Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer)

Johanne Poisson, Claudia Martinez-Tapia, Damien Heitz, Romain Geiss, Gilles Albrand, Claire Falandry, Mathilde Gisselbrecht, Anne-Laure Couderc, Rabia Boulahssass, Evelyne Liuu, Pascaline Boudou-Rouquette, Anne Chah Wakilian, Cedric Gaxatte, Fréderic Pamoukdjian, Laure de Decker, Valery Antoine, Catherine Cattenoz, Heidi Solem-Laviec, Olivier Guillem, Hayat Medjenah, Pierre André Natella, Florence Canouï-Poitrine, Marie Laurent, Elena Paillaud, Johanne Poisson, Claudia Martinez-Tapia, Damien Heitz, Romain Geiss, Gilles Albrand, Claire Falandry, Mathilde Gisselbrecht, Anne-Laure Couderc, Rabia Boulahssass, Evelyne Liuu, Pascaline Boudou-Rouquette, Anne Chah Wakilian, Cedric Gaxatte, Fréderic Pamoukdjian, Laure de Decker, Valery Antoine, Catherine Cattenoz, Heidi Solem-Laviec, Olivier Guillem, Hayat Medjenah, Pierre André Natella, Florence Canouï-Poitrine, Marie Laurent, Elena Paillaud

Abstract

Background: Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality.

Methods: A French nationwide cross-sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality.

Results: Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79-87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49-55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up-and-go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05-2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications.

Conclusions: More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.

Keywords: Cachexia; Cancer; Elderly; Malnutrition; Nutritional support; Prognostic value; Screening.

Conflict of interest statement

Elena Paillaud declares one paid congress by Nutricia. Anne Laure Couderc declares paid oral communications by BMS, Ferring et Nutricia. All other authors declare no potential conflicts of interest.

© 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Prevalence of cachexia by cancer site.
Figure 3
Figure 3
Kaplan–Meier curves of overall 6 month survival according to cachexia.

