Confirmation of the Dangers of Cachexia in Patients With Pancreatic and Colorectal Cancers

Cancer-associated cachexia, a wasting disorder characterized by anorexia, unintentional weight loss, and progressive functional impairment, is common in two-thirds of patients who die with advanced cancer, particularly when tumors are of upper gastrointestinal or pulmonary origin.

A recent systematic literature review of 26 studies confirmed that cancer-associated cachexia is linked to worse survival in patients with colorectal or pancreatic cancer.

In the study, presented at this year's ASCO Gastrointestinal Symposium, Richard Francis Dunne, MD, MS, of Wilmot Cancer Institute at the University of Rochester Medical Center in New York, and colleagues identified a significant association between cachexia and poor prognosis in eight of 13 studies of pancreatic cancer and nine of 13 studies of colorectal cancer. Validation of the consensus reached for the definition and classification of cancer cachexia "should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management," the team wrote.

ASCO's 2020 guideline on the management of cancer cachexia recommended the use of dietary counseling but not routine use of enteral feeding tubes or parenteral nutrition. Although no specific pharmacological intervention can be recommended as the standard of care, the document stated, the use of progesterone analogs and short-term corticosteroids may be considered.

The following Q&A discusses the details of the review. (The authors did not respond to requests for comment, and the answers here are from the text of the paper.)

How did you define cachexia for the purposes of your review?

Cancer cachexia, as per the International Consensus diagnostic criteria or a broader definition of any weight loss, was defined as an ongoing loss of skeletal muscle mass, with or without loss of fat mass, that couldn't be fully reversed by conventional nutritional support and which led to progressive functional impairment. The agreed-upon diagnostic criterion was weight loss greater than 5%, or greater than 2% in patients already experiencing cachexia, as indicated by a body mass index less than 20, and sarcopenia.

What studies were included?

We examined studies published between January 2016 and October 2021 that reported survival in 100 or more adults with colorectal or pancreatic cancer. The study participants either had cachexia or were at risk of cachexia. All the studies were observational and most were from Europe and the United States.

How did you assess the association between cancer survival and cachexia?

Dunne: We used multivariate analyses in 23 studies and univariate analyses in three. Within each study, the association between cachexia and survival was assessed across multiple weight loss categories, and this may have contributed to variability.

Cachexia and weight loss were associated with significantly poorer survival in nearly two-thirds of the studies. Of these 17, nine were in patients with colorectal cancer and eight were in patients with pancreatic cancer.

What is your main message to clinicians?

Physicians should be aware of the risk of cachexia in patients with advanced colorectal or pancreatic cancer. The routine assessment of weight change in clinical practice could inform early disease management strategies that improve prognosis. We recommend that clinical assessment include anorexia or reduced food intake, catabolic drive, muscle mass and strength, and functional and psychosocial impairment.

Read the study here and expert commentary about it here.