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Defining Cachexia in Children With Cancer in the United States: Developing a Framework to Inform Clinical and
Daniel V Runco1,2,3, Guohai Zhou4, Adina R Lemeshow4
1Division of Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
Insights
Developing criteria for pediatric cancer cachexia is crucial for understanding its impact. This study proposes new guidelines to identify and study this condition in children with cancer.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Epidemiology
Background:
- Cancer cachexia, characterized by muscle and weight loss, is common in adult cancers but lacks formal definition in children.
- This knowledge gap hinders clinical recognition and impact assessment of cachexia in pediatric cancer patients.
- Established undernutrition guidelines were adapted to create potential criteria for identifying cachexia in children with cancer.
Purpose of the Study:
- To develop and propose criteria for identifying cancer cachexia in pediatric patients.
- To estimate the prevalence and incidence of pediatric cancer cachexia using electronic health records.
- To provide a framework for future research and consensus guideline development.
Main Methods:
- Utilized Surveillance, Epidemiology, and End Results (SEER) and Optum Electronic Health Records (EHR) databases (2017-2021).
- Developed five sets of candidate criteria based on anthropometric measures (z-scores) and ICD-10-CM diagnosis codes.
- Analyzed data from 26,855 pediatric cancer patients (aged <18 years).
Main Results:
- Prevalence and incidence estimates varied significantly based on age, cancer type, and the specific cachexia definition used.
- Generally low estimates were observed across most categories, particularly in younger children (<2 years).
- Assessment challenges were noted in the youngest age groups due to limited patient numbers.
Conclusions:
- This study presents one of the initial efforts to establish criteria for pediatric cancer cachexia.
- The proposed criteria and data offer a foundation for further research.
- The goal is to inform the development of consensus guidelines for identifying childhood cancer cachexia.
Background:
Cancer cachexia describes the muscle and weight loss, anorexia, and physical impairment common in certain adult cancers. No formal criteria exist to define paediatric cancer cachexia, making its clinical recognition and impact largely unknown. Using established undernutrition guidelines, criteria were developed to identify potential cachexia in children with cancer based on standardised anthropometric measures or diagnostic codes.
Methods:
The Surveillance, Epidemiology, and End Results and Optum Electronic Health Records databases were used to estimate prevalence and incidence rates of cancer and cancer cachexia between 2017 and 2021 in patients aged < 20 and < 18 years, respectively. In the absence of a consensus definition for paediatric cachexia, four sets of candidate criteria were developed based on body weight for length/height or body mass index z-scores, or reduced gain or loss of body weight, corresponding to mild or severe undernutrition. A fifth criterion required a potentially cachexia-related ICD-10-CM diagnosis code.
Results:
This study included 26,855 paediatric patients (aged < 18 years) with cancer; ~90% were aged ≥ 2 years. Epidemiologic estimates for cancer cachexia prevalence and incidence rate varied considerably by age, cancer type and cachexia definition. Estimates were low for most categories, especially in the youngest age groups; however, cachexia was difficult to assess in patients aged < 2 years due to small patient numbers.
Conclusions:
We describe one of the first attempts to develop potential paediatric cachexia criteria. These criteria and resulting data provide a framework to inform further research into generating consensus guidelines for the identification of childhood cancer cachexia.
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