British Journal of Nutrition

Full Papers

Human and Clinical Nutrition

Pre-cachexia and cachexia at diagnosis of stage III non-small-cell lung carcinoma: an exploratory study comparing two consensus-based frameworks

Barbara S. van der Meija1 c1, Coline P. Schoonbeeka1, Egbert F. Smita2, Maurizio Muscaritolia3, Paul A. M. van Leeuwena4 and Jacqueline A. E. Langiusa1

a1 Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

a2 Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands

a3 Department of Clinical Medicine – Sapienza, University of Rome, Rome, Italy

a4 Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands

Abstract

Despite the development of consensus-based frameworks to define cancer cachexia, the validity and usefulness of these frameworks are relatively unknown. The aim of the present study was to study the presence of pre-cachexia and cachexia in patients with stage III non-small-cell lung carcinoma (NSCLC) by using a cancer-specific framework and a general framework for cachexia, and to explore the prognostic value of pre-cachexia and cachexia. In forty patients at diagnosis of stage III NSCLC, weight loss, fat-free mass, handgrip strength, anorexia and serum biochemistry, assessed before the first chemotherapy, were used to define ‘cancer cachexia’ or ‘cachexia’. The cancer-specific framework also classified for pre-cachexia and refractory cachexia. Additionally, quality of life was assessed by the European Organisation for Research and Treatment of Cancer – Quality of Life Questionnaire C30. Groups were compared using independent t tests, ANOVA, Kaplan–Meier and Cox survival analyses. Based on the cancer-specific framework, pre-cachexia was present in nine patients (23 %) and cancer cachexia was present in seven patients (18 %). Cancer cachexia was associated with a reduced quality of life (P= 0·03) and shorter survival (hazard ratio (HR) = 2·9; P= 0·04). When using the general framework, cachexia was present in eleven patients (28 %), and was associated with a reduced quality of life (P= 0·08) and shorter survival (HR = 4·4; P= 0·001). In conclusion, pre-cachexia and cachexia are prevalent in this small population of patients at diagnosis of stage III NSCLC. For both frameworks, cachexia appears to be associated with a reduced quality of life and shorter survival. Further studies are warranted to more extensively explore the validity and prognostic value of these new frameworks in cancer patients.

(Received April 11 2012)

(Revised July 25 2012)

(Accepted August 21 2012)

(Online publication November 16 2012)

Key Words:

  • Pre-cachexia;
  • Cachexia;
  • Non-small-cell lung cancer

Correspondence

c1 Corresponding author: B. S. van der Meij, fax +31 20 444 4143, email b.vandermeij@vumc.nl

Footnotes

  Abbreviations: CRP, C-reactive protein; EORTC-QLQC30, European Organisation for Research and Treatment of Cancer – Quality of Life Questionnaire C30; ESPEN, European Society for Parenteral and Enteral Nutrition; FFM, fat-free mass; HR, hazard ratio; NSCLC, non-small-cell lung cancer; REE, resting energy expenditure; TEE, total energy expenditure; VAS, visual analogue scale