP, Halabi S, Clamon G et al (2004) Phase II study of high-dose fish oil capsules for patients with cancer-related cachexia. Cancer 101:370–378PubMedCrossRefGoogle Scholar
  6. 6.
    Jatoi A, Rowland K, Loprinzi CL et al (2004) North Central Cancer Treatment Group. An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: a North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort. J Clin Oncol 22:2469–2476PubMedCrossRefGoogle Scholar
  7. 7.
    Bruera E, Strasser F, Palmer JL et al (2003) Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. J Clin Oncol 21:129–134PubMedCrossRefGoogle Scholar
  8. 8.
    Fearon KC, Von Meyenfeldt MF, Moses AG et al (2003) Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut 52:1479–1486PubMedCrossRefGoogle Scholar
  9. 9.
    Tayek JA, Bistrian BR, Hehir DJ et al (1986) Improved protein kinetics and albumin synthesis by branched chain amino acid-enriched total parenteral nutrition in cancer cachexia. A prospective randomized crossover trial. Cancer 58:147–157PubMedCrossRefGoogle Scholar
  10. 10.
    Daneryd P (2002) Epoetin alfa for protection of metabolic and exercise capacity in cancer patients. Semin Oncol 29:69–74PubMedGoogle Scholar
  11. 11.
    Lundholm K, Daneryd P, Bosaeus I et al (2004) Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: Effects on survival, metabolism and function. Cancer 100:1967–1977PubMedCrossRefGoogle Scholar
  12. 12.
    Daneryd P, Svanberg E, Korner U et al (1998) Protection of metabolic and exercise capacity in unselected weight-losing cancer patients following treatment with recombinant erythropoietin: a randomised prospective study. Cancer Res 58:5374–5379PubMedGoogle Scholar
  13. 13.
    Edelman MJ, Gandara DR, Meyers FJ et al (1999) Serotonergic blockade in the treatment of the cancer anorexia-cachexia syndrome. Cancer 86:684–688PubMedCrossRefGoogle Scholar
  14. 14.
    Baumberg L, Long A, Jefferson J (1995) International workshop: culture and outcomes. Barcelona, 9-10 June 1995; Leeds: European Clearing House on Health OutcomesGoogle Scholar
  15. 15.
    Kendall N (1997) Developing outcome assessments: a step-by-step approach. NZ J Physiol 25:11–17Google Scholar
  16. 16.
    McDowell I, Newell C (1997) Measuring Health—a guide to rating scales and questionnaires, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  17. 17.
    Vadell C, Segui MA, Gimenez-Arnau JM et al (1998) Anticachectic efficacy of megestrol acetate at different doses and versus placebo in patients with neoplastic cachexia. Am J Clin Oncol 21:347–351PubMedCrossRefGoogle Scholar
  18. 18.
    De Conno F, Martini Z, Zecca E et al (1998) Megestrol acetate for anorexia in patients with faradvanced cancer: a double-blind controlled clinical trial. Eur J Cancer 34:1705–1709PubMedCrossRefGoogle Scholar
  19. 19.
    Gebbia V, Testa A, Gebbia N (1996) Prospective randomised trial of two dose levels of megestrol acetate in the management of anorexia-cachexia syndrome in patients with metastatic cancer. Br J Cancer 73:1576–1580PubMedGoogle Scholar
  20. 20.
    Loprinzi CL, Kugler JW, Sloan JA et al (1999) Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol 17:3299–3306PubMedGoogle Scholar
  21. 21.
    Moskovitz DN, Kim YI (2004) Does perioperative immunonutrition reduce postoperative complications in patients with gastrointestinal cancer undergoing operations? Nutr Rev 62:443–447PubMedCrossRefGoogle Scholar
  22. 22.
    Laviano A, Muscaritoli M, Rossi-Fanelli F (2005) Phase II study of high-dose fish oil capsules for patients with cancer-related cachexia: a Cancer and Leukaemia Group B study (comment). Cancer 103:651–652PubMedCrossRefGoogle Scholar
  23. 23.
    Fearon KC, Preston T (1990) Body composition in cancer cachexia. Infusionstherapie 17:63–66PubMedGoogle Scholar
  24. 24.
    Koch J (1998) The role of body composition measurements in wasting syndromes. Semin Oncol 25:12–19PubMedGoogle Scholar
  25. 25.
    Pichard C, Kyle UG (1998) Body composition measurements during wasting diseases. Curr Opin Nutr Metab Care 1:357–361CrossRefGoogle Scholar
  26. 26.
