Malnutrition Risk and the Psychological Burden of Anorexia and Cachexia in Patients With Advanced Cancer

Abstract

Background

Patients with advanced cancer are at risk for malnutrition and anorexia-cachexia syndrome. The study objective was to determine the frequency of these conditions in patients evaluated in an outpatient supportive care clinic (SCC).

Methods

One hundred patients with cancer were prospectively enrolled to complete a cross-sectional one-time survey. We collected patient demographics, cancer diagnosis, weight history and height and Zubrod performance status from electronic health records. Patients completed the Functional Assessment of Anorexia Therapy–Anorexia/Cachexia Subscale (FAACT-A/CS) questionnaire, the Edmonton Symptom Assessment Scale (ESAS), the Patient-Generated Subjective Global Assessment–Short Form (PG-SGA-SF), the Hospital Anxiety and Depression Scale (HADS) and a Body Image Scale (BIS). A PG-SGA-SF cut-off of ≥ 6 indicated malnutrition risk, and loss of appetite was defined as either ESAS ≥ 3 or FAACT-ACS ≤ 37.

Results

Of the 165 patients approached, 100 (61%) completed the survey. The average (SD) age was 61.6 years old (11.5). The majority were female (52%), White (75%) and married (80%). The most common cancers were gastrointestinal (22%) and genitourinary (21%). Sixty-one per cent (61%) screened positive for risk of malnutrition (PG-SGA-SF ≥ 6), anorexia was noted in 60% (ESAS ≥ 3) and 53% (FAACT-A/CS ≤ 37) of patients, 10% of patients were noted to have a body mass index < 18.5, and 28% had body image dissatisfaction (BIS ≥ 10). Documented > 5% weight loss over the past 6 months was noted in 49%; 61% noted > 10% lifetime weight loss, relative to usual adult body weight or at time of diagnosis. Patients with anorexia (FAACT-ACS ≤ 37) compared with no anorexia reported significantly higher HADS anxiety score (4.4 vs. 3.2, p = 0.04), depression (5.9 vs. 3.5, p = 0.001), body image distress (BIS 7.2 vs. 4.9, p = 0.03) and worse appetite (ESAS 1.4 vs. 0.6, p = 0.02). Symptoms including depression, anxiety and body image distress were not significantly different between patients with either a history of > 10% lifetime weight loss or > 5% weight loss over 6 months.

Conclusions

Malnutrition risk was noted in roughly 60% of patients with advanced cancer. Inclusion of patients' body mass index to malnutrition or cachexia criteria resulted in underdiagnosis. Subjective symptoms of anorexia, but not objective weight loss, was significantly associated with anxiety and depression. Routine malnutrition screening with the PG-SGA-SF should be incorporated into all outpatient SCC visits and, comparing current weight to documented pre-illness baseline weight, should be obtained to determine the severity of cachexia.