Weight loss, appetite loss and food intake in cancer patients with cancer cachexia

Three peas in a pod?-analysis from a multicenter cross sectional study

Tora S. Solheim* (Corresponding Author), David Blum, Peter M. Fayers, Marianne J. Hjermstad, Guro B. Stene, Florian Strasser, Stein Kaasa

*Corresponding author for this work

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background. How to assess cachexia is a barrier both in research and in clinical practice. This study examines the need for assessing both reduced food intake and loss of appetite, to see if these variables can be used interchangeably. A secondary aim is to assess the variance explained by food intake, appetite and weight loss by using tumor-related factors, symptoms and biological markers as explanatory variables. Material and methods. One thousand and seventy patients with incurable cancer were registered in an observational, cross sectional multicenter study. A total of 885 patients that had complete data on food intake (PG-SGA), appetite (EORTC QLQ-C30) and weight loss were included in the present analysis. The association between reduced food intake and appetite loss was assessed using Spearman's correlation. To find the explained variance of the three symptoms a multivariate analysis was performed. Results. The mean age was 62 years with a mean survival of 247 days and a mean Karnofsky performance status of 72. Thirteen percent of the patients who reported eating less than normal had good appetite and 25% who had unchanged or increased food intake had reduced appetite. Correlation between appetite loss and food intake was 0.50. Explained variance for the regression models was 44% for appetite loss, 27% for food intake and only 13% for weight loss. Conclusion. Both appetite loss and food intake should be assessed in cachectic patients since conscious control of eating may sometimes overcome appetite loss. The low explained variance for weight loss is probably caused by the need for more knowledge about metabolism and inflammation, and is consistent with the cancer cachexia definition that claims that in cachexia weight loss is not caused by reduced food intake alone. The questions concerning appetite loss from EORTC-QLQ C30 and food intake from PG-SGA seem practical and informative when dealing with advanced cancer patients.

Original languageEnglish
Pages (from-to)539-546
Number of pages8
JournalActa Oncologica
Volume53
Issue number4
Early online date2 Sep 2013
DOIs
Publication statusPublished - 2014

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Cachexia
Peas
Appetite
Weight Loss
Cross-Sectional Studies
Eating
Neoplasms
Karnofsky Performance Status
Multicenter Studies
Multivariate Analysis
Biomarkers

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Weight loss, appetite loss and food intake in cancer patients with cancer cachexia : Three peas in a pod?-analysis from a multicenter cross sectional study. / Solheim, Tora S. (Corresponding Author); Blum, David; Fayers, Peter M.; Hjermstad, Marianne J.; Stene, Guro B.; Strasser, Florian; Kaasa, Stein.

In: Acta Oncologica, Vol. 53, No. 4, 2014, p. 539-546.

Research output: Contribution to journalArticle

Solheim, Tora S. ; Blum, David ; Fayers, Peter M. ; Hjermstad, Marianne J. ; Stene, Guro B. ; Strasser, Florian ; Kaasa, Stein. / Weight loss, appetite loss and food intake in cancer patients with cancer cachexia : Three peas in a pod?-analysis from a multicenter cross sectional study. In: Acta Oncologica. 2014 ; Vol. 53, No. 4. pp. 539-546.
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abstract = "Background. How to assess cachexia is a barrier both in research and in clinical practice. This study examines the need for assessing both reduced food intake and loss of appetite, to see if these variables can be used interchangeably. A secondary aim is to assess the variance explained by food intake, appetite and weight loss by using tumor-related factors, symptoms and biological markers as explanatory variables. Material and methods. One thousand and seventy patients with incurable cancer were registered in an observational, cross sectional multicenter study. A total of 885 patients that had complete data on food intake (PG-SGA), appetite (EORTC QLQ-C30) and weight loss were included in the present analysis. The association between reduced food intake and appetite loss was assessed using Spearman's correlation. To find the explained variance of the three symptoms a multivariate analysis was performed. Results. The mean age was 62 years with a mean survival of 247 days and a mean Karnofsky performance status of 72. Thirteen percent of the patients who reported eating less than normal had good appetite and 25{\%} who had unchanged or increased food intake had reduced appetite. Correlation between appetite loss and food intake was 0.50. Explained variance for the regression models was 44{\%} for appetite loss, 27{\%} for food intake and only 13{\%} for weight loss. Conclusion. Both appetite loss and food intake should be assessed in cachectic patients since conscious control of eating may sometimes overcome appetite loss. The low explained variance for weight loss is probably caused by the need for more knowledge about metabolism and inflammation, and is consistent with the cancer cachexia definition that claims that in cachexia weight loss is not caused by reduced food intake alone. The questions concerning appetite loss from EORTC-QLQ C30 and food intake from PG-SGA seem practical and informative when dealing with advanced cancer patients.",
author = "Solheim, {Tora S.} and David Blum and Fayers, {Peter M.} and Hjermstad, {Marianne J.} and Stene, {Guro B.} and Florian Strasser and Stein Kaasa",
note = "Acknowledgement The EPCRC (2006 – 2010) was funded by the European Commission’s Sixth Framework Programme (contract no LSHC-CT-2006 – 037777) with the overall aim to improve treatment of pain, depression, and fatigue through translation research. Core scientific group/work package leaders: Stein Kaasa (project coordinator), Frank Skorpen, Marianne Jensen Hjermstad, and Jon H {\aa} vard Loge, Norwegian University of Science and Technology; Geoffrey Hanks, University of Bristol; Augusto Caraceni and Franco De Conno, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan; Irene Higginson, King’s College London; Florian Strasser, Cantonal Hospital St. Gallen; Lukas Radbruch, RWTH Aachen University; Kenneth Fearon, University of Edinburgh; Hellmut Samonigg, Medical University of Graz; Ketil B{\o} , Trollhetta AS, Norway; Irene Rech Weichselbraun, Bender MedSystems GmbH, Austria; Odd Erik Gundersen, Verdande Technology AS, Norway. Scientific advisory group: Neil Aaronson, The Netherlands Cancer Institute; Vickie Baracos and Robin L. Fainsinger, University of Alberta; Patrick C. Stone, St. George’s University of London; Mari Lloyd Williams, University of Liverpool. Project management: Stein Kaasa, Ola Dale, and Dagny F. Haugen, Norwegian University of Science and Technology. There are no financial benefits or conflicts of interest that might bias this work.",
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T1 - Weight loss, appetite loss and food intake in cancer patients with cancer cachexia