    Buccheri G, Ferrigno D, Tamburini M (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32A:1135–1141PubMedCrossRefGoogle Scholar
  27. 27.
    Yates JW, Chalmer B, McKegney FP (1980) Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45:2220–2224PubMedCrossRefGoogle Scholar
  28. 28.
    Batel-Copel LM, Kornblith AB, Batel PC, Holland JC (1997) Do oncologists have an increasing interest in the quality of life of their patients? A literature review of the last 15 years. Eur J Cancer 33:29–32PubMedCrossRefGoogle Scholar
  29. 29.
    Schaafsma J, Osoba D (1994) The Karnofsky Performance Status Scale re-examined: a cross validation with the EORTC-C30. Qual Life Res 3:413–424PubMedCrossRefGoogle Scholar
  30. 30.
    Silvestri G, Pritchard R, Welch HG (1998) Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 317:771–775PubMedGoogle Scholar
  31. 31.
    Cella DF, Bonomi AE (1995) Measuring quality of life: 1995 update. Oncology 9:47–60PubMedGoogle Scholar
  32. 32.
    Osoba D (1994) Lessons learned from measuring health-related quality of life in oncology. J Clin Oncol 12:608–616PubMedGoogle Scholar
  33. 33.
    Moinpour CM (1994) Measuring quality of life: an emerging science. Semin Oncol 21:48–63PubMedGoogle Scholar
  34. 34.
    Kahn SB, Houts PS, Harding SP (1992) Quality of life and patients with cancer: a comparative study of patient versus physician perceptions and its implications for cancer education. J Cancer Educ 7:241–249PubMedCrossRefGoogle Scholar
  35. 35.
    Stephens RJ, Hopwood P, Girling DJ, Machin D (1997) Randomized clinical trials with quality of life endpoints: are doctors’ ratings of patient’s physical symptoms interchangeable with patients’ self-ratings? Qual Life Res 6:225–236PubMedCrossRefGoogle Scholar
  36. 36.
    Hyland ME, Sodergren SC (1996) Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales. Qual Life Res 5:469–480PubMedCrossRefGoogle Scholar
  37. 37.
    Somerfield M, Jatoi A, Nguyen PL et al (2003) Hazards of quality-of-life data for clinical decision making. J Clin Oncol 21:82–83CrossRefGoogle Scholar
  38. 38.
    Wigmore SJ, Plester CE, Ross JA, Fearon KC (1997) Contribution of anorexia and hypermetabolism to weight loss in anicteric patients with pancreatic cancer. Br J Surg 84:196–197PubMedCrossRefGoogle Scholar
  39. 39.
    Wigmore SJ, Plester CE, Richardson RA, Fearon KC (1997) Changes in nutritional status associated with unresectable pancreatic cancer. Br J Cancer 75:106–109PubMedGoogle Scholar
  40. 40.
    Brennan MF, Kattan MW, Klimstra D, Conlon K (2004) Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg 240:293–298PubMedCrossRefGoogle Scholar
  41. 41.
    Laviano A, Meguid MM, Rossi-Fanelli F (2003) Cancer anorexia: clinical implications, pathogenesis, and therapeutic strategies. Lancet Oncol 4:686–694PubMedCrossRefGoogle Scholar
  42. 42.
    DeWys WD (1977) Anorexia in cancer patients. Cancer Res 37:2354–2358PubMedGoogle Scholar
  43. 43.
    Westerterp KR, Goris AH (2002) Validity of the assessment of dietary intake: problems of misreporting. Curr Opin Clin Nutr Metab Care 5:489–493PubMedCrossRefGoogle Scholar
  44. 44.
    Kaskoun MC, Johnson RK, Goran MI (1994) Comparison of energy intake by semiquantitative food-frequency questionnaire with total energy expenditure by the doubly labelled water method in young children. Am J Clin Nutr 60:43–47PubMedGoogle Scholar
  45. 45.
    McCrory MA, Hajduk CL, Roberts SB (2002) Procedures for screening out inaccurate reports of dietary energy intake. Public Health Nutr 5:873–882PubMedCrossRefGoogle Scholar
  46. 46.
    Goran MI, Beer WH, Wolfe RR et al (1993) Variation in total energy expenditure in young healthy freeliving men. Metabolism 42:487–496PubMedCrossRefGoogle Scholar
  47. 47.
    Goran MI (1995) Variation in total energy expenditure in humans. Obes Res 3:59–66PubMedGoogle Scholar
  48. 48.
