Prevalence of cachexia in advanced cancer and its impact on death: a retrospective analysis

Cancer cachexia (CC) reduces treatment efficacy, quality of life and survival. However, few contemporary data quantify its prevalence or impact on death. This study assessed cachexia prevalence in advanced cancer using multiple diagnostic frameworks and explored its role in cancer-related mortality.

A retrospective analysis was conducted of all deaths over 3 years (August 2020 to August 2023) at a specialist palliative care unit. Using clinical, biochemical and CT body composition data, four definitions of CC (Evans et al, Fearon et al, Global Leadership Initiative on Malnutrition (GLIM) and the modified Glasgow Prognostic Score) were applied. A cachexia-related death was defined as one of global deterioration, infection, thrombo-embolic event or cardiac failure. Paired within-patient analysis compared measurements 30-90 days versus <30 days before death. Only patients with both measurements were included.

There were 513 cancer-related deaths over 3 years, with lung (n=122, 23.8%) and colorectal (n=65, 12.7%) cancer most prevalent. 91.9% (n=421/458) of patients, with available data, met at least one definition of CC, with estimates ranging from 67.6% (Fearon, n=171/253) to 91.6% (GLIM, n=262/286) for specific definitions. Cachexia contributed to 69.6% (199/286) of deaths. Paired within-patient analyses showed C-reactive protein increased, while haemoglobin, albumin, body mass index and adipose tissue indices declined (all p<0.001).

These findings support the hypothesis that cachexia develops in a large proportion of patients with advanced cancer and contributes to most cancer deaths. Highlighting the potential value of earlier identification and intervention during oncological care. Importantly, these results also highlight the importance of recognising cachexia in palliative care so that symptom management can be optimised accordingly.