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7–34.
    1. Arnold M, Karim‐Kos HE, Coebergh JW, Byrnes G, Antilla A, Ferlay J, et al. Recent trends in incidence of five common cancers in 26 European countries since 1988: analysis of the European Cancer Observatory. Eur J Cancer 2015;51:1164–1187.
    1. Caillet P, Laurent M, Bastuji‐Garin S, Liuu E, Culine S, Lagrange J‐L, et al. Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment. Clin Interv Aging 2014;9:1645–1660.
    1. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen‐Heijnen MLG, Extermann M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014;32:2595–2603.
    1. Sifer‐Rivière L, Saint‐Jean O, Gisselbrecht M, Cudennec T, Girre V, Programme d'OncoGériatrie de l'Ouest Parisien (POGOP) . What the specific tools of geriatrics and oncology can tell us about the role and status of geriatricians in a pilot geriatric oncology program. Ann Oncol 2011;22:2325–2329.
    1. Song C, Cao J, Zhang F, Wang C, Guo Z, Lin Y, et al. Nutritional risk assessment by scored patient‐generated subjective global assessment associated with demographic characteristics in 23,904 common malignant tumors patients. Nutr Cancer 2019;71:50–60.
    1. Lacau St Guily J, Bouvard É, Raynard B, Goldwasser F, Maget B, Prevost A, et al. NutriCancer: a French observational multicentre cross‐sectional study of malnutrition in elderly patients with cancer. J Geriatr Oncol 2018;9:74–80.
    1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr 2008;27:793–799.
    1. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011;12:489–495.
    1. Laurent M, Paillaud E, Tournigand C, Caillet P, Le Thuaut A, Lagrange J‐L, et al. Assessment of solid cancer treatment feasibility in older patients: a prospective cohort study. Oncologist 2014;19:275–282.
    1. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011;29:3457–3465.
    1. Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High‐Age Patients (CRASH) score. Cancer 2012;118:3377–3386.
    1. Aaldriks AA, Maartense E, le Cessie S, Giltay EJ, Verlaan HACM, van der Geest LGM, et al. Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Crit Rev Oncol Hematol 2011;79:205–212.
    1. Kim JW, Kim YJ, Lee K‐W, Chang H, Lee J‐O, Kim K‐I, et al. The early discontinuation of palliative chemotherapy in older patients with cancer. Support Care Cancer 2014;22:773–781.
    1. Paillaud E, Herbaud S, Caillet P, Lejonc J‐L, Campillo B, Bories P‐N. Relations between undernutrition and nosocomial infections in elderly patients. Age Ageing 2005;34:619–625.
    1. Schneider SM, Veyres P, Pivot X, Soummer A‐M, Jambou P, Filippi J, et al. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 2004;92:105–111.
    1. Fukuta A, Saito T, Murata S, Makiura D, Inoue J, Okumura M, et al. Impact of preoperative cachexia on postoperative length of stay in elderly patients with gastrointestinal cancer. Nutrition 2019;58:65–68.
    1. Soubeyran P, Fonck M, Blanc‐Bisson C, Blanc J‐F, Ceccaldi J, Mertens C, et al. Predictors of early death risk in older patients treated with first‐line chemotherapy for cancer. J Clin Oncol 2012;30:1829–1834.
    1. Ferrat E, Paillaud E, Laurent M, Le Thuaut A, Caillet P, Tournigand C, et al. Predictors of 1‐year mortality in a prospective cohort of elderly patients with cancer. J Gerontol A Biol Sci Med Sci 2015;70:1148–1155.
    1. Zhang X, Tang T, Pang L, Sharma SV, Li R, Nyitray AG, et al. Malnutrition and overall survival in older adults with cancer: a systematic review and meta‐analysis. J Geriatr Oncol 2019;10:874–883.
    1. Camus V, Lanic H, Kraut J, Modzelewski R, Clatot F, Picquenot JM, et al. Prognostic impact of fat tissue loss and cachexia assessed by computed tomography scan in elderly patients with diffuse large B‐cell lymphoma treated with immunochemotherapy. Eur J Haematol 2014;93:9–18.
    1. Broughman JR, Williams GR, Deal AM, Yu H, Nyrop KA, Alston SM, et al. Prevalence of sarcopenia in older patients with colorectal cancer. J Geriatr Oncol 2015;6:442–445.
    1. Sasaki S, Oki E, Saeki H, Shimose T, Sakamoto S, Hu Q, et al. Skeletal muscle loss during systemic chemotherapy for colorectal cancer indicates treatment response: a pooled analysis of a multicenter clinical trial (KSCC 1605‐A). Int J Clin Oncol 2019;24:1204–1213.
    1. Mayr R, Gierth M, Zeman F, Reiffen M, Seeger P, Wezel F, et al. Sarcopenia as a comorbidity‐independent predictor of survival following radical cystectomy for bladder cancer. J Cachexia Sarcopenia Muscle 2018;9:505–513.
    1. Cruz‐Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16–31.
    1. Bauer J, Morley JE, Schols AMWJ, Ferrucci L, Cruz‐Jentoft AJ, Dent E, et al. Sarcopenia: a time for action. An SCWD position paper. J Cachexia Sarcopenia Muscle 2019;10:956–961.