T2 - Three peas in a pod?-analysis from a multicenter cross sectional study

AU - Solheim, Tora S.

AU - Blum, David

AU - Fayers, Peter M.

AU - Hjermstad, Marianne J.

AU - Stene, Guro B.

AU - Strasser, Florian

AU - Kaasa, Stein

N1 - Acknowledgement The EPCRC (2006 – 2010) was funded by the European Commission’s Sixth Framework Programme (contract no LSHC-CT-2006 – 037777) with the overall aim to improve treatment of pain, depression, and fatigue through translation research. Core scientific group/work package leaders: Stein Kaasa (project coordinator), Frank Skorpen, Marianne Jensen Hjermstad, and Jon H å vard Loge, Norwegian University of Science and Technology; Geoffrey Hanks, University of Bristol; Augusto Caraceni and Franco De Conno, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan; Irene Higginson, King’s College London; Florian Strasser, Cantonal Hospital St. Gallen; Lukas Radbruch, RWTH Aachen University; Kenneth Fearon, University of Edinburgh; Hellmut Samonigg, Medical University of Graz; Ketil Bø , Trollhetta AS, Norway; Irene Rech Weichselbraun, Bender MedSystems GmbH, Austria; Odd Erik Gundersen, Verdande Technology AS, Norway. Scientific advisory group: Neil Aaronson, The Netherlands Cancer Institute; Vickie Baracos and Robin L. Fainsinger, University of Alberta; Patrick C. Stone, St. George’s University of London; Mari Lloyd Williams, University of Liverpool. Project management: Stein Kaasa, Ola Dale, and Dagny F. Haugen, Norwegian University of Science and Technology. There are no financial benefits or conflicts of interest that might bias this work.

PY - 2014

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N2 - Background. How to assess cachexia is a barrier both in research and in clinical practice. This study examines the need for assessing both reduced food intake and loss of appetite, to see if these variables can be used interchangeably. A secondary aim is to assess the variance explained by food intake, appetite and weight loss by using tumor-related factors, symptoms and biological markers as explanatory variables. Material and methods. One thousand and seventy patients with incurable cancer were registered in an observational, cross sectional multicenter study. A total of 885 patients that had complete data on food intake (PG-SGA), appetite (EORTC QLQ-C30) and weight loss were included in the present analysis. The association between reduced food intake and appetite loss was assessed using Spearman's correlation. To find the explained variance of the three symptoms a multivariate analysis was performed. Results. The mean age was 62 years with a mean survival of 247 days and a mean Karnofsky performance status of 72. Thirteen percent of the patients who reported eating less than normal had good appetite and 25% who had unchanged or increased food intake had reduced appetite. Correlation between appetite loss and food intake was 0.50. Explained variance for the regression models was 44% for appetite loss, 27% for food intake and only 13% for weight loss. Conclusion. Both appetite loss and food intake should be assessed in cachectic patients since conscious control of eating may sometimes overcome appetite loss. The low explained variance for weight loss is probably caused by the need for more knowledge about metabolism and inflammation, and is consistent with the cancer cachexia definition that claims that in cachexia weight loss is not caused by reduced food intake alone. The questions concerning appetite loss from EORTC-QLQ C30 and food intake from PG-SGA seem practical and informative when dealing with advanced cancer patients.

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