With a breadth of literature relating to background, prevalence and impact of cancer cachexia, there remains a gap in incorporating theory into practice, with cachexia being underdiagnosed and undertreated. The importance of having a multidisciplinary team to build a cachexia clinic has been acknowledged.¹ This gave inspiration to the exploratory work conducted in Gateshead.

We aimed to identify cachexia prevalence within an upper GI cohort, to identify the demand for a multidisciplinary clinic. For newly diagnosed Upper GI oncology patients, a retrospective audit over a four month period was completed - collecting data including; weight parameters, appetite, nutritional risk, malnutrition diagnosis/severity using GLIM criteria² and identification of inflammation using Modified Glasgow Prognostic score. Defining cachexia as disease related malnutrition based on the GLIM definition and presence of inflammation is recommended.¹ Additionally, we attempted to identify stage of cachexia where inflammation was present using criteria by Fearon.³

In total 31 patient notes were analysed, 22 male and 9 female. The average age range was 46–89 years (mean 71 years).

13 patients (41.9%) were diagnosed with malnutrition using GLIM, 8 moderately and 5 severely malnourished. Eleven (35.4%) also had presence of inflammation and cachexia. Using classification by Fearon as a grading rather than diagnostic method, 5 were found to have refractory cachexia (3 severe malnutrition, 2 moderate), whilst 5 had cachexia (1 severe malnutrition, 4 moderate). One had pre-cachexia (with moderate malnutrition).

When using Fearon classification to diagnose cachexia without a positive GLIM diagnosis, 6 patients had pre cachexia, although no diagnosis of malnutrition.

We have found GLIM to be useful in identifying malnutrition and inflammation, with severe malnutrition more prevalent in refractory cachexia and moderate malnutrition most prevalent in cachexia. Fearon classification is useful to detect pre cachexia with no malnutrition diagnosis and a limited loss in weight.

References

1. Arends J, et al. (2021). Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines, (Accessed 29/04/2023), https://doi.org/10.1016/j.esmoop.2021.100092

2. Cederholm T, et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community, Clinical Nutrition 2019;38:1–9. https://doi.org/10.1016/j.clnu.2018.08.002.

3. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE. Definition and classification of cancer cachexia: an international concensus, Lancet Oncol 2011;12:489–495.