    1. Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC‐F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle 2016;7:28–36.
    1. Woo J, Leung J, Morley JE. Defining sarcopenia in terms of incident adverse outcomes. J Am Med Dir Assoc 2015;16:247–252.
    1. Bahat G, Yilmaz O, Kılıç C, Oren MM, Karan MA. Performance of SARC‐F in regard to sarcopenia definitions, muscle mass and functional measures. J Nutr Health Aging 2018;22:898–903.
    1. Caillet P, Liuu E, Raynaud Simon A, Bonnefoy M, Guerin O, Berrut G, et al. Association between cachexia, chemotherapy and outcomes in older cancer patients: a systematic review. Clin Nutr 2017;36:1473–1482.
    1. Dunne RF, Roussel B, Culakova E, Pandya C, Fleming FJ, Hensley B, et al. Characterizing cancer cachexia in the geriatric oncology population. J Geriatr Oncol 2019;10:415–419.
    1. Zopf Y, Schink K, Reljic D, Herrmann HJ, Dieterich W, Kiesswetter E, et al. Assessing cachexia in older patients: different definitions—but which one is the most practical for clinical routine? Arch Gerontol Geriatr 2020;86:103943, 10.1016/j.archger.2019.103943
    1. Pamoukdjian F, Laurent M, Martinez‐Tapia C, Rolland Y, Paillaud E, Canoui‐Poitrine F. Frailty parameters, morbidity and mortality in older adults with cancer: a structural equation modelling approach based on the Fried phenotype. J Clin Med 2020;9:10.3390/jcm9061826
    1. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–148.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini‐mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
    1. D'Ath P, Katona P, Mullan E, Evans S, Katona C. Screening, detection and management of depression in elderly primary care attenders. I: the acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract 1994;11:260–266.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
    1. van Putten W. CART: stata module to perform classification and regression tree analysis. 2006.
    1. Cruz‐Jentoft AJ, Kiesswetter E, Drey M, Sieber CC. Nutrition, frailty, and sarcopenia. Aging Clin Exp Res 2017;29:43–48.
    1. Ida S, Kojima Y, Hamaoka S, Urawa N, Araki J, Kaneko R, et al. Validity of Japanese version of SARC‐F questionnaire in patients with chronic liver disease. J Gastroenterol Hepatol 2019;34:947–953.
    1. Zhang X, Pang L, Sharma SV, Li R, Nyitray AG, Edwards BJ. Prevalence and factors associated with malnutrition in older patients with cancer. J Geriatr Oncol 2019;10:763–769.
    1. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980;69:491–497.
    1. Huisman MG, Veronese G, Audisio RA, Ugolini G, Montroni I, de Bock GH, et al. Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco‐geriatric surgical patients—a multicentre cohort study. Eur J Surg Oncol 2016;42:1009–1017.
    1. Attar A, Malka D, Sabaté JM, Bonnetain F, Lecomte T, Aparicio T, et al. Malnutrition is high and underestimated during chemotherapy in gastrointestinal cancer: an AGEO prospective cross‐sectional multicenter study. Nutr Cancer 2012;64:535–542.
    1. Badgwell B, Stanley J, Chang GJ, Katz MHG, Lin HY, Ning J, et al. Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery. J Surg Oncol 2013;108:182–186.
    1. Jacobsen EL, Brovold T, Bergland A, Bye A. Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross‐sectional study. BMJ Open 2016;6:e011512, 10.1136/bmjopen-2016-011512
    1. Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr 2014;38:196–204.
    1. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer‐related malnutrition. Clin Nutr 2017;36:1187–1196.
    1. Li Z, Chen W, Li H, Zhao B, Chinese Oncology Nutrition Survey Group . Nutrition support in hospitalized cancer patients with malnutrition in China. Asia Pac J Clin Nutr 2018;27:1216–1224.
    1. Planas M, Álvarez‐Hernández J, León‐Sanz M, Celaya‐Pérez S, Araujo K, García de Lorenzo A, et al. Prevalence of hospital malnutrition in cancer patients: a sub‐analysis of the PREDyCES® study. Support Care Cancer 2016;24:429–435.
    1. Martin L, de van der Schueren MAE, Blauwhoff‐Buskermolen S, Baracos V, Gramlich L. Identifying the barriers and enablers to nutrition care in head and neck and esophageal cancers: an international qualitative study. JPEN J Parenter Enteral Nutr 2016;40:355–366.
    1. Cotogni P, Pedrazzoli P, De Waele E, Aprile G, Farina G, Stragliotto S, et al. Nutritional therapy in cancer patients receiving chemoradiotherapy: should we need stronger recommendations to act for improving outcomes? J Cancer 2019;10:4318–4325.
    1. von Haehling S, Morley JE, Coats AJS, Anker SD. Ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2019. J Cachexia Sarcopenia Muscle 2019;10:1143–1145.

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