    Bosaeus I, Daneryd P, Lundholm K (2002) Dietary intake, resting energy expenditure, weight loss and survival in cancer patients. J Nutr 132:3465S–3466SPubMedGoogle Scholar
  49. 49.
    Moses AW, Slater C, Preston T et al (2004) Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90:996–1002PubMedCrossRefGoogle Scholar
  50. 50.
    Gibney ER (2000) Energy expenditure in disease: time to revisit? Proc Nutr Soc 59:199–207PubMedGoogle Scholar
  51. 51.
    Mollinger LA, Spurr GB, el Ghatit AZ et al (1985) Daily energy expenditure and basal metabolic rates of patients with spinal cord injury. Arch Phys Med Rehabil 66:420–426PubMedGoogle Scholar
  52. 52.
    Stallings VA, Zemel BS, Davies JC et al (1996) Energy expenditure of children and adolescents with severe disabilities: a cerebral palsy model. Am J Clin Nutr 64:627–634PubMedGoogle Scholar
  53. 53.
    Libby P (2002) Inflammation in atherosclerosis. Nature 420:868–874PubMedCrossRefGoogle Scholar
  54. 54.
    Falconer JS, Fearon KC, Ross JA et al (1995) Acutephase protein response and survival duration of patients with pancreatic cancer. Cancer 75:2077–2082PubMedCrossRefGoogle Scholar
  55. 55.
    Rashid SA, O’Quigley J, Axon AT, Cooper EH (1982) Plasma protein profiles and prognosis in gastric cancer. Br J Cancer 45:390–394PubMedGoogle Scholar
  56. 56.
    Ikeda M, Natsugoe S, Ueno S et al (2003) Significant hostand tumor-related factors for predicting prognosis in patients with esophageal carcinoma. Ann Surg 238:197–202PubMedGoogle Scholar
  57. 57.
    McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90:215–219PubMedCrossRefGoogle Scholar
  58. 58.
    Forrest LM, McMillan DC, McArdle CS et al (2004) Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small cell lung cancer. Br J Cancer 90:1704–1706PubMedGoogle Scholar
  59. 59.
    Heys SD, Ogston KN, Simpson WG et al (1998) Acute phase proteins in patients with large and locally advanced breast cancer treated with neo-adjuvant chemotherapy: response and survival. Int J Oncol 13:589–594PubMedGoogle Scholar
  60. 60.
    Bromwich E, McMillan DC, Lamb GW et al (2004) The systemic inflammatory response, performance status and survival in patients undergoing alphainterferon treatment for advanced renal cancer. Br J Cancer 91:1236–1238PubMedCrossRefGoogle Scholar
  61. 61.
    McMillan DC, Elahi MM, Sattar N et al (2001) Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer 41:64–69PubMedCrossRefGoogle Scholar
  62. 62.
    Todorov P, Cariuk P, McDermott T et al (1996) Characterization of a cancer cachectic factor. Nature 379:739–742PubMedCrossRefGoogle Scholar
  63. 63.
    Wigmore SJ, Todorov PT, Barber MD et al (2000) Characteristics of patients with pancreatic cancer expressing a novel cancer cachectic factor. Br J Surg 87:53–58PubMedCrossRefGoogle Scholar
  64. 64.
    O’Riordain MG, Falconer JS, Maingay J et al (1999) Peripheral blood cells from weight-losing cancer patients control the hepatic acute phase response by a primarily interleukin-6 dependent mechanism. Int J Oncol 15:823–827Google Scholar
  65. 65.
    Barber MD, Fearon KCH, Ross JA (1999) Relationship of serum levels of interleukin-6, soluble interleukin-6 receptor and tumour necrosis factor receptors to the acute-phase protein response in advanced pancreatic cancer. Clin Sci 96:83–87PubMedCrossRefGoogle Scholar
  66. 66.
    Falconer JS, Fearon KC, Plester CE et al (1994) Cytokines, the acute-phase response, and resting energy expenditure in cachectic patients with pancreatic cancer. Ann Surg 219:325–331PubMedCrossRefGoogle Scholar
  67. 67.
    Black AE, Coward WA, Cole TJ, Prentice AM (1996) Human energy expenditure in affluent societies: an analysis of 574 doubly-labelled water measurements. Eur J Clin Nutr 50:72–92PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Kenneth C. H. Fearon
    • 1
  • Richard J. E. Skipwoth
    • 1
  1. 1.Department of Clinical and Surgical Sciences (Surgery)The University of EdinburghRoyal InfirmaryUK

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