The applicability of a weight loss grading system in cancer cachexia:  a longitudinal analysis

Ola Magne Vagnildhaug; David Blum; Andrew Wilcock; Peter Fayers; Florian Strasser; Vickie E Baracos; Marianne J Hjermstad; Stein Kaasa; Barry Laird; Tora S Solheim

doi:10.1002/jcsm.12220

The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis

Ola Magne Vagnildhaug (Corresponding Author), David Blum, Andrew Wilcock, Peter Fayers, Florian Strasser, Vickie E Baracos, Marianne J Hjermstad, Stein Kaasa, Barry Laird, Tora S Solheim

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

Background A body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression. Methods An international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0–4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains[anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade. Results One thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS≤70). The overall effect of the WLGS on survival was significant as expressed by change in−2 log likelihood (P< 0.001) and persisted after adjustment for age, sex, and cancer type and stage (P< 0.001). Median survival decreased across the weight loss grades ranging from 407 days (95% CI 312–502)—weight loss grade 0 to 119 days (95% CI 93–145)—weight loss grade 4. All cachexia domains significantly deteriorated with increasing weight loss grade, and deterioration was greatest for dietary intake, with a difference corresponding to 0.87 standard deviations between weight loss grades 0 and 4. The addition of KPS, anorexia, and physical and emotional functioning improved the prognostic accuracy of the WLGS. Likelihood of cachexia progression was greater in patients with weight loss grade 2 (39%) than that with weight loss grade 0 (19%) or 1 (22%). Conclusions The WLGS is related to survival, cachexia domains, and the likelihood of progression. Adding certain cachexia domains to the WLGS improves prognostic accuracy.

Original language	English
Pages (from-to)	789-797
Number of pages	9
Journal	Journal of Cachexia, Sarcopenia and Muscle
Volume	8
Issue number	5
Early online date	18 Jun 2017
DOIs	https://doi.org/10.1002/jcsm.12220
Publication status	Published - Oct 2017

Bibliographical note

Acknowledgements
The European Palliative Care Cancer Symptom study is a collaborative effort between the European Palliative Care Research Centre (PRC) and the European Association for Palliative Care Research Network (EAPC‐RN). The study was approved by all appropriate ethical committees and was conducted in keeping with the Helsinki declaration. The authors certify that they comply with the ethical guidelines for authorship and publishing of the Journal of Cachexia, Sarcopenia, and Muscle.
This study was funded by the Joint Research Council at Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital‐Trondheim University Hospital (6070);Norwegian Cancer Society; Helsinn.

Keywords

Neoplasms
Cachexia
Classification
Weight loss
Survival
Nutritional status

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1002/jcsm.12220Licence: CC BY-NC-ND

The applicability of a weight loss grading system in cancer cachexia
© 2017 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. https://creativecommons.org/licenses/by-nc-nd/4.0/
Final published version, 435 KBLicence: CC BY-NC-ND

Cite this

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title = "The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis",

abstract = "Background A body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression. Methods An international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0–4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains[anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade. Results One thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS≤70). The overall effect of the WLGS on survival was significant as expressed by change in−2 log likelihood (P< 0.001) and persisted after adjustment for age, sex, and cancer type and stage (P< 0.001). Median survival decreased across the weight loss grades ranging from 407 days (95% CI 312–502)—weight loss grade 0 to 119 days (95% CI 93–145)—weight loss grade 4. All cachexia domains significantly deteriorated with increasing weight loss grade, and deterioration was greatest for dietary intake, with a difference corresponding to 0.87 standard deviations between weight loss grades 0 and 4. The addition of KPS, anorexia, and physical and emotional functioning improved the prognostic accuracy of the WLGS. Likelihood of cachexia progression was greater in patients with weight loss grade 2 (39%) than that with weight loss grade 0 (19%) or 1 (22%). Conclusions The WLGS is related to survival, cachexia domains, and the likelihood of progression. Adding certain cachexia domains to the WLGS improves prognostic accuracy.",

keywords = "Neoplasms, Cachexia, Classification, Weight loss, Survival, Nutritional status",

author = "Vagnildhaug, {Ola Magne} and David Blum and Andrew Wilcock and Peter Fayers and Florian Strasser and Baracos, {Vickie E} and Hjermstad, {Marianne J} and Stein Kaasa and Barry Laird and Solheim, {Tora S}",

note = "Acknowledgements The European Palliative Care Cancer Symptom study is a collaborative effort between the European Palliative Care Research Centre (PRC) and the European Association for Palliative Care Research Network (EAPC‐RN). The study was approved by all appropriate ethical committees and was conducted in keeping with the Helsinki declaration. The authors certify that they comply with the ethical guidelines for authorship and publishing of the Journal of Cachexia, Sarcopenia, and Muscle. This study was funded by the Joint Research Council at Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital‐Trondheim University Hospital (6070);Norwegian Cancer Society; Helsinn.",

year = "2017",

month = oct,

doi = "10.1002/jcsm.12220",

language = "English",

volume = "8",

pages = "789--797",

journal = "Journal of Cachexia, Sarcopenia and Muscle",

issn = "2190-6009",

publisher = "Wiley",

number = "5",

}

TY - JOUR

T1 - The applicability of a weight loss grading system in cancer cachexia

T2 - a longitudinal analysis

AU - Vagnildhaug, Ola Magne

AU - Blum, David

AU - Wilcock, Andrew

AU - Fayers, Peter

AU - Strasser, Florian

AU - Baracos, Vickie E

AU - Hjermstad, Marianne J

AU - Kaasa, Stein

AU - Laird, Barry

AU - Solheim, Tora S

N1 - Acknowledgements The European Palliative Care Cancer Symptom study is a collaborative effort between the European Palliative Care Research Centre (PRC) and the European Association for Palliative Care Research Network (EAPC‐RN). The study was approved by all appropriate ethical committees and was conducted in keeping with the Helsinki declaration. The authors certify that they comply with the ethical guidelines for authorship and publishing of the Journal of Cachexia, Sarcopenia, and Muscle. This study was funded by the Joint Research Council at Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital‐Trondheim University Hospital (6070);Norwegian Cancer Society; Helsinn.

PY - 2017/10

Y1 - 2017/10

N2 - Background A body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression. Methods An international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0–4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains[anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade. Results One thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS≤70). The overall effect of the WLGS on survival was significant as expressed by change in−2 log likelihood (P< 0.001) and persisted after adjustment for age, sex, and cancer type and stage (P< 0.001). Median survival decreased across the weight loss grades ranging from 407 days (95% CI 312–502)—weight loss grade 0 to 119 days (95% CI 93–145)—weight loss grade 4. All cachexia domains significantly deteriorated with increasing weight loss grade, and deterioration was greatest for dietary intake, with a difference corresponding to 0.87 standard deviations between weight loss grades 0 and 4. The addition of KPS, anorexia, and physical and emotional functioning improved the prognostic accuracy of the WLGS. Likelihood of cachexia progression was greater in patients with weight loss grade 2 (39%) than that with weight loss grade 0 (19%) or 1 (22%). Conclusions The WLGS is related to survival, cachexia domains, and the likelihood of progression. Adding certain cachexia domains to the WLGS improves prognostic accuracy.

AB - Background A body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression. Methods An international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0–4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains[anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade. Results One thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS≤70). The overall effect of the WLGS on survival was significant as expressed by change in−2 log likelihood (P< 0.001) and persisted after adjustment for age, sex, and cancer type and stage (P< 0.001). Median survival decreased across the weight loss grades ranging from 407 days (95% CI 312–502)—weight loss grade 0 to 119 days (95% CI 93–145)—weight loss grade 4. All cachexia domains significantly deteriorated with increasing weight loss grade, and deterioration was greatest for dietary intake, with a difference corresponding to 0.87 standard deviations between weight loss grades 0 and 4. The addition of KPS, anorexia, and physical and emotional functioning improved the prognostic accuracy of the WLGS. Likelihood of cachexia progression was greater in patients with weight loss grade 2 (39%) than that with weight loss grade 0 (19%) or 1 (22%). Conclusions The WLGS is related to survival, cachexia domains, and the likelihood of progression. Adding certain cachexia domains to the WLGS improves prognostic accuracy.

KW - Neoplasms

KW - Cachexia

KW - Classification

KW - Weight loss

KW - Survival

KW - Nutritional status

U2 - 10.1002/jcsm.12220

DO - 10.1002/jcsm.12220

M3 - Article

SN - 2190-6009

VL - 8

SP - 789

EP - 797

JO - Journal of Cachexia, Sarcopenia and Muscle

JF - Journal of Cachexia, Sarcopenia and Muscle

IS - 5

ER -